Physicians under the influence
Pharma firms use financial and non financial tactics to influence health care provider’s attitudes and decision making.
Financial Inducements include
unrestricted education grants
and other funder resources
Non financial inducements include
the opportunity to be referred as an expert
publication productivity facilitated by industry funded ghostwriters that further the health care professionals career
“Physicians often do not recognize their vulnerability to commercial information and subtle selling techniques” (p.667)
People even doctors are more strongly influenced by messages delivered with confidence and especially if there is money involved, extracting objective information in messages becomes difficult. Most physicians think they are immune to marketing strategies and often believe their own prescribing behavior is unaffected by industry influence, while at the same time they place blame on other physicians for being susceptible to industry influence. So there is an issue with self serving biases within the culture of physicians. There is also a sense of entitlement. Physicians who receive industry funded benefits (like the ones written above) usually use those as a way to unconsciously rationalize questionable behavior regarding ethics in their practice.
Obligations to help those who have helped you
Relationship between physicians and industry uses formalized gift giving rituals
physicians pay back the industry gifts through changes in their practice, however this is seen as showing loyalty in the business relationship NOT a bribe
Commitment and consistency
Pharma industry knows the power help in small commitments
Example: drug rep asks a doctor “will you try my drug on next 5 patients with diabetes?” and because this is a small request it increases the likelihood that the physician will start using the targeted drug
Drugs reps tract physicians’ prescriptions and those who haven’t honored their commitments are reminded and encouraged again and again to try the drug - so there is a lot pressure on doctors as well
Accepting industry gifts is a cultural norm in medicine, so it will continue to happen
Opinions of colleagues are used by industry reps to sway physicians to adopt particular way of thinking
They create social validation and conformity
Rapport increases with familiartiy
The more interactions and the longer you have a relationship matters in medicine
Drug reps spend a considerable amount of time and effort befriending physicians - they try to make everything seem like a gesture of friendship instead of a business deal
They do this by providing free samples of products, office lunches or dinners etc.
It is similar to buying love in a sense because doctors will write prescriptions for who they like because remember, doctors are people too
Physicians feel overworked, underpaid and unappreciated
Drug reps show sympathy, flattery, food, gifts, services, and income enhancing opportunities and pretend that they want nothing in return. However, this usually is beneficial for their drugs.
Drug reps will usually not continue a relationship with a physician who isn’t prescribing a targeted drug or helping in a way to boost its market share
Physicians want to have a “key opinion leader” status
This leads to research funding, consulting fees, and more publication productivity that the industry funds
They also feel the personal achievement of being special and important in the medical world
The concept of receiving a “key opinion leader” status obviously gives physicians the feeling they are authoritative figures and it also makes them fight for the stars because of scarcity. This is because the opportunity seems limited so it must mean its more valuable.
Through these methods the industry gives off this illusion that they are generous to physicians when really there have underlining motives.
Sah, S., & Fugh-Berman, A. (2013). Physicians under the Influence: Social Psychology and Industry Marketing Strategies. The Journal of Law, Medicine & Ethics, 41(3), 665-672.