Pharmaceutical sales – ethical considerations for doctors
At the core of patient care there is a distinct intersection between the presenting symptoms of patients and the pharmaceutical products available on the market.
Doctors find themselves navigating this decision with the desire to do the best for each patient yet simultaneously bombarded by information promoting specific pharmaceutical products.
Billions of dollars are spent every year by the pharmaceutical industry to increase medical sales. The majority of the fund is used for free samples, followed by direct marketing to health professionals by pharmaceutical representatives, known as detailing.
This poses a prominent ethical problem for doctors prescribing pharmaceuticals and several factors need to be considered to make clear, justifiable decisions that promote optimal patient health.
Ethical response to sales pitches
As the pharmaceutical industry runs on a private business model, sufficient sales are needed to sustain future research and medical advances. However, this results in promotion of products to increase sales and cover expenses, potentially toying with the health of the public.
Pharmaceutical industry sales representatives are paid to present new and relevant information to health professionals, educating them on the efficacy and safety of new medications. Often the information is presented in a positive light to promote sales, regardless of the actual effect on patient health.
Doctors often bear the brunt of these sales pitches and need to respond in an ethical manner to provide the optimal quality care to patients.
Should doctors accept visits from pharmaceutical reps?
Doctors are free to accept or reject visits from pharmaceutical representatives. Should they avoid the visits on ethical grounds?
On one hand, pharmaceutical representatives have current knowledge about recent new developments made by their pharmaceutical company and are able to communicate this knowledge in a quick and efficient manner.
"The idea that you can ignore information from a pharmaceutical company that has conducted extensive research and development to help treat disease is laughable at best and negligent at worst," Martin Cross from Medicines Australia told the Sydney Morning Herald.
However, the information presented is from a source likely to be biased. Representatives are often employed for charisma and relationships skills rather than pharmaceutical knowledge, and they receive commission based on sales resulting from their pitches.
Doctors generally feel they are aware of and able to manage biased advice whilst taking the benefits from detailing, but evidence claims the ability to do this is somewhat lacking. Several research sources have concluded that doctors should decline visits from pharmaceutical representatives entirely. On average, doctors spend 40 minutes/month with representatives, which could be spent reading current research from impartial scientific papers.
It remains each doctor's individual decision as to how to respond to pharmaceutical industry detailing. Whilst research suggests more informed decisions are made without the pharmaceutical industry's input, it is up to the physician's discretion.
Impartiality – the number one priority
A substantial quantity of information needs to be digested when making decisions about patient health. Each patient should be considered individually and the best management solution of several possible alternatives chosen.
Ideally, impartial information about the efficacy and safety of possible pharmaceutical treatments should drive the decision. Administration of the treatment is also important, particularly for patients that may struggle to adhere to difficult medication regimes. Doctors should recognise information sources and consider their reliability.
To maintain high ethical standards, it is most important to remember that patients are the first priority. The informational sources used to make pharmaceutical decisions should be impartial, to help doctors make the best choices to promote the safe and effective use of medicines.
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