DOCTOR AND PHARMACEUTICALS
companies
OBJECTIVES:
1. to define the roles of physicians and
pharmaceutical companies in medical
care
a. Research and drug development
b. Marketing
2. to identify issues of concern in the
relationships between physician and
the pharmaceutical industry
3. to propose ways by which physicians
(and pharmaceutical companies) may
act ethically in the interest of patients
Scientists are the producers
Pharmaceutical companies are the
distributors.
Patient is the consumer.
Physician can be all three.
Forms of Entanglement
• Face to face visits from drug company
representatives – food, flattery,
friendships, ads (“drug information”)
and gift trinkets
• Acceptance of direct gifts of
equipment, travel, or accommodation
• Acceptance of indirect gifts, through
sponsorship of software or travel
• Attendance at sponsored educational
events, continuing medical education,
workshops or seminars
• Attendance at sponsored scientific
conferences
• A medical journals’ reliance on drug
company advertising, company
purchased reprints, and sponsored
supplements
• Ownership of stock or equity holdings
• Conducting sponsored research
• Company funding for medical schools,
academic chairs, or lecture halls
• Membership of sponsored professional
societies and associations
• Advising a sponsored disease
foundation or patient’s group; illness
promotion
• Involvement with or use of sponsored
clinical guidelines
• Undertaking paid consultancy work for
• Membership of company advisory
boards of “though leaders” or
“speakers’ bureau”
• Authoring “ghostwritten” scientific
articles
Research
• An estimated 60% of biomedical RnD
in the US is now privately funded
• 2/3 of academic institutions have
equity ties with outside sponsors
• Finding senior medical researches or
clinicians without financial ties to
pharmaceutical companies has
become exceedingly difficult
• Those regarded as “though leaders”
routinely work as paid members of
drug companies advisory boards
• Concern that the evidence base of
healthcare is being distorted
fundamentally:
• A. Evidence shows that industry
sponsored research tends to draw
conclusions favorable to industry
• “systemic bias” in results is not that
sponsored science is bad science but
rather that the scientific questions
being asked reflect the self-interest of
the sponsor
Information
• most physicians felt academic sources
to be important; few felt commercial
sources to be an important source of
information
• nevertheless many held views
consistent with the commercial, rather
than the academic literature
The Gap between Science and Practice
1. Technologic Lag
2. access to information
3. patient demands
4. patient needs
5. sciences is questionable physician’s
self interest
So what’s wrong with receiving gifts?
• gifts cost money, and these costs are
passed on to patients
• physician’s acceptance of gifts
contribute to the erosion of the image
 of the medical profession as acting in
other than the patient’s best interest
• acceptance of gifts establishes a
relationship between giver and
receiver, it creates a strong need for
reciprocation on the part of the
recipient from which arises conflicts of
interest
• culture of gift giving, which starts with
medical students, breeds a long term
sense of entitlement = “so it’s a not a
bribe; it’s their due”
• the flipside of the this sense of
entitlement is indebtedness, to be
repaid by support of the patron’s
drugs, a sense of obligation in direct
conflict with doctors’ primary
obligation to their patients
• entitlement –may karapatan
• indebtedness – utang na loob
What is wrong with these Pictures?
Case1: Dr. P. is choosing between two drugs
from Mr. A. Brand X and Y are equally
effective for Mr. A’s condition but Brand Y is
more expensive. After seeing the medical
representatives for Brand Y who gave out
product information about the superiority of
Brand Y over X. Dr. P. decided to prescribed
Brand Y to Mr. A
Case 4: Dr. R. has been texting and calling
Med Reps all week. He wants to go to
Palawan for the mid year Subspecialty
conference and expects one of the
companies to fund him and his wife for the
trip. He also expects them to pay for his
registration fee and RnR after. If a company
turns him down he will ban them for his
hospital’s pharmacy:
Ethical issue: entitlement
Case 5: Dr. B is a well-known speaker and
researcher. He has written a few papers on
Drug M and speaks on its merits all over the
world. Dr. B is a consultant for company Z,
the makers of Drug M. he receives a regular
stipend form this company and they also
fund his researches
Ethical issues: Conflict of Interest
Case 6: Drs. A and B are getting paid for
“post-marketing surveillance” from company
L on Drug XDE. Patients who come in for a
certain condition are prescribed the drug by
these 2 physicians and response is
monitored.

Ethical Issue: Information and Economics

Case2: Dr. Q has been prescribing a new
brand antibiotic X to most of his patients this
week. A close associate Dr. S made a
comment that this is due to the free dinner
given last week by the company making
antibiotic X. Dr. Q reported that

all of his prescriptions were indicated and

those promotions do not affect other
prescribing habits.
Ethical Issue: Self-assessment – naiveté or
denial

Case 3: Dr T plays badminton with Medreps

and executives from company Z. he
considers them his friends. When he was in
training this company funded his salary. In
order to help them with their quota, he
prescribes only the brands from company Z
and feels a pang of gilt whenever he
prescribes other brands.
Ethical Issue: Indebtedness