Doctors Drugs
Although the Affordable Health Care Act represents a step in the right direction towards encouraging all Americans to avail themselves of medical services, the bill fails to address the root causes of problems in the system. The American health care system is flawed because it is a for-profit model that places profits far ahead of patients. When profits come ahead of patients, the result is an inability to fulfill the ethical duties of being a health care worker. A progressive transformation of the American health care system would systematically undo the nefarious link between corporate interests and the interests of health care.
The relationship between doctors and drug companies has been well established and well documented. Major news media resources like The Atlantic, as well as professional peer-reviewed journals like the New England Journal of Medicine cover stories addressing the potential ethical conundrums inherent in a cozy connection between physicians and pharmaceutical companies. Shaywitz (2013) has described the problem as "a bunch of nefarious pushers who pay off vulnerable doctors to prescribe their latest expensive, mediocre product," while still defending the special relationship that has developed between doctors and pharmaceutical companies (p. 1). Shaywitz's (2013) argument is based on opinion on conjecture only. Most established professional journals imply that collusion between doctors and drug companies leads to a range of problems that potentially harm patients. Writing for the British Medical Journal, Moynihan (2003) locates actual empirical evidence showing that doctors' prescribing habits changes measurably after the skillful marketing techniques used by pharmaceutical industry representatives: techniques ranging from free dinners to gifts. For example, doctors' prescribing habits are "less appropriate" after exposure to the marketing, including "a rise in both prescription expenditures and irrational and incautious prescribing, according to a recent analysis of the ethics of gift giving," (Moynihan, 2003, p. 1189).
What's even more disturbing is that doctors seem to be unaware that their behaviors change as a result of the marketing. Shaywitz's (2013) ridiculously laudatory comments underscore the problem of blissful ignorance among medical professionals. Moynihan (2003) found that doctors "deny their influence despite considerable evidence to the contrary," (p. 1189). Campell (2007) also concludes, "physicians vehemently deny that their industry relationships have any of these negative effect," but are ironically suspicious of their colleagues' ethical practices related to pharmaceutical company payoffs. Often the denial reaches epic proportions, as with the Shaywitz (2013) piece for The Atlantic, in which the author claims, "it's often these experts who are the smartest scientists or the most experienced clinicians -- that's why companies seek them out." This assessment is false. Drug companies seek out physicians who are amenable to working with them and susceptible to their style of direct marketing. The pharmaceutical manufacturers are in it for the money, and they would not invest in physicians with integrity.
It makes it much harder to influence public policy related to this problem when doctors deny that a problem exist, especially because doctors represent a high social status position in society and wield considerable clout politically. Currently, it is perfectly legal for doctors to be able to accept gifts -- essentially bribes -- from pharmaceutical representatives. A recent law attempts to at least inject some added transparency into the laws by forcing manufacturers to disclose the amounts of money they give to physicians, including free dinners and gifts (Campbell, 2007). The so-called Sunshine Law is actually bundled with the Affordable Health Care Act. However, the disclosure laws only apply to companies with revenues of over $100 million. They do not apply to the delivery of free samples to doctors, which is a large portion of their marketing. Because many pharmaceutical giants have subsidiaries, it is unlikely this law will have any impact on practices and behaviors. Moreover, disclosure of information does nothing to stop the practice. As an article in The Economist points out, the Sunshine Law might actually play right into the pharmaceutical companies' desire for financial growth at all costs, by providing them with a publically available (and therefore cost-free) method of marketing data and marketing research ("Let the Sunshine In," 2013). Pharmaceutical companies will be able to track their per-doctor expenditures with their per-patient prescription data, to reveal causal connections between marketing methods and sales. Removing the veil of secrecy from the practice is a step in the right direction in terms of the ethics of transparency, but it is as halfhearted a measure as the rest of the Affordable Health Care Act.
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