aetcom model on physican and industry relationship

Physician industry relationship

1. Case Studies in Ethics: The Doctor–Industry Relationship Dr J. Harikrishna MD, DM Professor Dept. of Medicine SVIMS

2. Learning Objectives Understand, recognize, explain and defend Medicolegal Socio-cultural Professional and ethical issues in The physician – industry relationships

3. Case scenario It was the end of the morning session in your clinic You were getting ready to have lunch when you are told that a drug company representative wants to meet you. You let him in and he tells you Madam, we are launching a new combination drug next month. We are planning a one hour meeting to introduce you to the product.

4. Case scenario The meeting will be held in Singapore and we will fly you and your spouse in business class All expenses will be borne by us. You can stay there for 3 days The meeting will be held in a cruise ship, The meeting will be only for one hour After that there will be a gala dinner and entertainment

5. Case scenario Also, to compensate you for losing your practice for those three days we will pay you an honorarium of Rs. 25000 for each day that you are there. This is our way of saying thank you for all the support in the past and the support that you are going to provide in making this new molecule a success

6. Case scenario What is your response?

7. Case scenario What is the influence of pharmaceutical industry on doctor’s prescription behavior?

8. Influence of pharmaceutical industry Pharma companies are not charitable organizations They are not in the business of education, or philanthropy, or poverty relief, or even—let’s be honest—health care Their business is to manufacture and sell drugs

9. Influence of pharmaceutical industry Pharmaceutical industry pays the vast majority of physicians for only one reason To market their drugs

10. Position of physician Unlike most any other businesses, however, pharmaceutical companies must go through an intermediary in order to sell their product This places physicians in a position of singular trust They stand between corporations and the vulnerable, sometimes desperate patients that those corporations call “customers.”

11. Pharmaceutical industry Pharmaceutical companies were forced to pay $19.8 billion in penalties over a 20-year period in USA

12. Pharmaceutical industry Pharmaceutical companies have Rigged clinical trials Buried unfavorable results Published ghostwritten journal articles Paid kickbacks to high-prescribers Bullied academic critics Produced fake medical journals Manipulated treatment guidelines

13. Influence of pharmaceutical industry The available evidence does not suggest that doctors who receive payments and gifts from industry will reciprocate directly Rather, the influence of gifts and payments is unconscious Most doctors believe they are not affected While 61% of physicians believed that financial incentive did not influence their own practice, only 16% believed that the same was true for their colleagues

14. Influence of pharmaceutical industry In fact, it is the cornerstone of effective marketing Just as nobody thinks they are influenced by advertising, nobody thinks their decisions are altered by gifts and payments, simply because they cannot observe the influence themselves

15. Medical representative A skillful rep is the person who knows how to pay off doctors without giving them the sense that they are being bought “Bribes that aren’t considered bribes”

16. Influence of pharmaceutical industry Gifts, speaking fees, samples, and consultancies Increase prescriptions And if they do not The tap is simply turned off

17. Influence of pharmaceutical industry The story of GABAPENTIN FDA approved Gabapentin only as adjunct therapy for seizures Manufacturing company has deployed a breathtaking array of covert marketing tactics to persuade doctors to prescribe the drug for all manner of conditions Ranging from migraines to bipolar disorder For which there was no evidence of efficacy

18. Influence of pharmaceutical industry The story of GABAPENTIN Bought tickets to Hawaii or the Olympics Peer-to-peer influence by presenting case studies to their peers It deployed a sophisticated publication strategy along with CME activities

19. Influence of pharmaceutical industry The story of GABAPENTIN STEPS seeding trial 772 physicians to serve as “investigators” for an uncontrolled, unblinded study aimed at studying the efficacy of Gabapentin In fact, the trial was a marketing exercise designed to familiarize the investigators with Gabapentin and write more prescriptions

20. Influence of pharmaceutical industry The story of GABAPENTIN Eleven patients in the study died and 73 others experienced serious adverse events Company was forced to pay $430 million in criminal fines and civil damages But the marketing worked The popularity of Gabapentin skyrocketed, mainly for off-label uses

21. Influence of pharmaceutical industry Some physicians do not accept gifts, sponsorship of conference, vacation, speaking or consulting fees from industry But they agree to do industry-sponsored clinical trials But the pharmaceutical industry has demonstrated that it can corrupt clinical research just as easily as it can corrupt clinical practice.

22. Why physicians should say no to industry money The industry money distorts the judgment of physicians It leads to More likely to write prescriptions for that company’s products More likely to recommend that the company’s products be added to hospital formularies and More likely to publish research findings favorable to that company

23. Case scenario What is your response medical representative’s offer?

24. NMC regulation

25. NMC regulation

26. Thank you