CAN YOU TRUST YOUR DOCTOR’S PRESCRIPTION?

When I was a child, I trusted my doctor. He made home visits, which is what you want when you’re sick.. He even gave me used syringes with the needles attached so I could refill the cartridges for my fountain pen from a big bottle of ink. I felt that he had my best interests at heart. Is the same true today?

Good People. Bad Results.

“… small branded promotional items should increase favorable attitudes for the brand being promoted …  but many physicians, because they are medical experts, believe they are not susceptible to these influences. In one survey, just 8% of physicians believed they were susceptible to influence by marketing items such as branded pens, whereas 31% of patients felt these items could influence physicians.”  — The Journal of the American Medical Association (May 2009)

Doctors may not think they’re influenced by vendors but they’re people too. Studies show that “even small drug company payments as low as $10 influence doctors’ prescribing patterns” (Australian Doctor).

Independence

The New England Journal of Medicine found that 94% of doctors have a relationship with a drug company. They receive

• free meals at work (83%)
• free drug samples (78%)
• reimbursement for professional meetings or continuing medical education (35%)
• payment for consulting, lecturing or enrolling patients in trials (28%)

The diagnosis and prescriptions may not be best for you. The problem lies in conflicts of interest. 

Schooling

Are medical schools are addressing the problems caused by conflicts of interest among their faculty? A study of policies found that  over 70% of Canadian medical schools failed. The highest score was 79% at Western University.

The big issues were

• interactions with sales representatives (70%)
• conflicts of interest or drug promotion in the curriculum (70%)

Having policies doesn’t mean they are effective or enforced. For instance, American medical schools tend to have strict policies but tend to ignore ghostwriting (that’s “when researchers take studies or parts of studies that were written by pharma and pass them off as their own independent work without disclosing the industry ties”). How objective do you think the articles will be? Perhaps court challenges will help since “medical journals, academic institutions and professional disciplinary bodies haven't succeeded in enforcing sanctions”.

Protecting Yourself

Spotting conflicts of interest is much tougher if you don’t know about them. An Australian study found that 76% of patients didn’t know about relationships their doctor might have with a drug company. They wanted transparency, which includes knowing about

• any benefits in cash or kind from drug companies (71%)
• financial incentives for participating in research (69%)
• sponsorship to attend conferences (61%)

Patients felt that disclosure would help them make better decisions about their treatment (78%).

If you remember that people are people, you’re better able to protect yourself whether you’re dealing with a doctor or any other advisor.

Links

• Why we get bad advice
• Med schools are ignoring conflict-of-interest problems (Macleans, Jul 2013)
• Before the prescription, ask about your doctor’s finances (NPR, Dec 2013)
• Too few, too weak: Conflict of Interest policies at Canadian medical schools (PLOS One, Jul 2013)
• Following the script: how drug reps make friends and influence doctors (PLOS Medicine, April 2007)
• Challenging medical ghostwriting in US courts (PLOS Medicine, Jan 2012)
• The mistakes medical doctors make
• The selling of Attention Deficit Disorder (New York Times, Dec 2013)
• The CBC’s hidden camera investigation of investment advisors
• The doctor the advisor mistreated
• The wealthy reveal how their advisors fail them
• How your brain works … against you
• How healthy are you really?
• image courtesy of dinostock

PS Buyer beware.