Drug companies often provide a variety of benefits to physicians to incentivize them to advertise their product to patients, be it company-sponsored stethoscopes, stock options in the organization, or even financial compensation. Although this may just seem like an effect of market forces, this compensation has given rise to the escalating cost of health care, a topic capturing national headlines.
Amalia Issa and Jerome Kassirer, both doctors, discussed the problem of translation in science from doctors to patients. Financial incentives in the pharmaceutical industry interrupt genuine dialogue between doctors and patients, often resulting in misleading recommendations to consumers.
Amalia Issa is a doctor who specializes in the intersection of pharmacogenomics, personalized genomic medicine applications, and how both these scientific developments will be translated and integrated into health care delivery and health care systems.
One key topic she emphasized was publication bias, which occurs when the outcome of research or an experiment influences the decision to publish or distribute it. The pharmaceutical industry commonly uses sophisticated tricks and strategies to distort the evidence given to doctors and patients in order to promote certain products.
This type of practice occurred with Risperidone, an antipsychotic medication used to treat schizophrenia 10 years ago. When it became legal to replicate it, drug companies developed virtually identical products to Risperidone. Trials compared the new antipsychotic drugs at a dose of eight milligrams per day against Risperidone at two milligrams per day, which was bound to make their new drugs provide better results.
This blatant example of publication bias is far too common in the industry, and it problematically prevents the most effective treatments from ending up in the hands of consumers, according to Issa.
“We need to have all of the data on a particular treatment to know whether it’s really effective or not,” Issa said.
Issa suggested following the guidance of third-party research firms. One such firm is Cochrane, a global independent network of researchers, professionals, and patients dedicated to producing high-quality, comprehensive research on various drugs. In order to execute this important work, they need access to all the data collected by pharmaceutical companies on the drug they test, which companies commonly withhold due to negative outcomes.
Still, studies that produce proper data are very difficult to get a hold of, even as an academic, she said. Professional norms, national regulations, hospital policies, and countless other factors affect the results produced in trials, justifying a call to ethics and social justice in the industry.
Issa said the pharmaceutical industry should embrace the reality that medicines and how they are developed, marketed, and communicated are a human right rather than a commodity. Public health should not be a money-making tactic for big businesses to profit from, but a resource with which all members of society can prosper. Now, more than ever, is the time to advocate for fair health care, and this fight involves everyone, she said.
“Educate yourselves, your families, your friends, and your neighbors about medications and pharma industry practices,” Issa said. “Lobby and advocate alongside scientists and other academics for increased transparency in the publications process.”
Kassirer, the former editor of the New England Journal of Medicine and a distinguished professor of medicine at Tufts University, discussed how financial conflicts of interest influence physicians.
Kassirer cited the “Candy Experiment” at the Cornell School of Hotel Administration, which conveyed the basic human tendency to respond to financial incentives. When servers at a restaurant gave a piece of candy to customers, their tips were shown to increase.
And this same logic applies to physicians, as financial conflicts translate into bias. When offered an incentive to promote a certain drug, they will knowingly misdiagnose patients at their own risk.
To reduce the effect of incentives in the industry, many foundations require that physicians provide full disclosure to their patients. Yet there are even limits to this solution, as disclosure requires no substantive change.
“The problem is that disclosure is necessary but is not a sufficient solution to the conflict of interest,” Kassirer said. “The conflict is the problem, not the lack of disclosure.”
In order to resolve the effect of incentives in the industry, the guidelines provided by physicians prove most helpful when given without funding from the industry. Medical society officers and journal editors should have no financial conflicts and the industry should have minimal financial support. These solutions in themselves will help restore professionalism to the field.
“The health care system would be very different if patients received honest evaluations up front,” Issa said. “I’m sure that transparency in terms of all the studies will make a huge difference.”
Featured Image by Kaitlin Meeks / Heights Staff