In the United States, there is a major conflict of interest when it comes to drug companies’ relationship to doctors and the potential danger it can pose for the public. Because the United States is the only industrialized nation in the Western world that doesn’t have a system of universal or socialized healthcare, money plays a huge role in the quantity and type of drugs that doctors prescribe to patients.
This seems contrary to the Hippocratic Oath that doctors take upon entering into the profession where they vow to never do harm to their patients, by practicing medicine to the best of their ability and keeping the wellness of the patient as the highest priority. Also, included in the modern day Hippocratic Oath is the idea of avoiding over treatment. These ideals taken on by doctors can be, and have been, compromised by the pull of money and outstanding interest groups that do not have the well-being of the patient as their first priority.
For example, a recent New York Times article pointed to the fact that the worlds largest drug companies (which are American companies) are paying hundreds of millions of dollars to doctors every year in return for them giving their patients certain medicines (March 9 2007). Amgen and Johnson & Johnson, like any other business in a capitalist market, compete for market share and attempt to expend their business and its profits. However, when these attempts get in the way of a patient’s health and doctors’ commitment to do no harm and avoid over-treating patients, there is a serious problem that needs to be addressed. The Hippocratic Oath is violated, the integrity of the medical profession is compromised, and patient’s lives are in danger unnecessarily.
It is difficult to keep the interest and well-being of the patient as the highest priority when doctors are offered huge monetary incentives to prescribe drugs that have been known to be detrimental to a patient’s health.
Specifically, Amgen and Johnson & Johnson have been under fire recently for their anemia medicines, which are used to treat anemia caused by kidney disease or cancer chemotherapy. The main problem lies in the dosage of the drug prescribed, which regulating companies like the Food and Drug Administration (FDA) say are unsafe. Due to the payments received from these huge pharmaceutical companies, doctors may be more prone to give their patients increased amounts of the anemia medicine – a step that could increase a patients’ risk of having a heart attack or a stroke.
While there is evidence that anemia drugs can improve a patients’ quality of life when appropriate doses are used, scientists in the FDA reported that there was no evidence that indicated the medicines improved quality of life or lengthened lifespan, and perhaps even shortened the patient’s life when used at high levels. This is precisely where the problem lies – doctors are paid more to give more of the drug. It is very unlikely that a medical doctor would ever purposely put a patient’s life on the line in order to make money, but there is always the chance that big pharmaceutical companies can persuade the doctor that the drug is perfectly safe, even at high doses.
The New York Times article pointed to the fact that American patients receive more of the anemia drugs than patients in Europe, both for the dialysis and cancer patients. This goes back to the argument that America’s healthcare system is not the most effective when it comes to separating money and the ethics of the medical profession. With universal or socialized healthcare, doctors in Europe do not have the same initiative to prescribe controversial medicines for the sake of earning money. And because anemia medicines don’t come in fixed doses, doctors have greater personal discretion when deciding how much to prescribe.
However, there is a dangerous discrepancy here because doctors are not always fully informed about the medicines that are out there. Critics say that drug companies have failed to clarify the safety of the anemia drug by not testing whether lower doses would work better than higher ones. By avoiding to do so, the companies have effectively steered clear of the possibility of finding that lower doses work better, a discovery that would decrease the use of the drug as well as their profits.
So what can be done? There are certain restrictions already in place that have the correct idea in terms of regulating pharmaceutical companies. For example, federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies (New York Times, May 9 2007). However, drug companies can still pay doctors’ money for certain medications, such as the anemia drugs, which are given to patients at the doctors’ offices. This gives drug companies a loophole in which they can actively market and distribute their product by giving doctor’s rebates every time they prescribe it. More federal regulations need to be put in place to ensure that drug companies don’t influence what doctors prescribe their patients.
While both pharmaceutical companies and the doctors are to blame in this situation, it is ultimately the doctor’s that should be doing the right thing. The goal of any business is to make money, but the goal of a doctor is clear: do no harm. Money should never be the determining factor in a doctor’s decision on how to treat a patient. Doctor’s have chosen a profession that requires morality and ethics, not greed and misjudgment.
Léalo en español.