Editor’s Note: Robert Klitzman is a professor of psychiatry and director of the Masters of Bioethics Program at Columbia University. He is author of “The Ethics Police? The Struggle to Make Human Research Safe.” The opinions expressed in this commentary are solely those of the author.
At night, on call as a medical intern, I would race from one medical crisis to another in the hospital, often staying up all night, and having no time to eat dinner.
Periodically, drug company representatives would show up with huge hot pizzas dripping with luscious warm melted cheese, and bottles of Coke for other weary interns and residents and me. Pizza never seemed so good. Hungry and sleep-deprived, we gobbled up the free food. The drug reps would sit around and chat with us. They seemed nice and we appreciated that they were feeding us.
Alas, there is no such thing as a “free lunch” or a “free dinner,” especially from a drug company.
I didn’t think of the pizza as a bribe to later prescribe the representative’s drugs, but studies have shown that even small gifts, such as pens and coffee mugs emblazoned with the names of expensive drugs – and certainly free meals – turn out to influence what physicians prescribe.
Pharmaceutical companies used to give medical schools millions of dollars for free continuing medical education on particular drugs. But many schools have since instituted policies of “zero tolerance” for these company’s gifts, letting these corporations now donate money only to unrestricted funds, without abilities to discuss particular drugs. In response, these companies have essentially stopped giving these institutions educational funds.
CNN’s recent report that most physicians who prescribed opioids received payments from pharmaceutical companies making these drugs thus raises many concerns.
The details are even more disturbing: that the amounts of these payments increased with the more opioids that the doctor prescribed.
While drug companies may argue these doctors have more expertise and therefore deserve more money, these new reports come on top of other recent revelations that several opioid manufacturers engaged in various illegal and unethical practices.
Some of these companies hid information about the dangerous effects of their drugs, distorted claims, and engaged in misbranding and misleading advertising, minimizing lethal risks, while reaping massive profits.
From 1999 to 2016, prescriptions of narcotics have quadrupled, and deaths from these drugs have increased fivefold, killing over 200,000 Americans. Over 2 million others have become addicted to these opioids, impeding abilities to function and live.
Since the days of the Hippocratic Oath in Ancient Greece, physicians are supposed to follow a moral code – to dedicate themselves first and foremost to their patients’ well-being, and to avoid harm to patients. Such moral commitment is crucial for maintaining the trust of patients and that of the broader public.
If physicians instead choose treatments based on how much they themselves profit, rather than on how much patients will get better, patients would trust doctors much less, or not want to pay these providers. Such trust must be earned and carefully upheld, not abused.
Yet these payments to physicians may easily influence which drugs doctors prescribe (milder generic ones or stronger and more expensive ones), and how much and for how long.
If nothing else, patients should, arguably, be informed that their doctor is getting money from these companies and that the amounts of these funds increase with the quantity of these drugs they give.
Alas, studies have shown that many patients may misunderstand these disclosures, thinking that a doctor must be good if he or she is receiving drug company money. Patients thus also need to be informed about what these payments mean.
We need better oversight and restrictions of such payments, better training of doctors, and more awareness of these problems among patients, policymakers and the public at large.
President Trump has pushed for the death penalty for some drug dealers. Yet that approach poses many problems, and will not address the fact that doctors’ prescriptions are contributing to the increasing rates of addiction and death. Hopefully, he will take adequate actions to address the roles of pharmaceutical companies in fueling the epidemic. More funding for effective drug addiction treatment is also critical for avoiding deaths.
Given the hundreds of thousands of people whom prescribed narcotics have killed and harmed, we need to err on the side of caution.
Free pizza may be good, but our patients’ lives should count far more.