Consumer Reports recently conducted its 2nd annual prescription drug survey, which was carried out by Consumer Reports National Research Center. The project surveyed more than 1,150 adults who are currently taking a prescription drug.
After gathering their responses, the survey “found that the vast majority of adults object to the payments and rewards pharmaceutical companies routinely dole out to doctors because they feel these are negatively influencing how they treat patients.” The problem with a finding like this however, is that we do not know how the question was worded and the context in which it was asked.
In other words, the survey could have asked “Is it wrong to accept payments from industry,” instead of asking a more neutral question like “how would you characterize payments and rewards to doctors who work with industry: negative, positive, or neutral.” Essentially, this survey was looking to prove that working with industry is wrong, and not so coincidently, got those answers.
Despite the likely possibility that the survey conducted used a framing bias, the survey boasted that “more than two thirds, or 69 percent, of consumers surveyed said they think drugmakers have too much influence on doctors’ decisions about which drug to prescribe.” What they do you think insurance or the government have too much influence on doctors descisions about which drug to prescribe. It is often the case that the insurance company rejects reimbursement of a physicians prescription. Recently, I was at a physicians office and the patient was pleading with the doctor to keep her on a medication that the insurance company refused to allow her to have. The poor woman was been on the drug for two months that for the first time she was able to tolerate a drug in that class. Because it was a new product the insurance company refused to pay or it and demanded that she be placed on a drug that the woman had tried before with very bad side effects.
As a consumer, you should want a drug company to be working with your physician explaining about the risks and benefits, as well as the clinical data regarding the product they are about to prescribe you. This is necessary and in fact legal, whether through labeling, advertising or educational programming.
Another finding showed that “half of those polled said they feel doctors are too eager to prescribe a drug rather than consider alternate methods of managing a condition.” What alternate methods are we talking about here? Usually, medicine or drugs are a first resort for physicians before they move to more evasive procedures such as imaging or surgery.
In addition, 47 percent said they think gifts from pharma companies influence doctors to prescribe certain drugs, with 41 percent saying they think doctors tend to prescribe newer, more expensive drugs. Other significant findings included:
– 81 percent of consumers said they were concerned about the rewards drugmakers give to doctors who write a lot of prescriptions for a company’s drugs; and
– 72 percent were displeased with payments pharmaceutical companies give to doctors for testimonials or for serving as a company spokesperson for a given drug.
– 61 percent of consumers voiced concern about pharmaceutical companies paying doctors to speak at industry conferences, while 58 percent were concerned by big drug companies buying meals for doctors and their staffs.
The survey also covered issues such as consumers struggling to cover the costs of their drugs. The survey showed that 37 percent reported asking their doctor or pharmacist if there’s a less expensive generic version of the drug available.
One factor that the survey tried to associate with the prescribing of more expensive drugs was the fact that pharmaceutical companies have “massive advertising budgets.” The survey claimed that “one-fifth (20 percent) of consumers who take a prescription drug have asked their doctor for a drug they saw advertised, and among them, the majority of doctors issued the requested prescription (59 percent). What this number in fact demonstrates however, is the impact advertising has on populations who would otherwise be unaware of treatments for their diseases or conditions. To that effect, the survey did not attempt to discuss the amount of money that would be spent or incurred if the 20 percent of consumers who saw such advertisements did not seek treatment.
The survey also examined how the “public has a strong appetite for more safety information and details about possible side effects.” For example, 87 percent said that knowing the safety of a prescription drug was a top priority to them, while 79 percent were concerned about drug interactions, and 78 percent cared about the side effects of a drug.
As a result, John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center, noted that a top priority going forward is to help reassure consumers about issues and concerns regarding safety and side effects of drugs. Dr. Santa even asserted that “being attuned to those concerns can help counterbalance the tremendous influence of the drug companies.” He pointed to the fact that “at least 1.5 million serious, preventable drug errors occur in the U.S. each year,” which suggests that he associated these errors somehow to the companies instead of physicians. It seems obvious that few of these errors were manufacturer caused, and in fact many were the result of healthcare provider use.
This reminds me of an incident that happened over the weekend, a triage nurse at a local medical facility made an appointment with a physician at the facility and was given 100 milligrams of generic drug which is normally started at 25 milligrams. Prior to going to work she took the medication and arrived and had stroke like symptoms, was immediately transferred to a facility with a stroke center. Once she partially recovered (the effects of the drug wore off), she was transferred to a patient room. The specialist on call though aware of the situation also prescribed 100 milligram dose of the generic drug which her children who were with her prevented her from taking it and the stroke cycle starting all over again. The point is that medical errors are often from lack of interaction with industry (generic companies don’t educate physicians on the proper use and side effects of their drugs and places like consumer reports hold to a belief system that once a drug goes generic it has no side effects – what a feature).
Still, Santa acknowledged the need for consumers to ask “their doctors about the drug in question, its purported use, how it should be taken, whether certain activities should be avoided, whether drug interactions are possible, and the types of side effects that could occur.” He noted that more than half (53 percent) of Americans currently taking a medication have talked to their doctor in the past 12 months about switching to a different prescription drug, with side effects being one of the main reasons, in addition to cost and lack of insurance coverage.
In the end, the results from this survey, which are anecdotal at best, should be taken with a grain of salt because surveys like this often reflect the bias of the author of the study.
Instead, another survey should be conducted which asks questions aimed at the importance of the relationship between physicians and industry, such as the training, experience, and education doctors receive in collaborating with pharmaceutical and device companies. We are confident that if the same group of adults was asked whether it was important for their physician to stay up to date on the latest techniques, technologies, and treatments in their particular specialty or practice, almost 100% would agree.
And if you asked that same group whether they would want the companies, doctors, and researchers who developed and researched those products to provide such training, most would support that contention. It’s a tradeoff, and since most consumers want the best, most would realize that working with industry is the most effective way to achieve that.
In addition, it is important to realize that if Congress and policymakers believe such data to be true, policymakers may begin to impede the relationships physicians have with industry, and control the level of research and collaboration companies can have. If this happens, we will truly have a government run healthcare system, like the United Kingdom. Should that ever become the case, consumers will be more concerned not about the relationships physicians have with industry, but by the fact that government run healthcare programs, such as those run in the UK, have the power to deny drugs from entering the country, essentially leaving patients with no options.
Accordingly, America must maintain a proper balance of innovation and collaboration between industry and academia because otherwise consumers and the public will suffer. Despite the results from this survey, previous surveys have shown that Americans are confident in the medical and research field, and the recently enacted transparency provisions by companies and the federal government will only increase the integrity of industry and the trust of the patients they serve.