How much does industry influence how we prescribe?

There is an obligation on us as doctors to question why we are choosing a particular medication when we write a prescription

TV recommendations are still one of the greatest currencies we have as we gradually emerge from lockdown and I’m happy to share that I recently watched a brilliant documentary originally broadcast on HBO called Crime of the Century. It was a shocking exposé of how corrupt drug companies in the US have lied to and manipulated doctors in their marketing of oxycodone and fentanyl products since the 1990s, which has directly led to the deaths of more than 760,000 Americans in what is known as the opioid crisis.

In times long ago when we were still able to get on planes and travel to the United States, part of the fun was turning on the TV and marvelling at the ads for antipsychotics or anticoagulants on news channels. This could never happen back home, we would say. Drug companies are far more regulated. We could never be influenced in this way.
Although the documentary was about actual criminal acts, the bribing of doctors, and lying in Congress; it did lead me to think how the medical profession interacts with pharma companies here.

The days of the free holiday or even the free pen are gone, but we’ve all been there and done the polite smile as the very nice rep gives their spiel about their latest hot new thing, which is 50 per cent more effective than its closest market rival, praying for it to end so we can go back to the free platter of sandwiches and the paper cup of coffee.
I’m not for a second suggesting that drug reps here don’t act with the greatest integrity and standards, but it is naive at best to think that we wouldn’t be as subconsciously influenced by that advertising as we are by the ads we see on TV after a long day at work.

It can be very easy to think highly of ourselves and say I wouldn’t dream for a second of prescribing that opioid or that benzo or sleeper, sure everyone knows that they’re bad news. But we do find ourselves prescribing a hell of a lot of the newer heavily-marketed painkillers without really wondering how they can truly be different than anything else that acts upon an opioid receptor in the brain.

Previous opioids brought onto the market have ironically caused huge headaches for doctors as years later we’re still trying to wean patients off them. The plastic packets of the neuropathic analgesics that we were all told were brilliant for sciatic back pain litter the pavements of our towns and cities as they now hold a street value almost as great as heroin, which, let’s not forget, was originally a brand name for morphine brought onto the market by Bayer in 1895.
Patients are always going to need serious analgesia and there should be a role for it in our clinical practice. But we have to question why we are choosing a particular medication as we write a prescription or fill a kardex.

Is it because it’s the most evidence-based for that indication or is it just the one drug in its class that you consistently know the dose of off the top of your head? (It can’t just be me.) Or perhaps it is because you have been more subconsciously influenced than you realise by the free croissant at grand rounds or the sponsorship at the annual conference.

Some hospitals and clinical sites have a policy of not allowing drug reps in at all and perhaps that is to be applauded. Conversely, it could be argued that there is a valid role for drug reps in the course of our daily clinical practice and that drug companies have the right as businesses in a capitalist society to market and profit from their drugs they develop.
There is a myriad of factors that lead us to choose a certain medication over another.

However, it is important to remember that doctors are consistently named in surveys as one of the most trusted professions by the public and we have a responsibility to uphold that trust every time we sign a script with our name and Medical Council number. When both suspicion of ‘big pharma’ is at an all-time high and drug companies like Pfizer and AstraZeneca are household names, it beholds us all to act with the greatest integrity, now more than ever.