Effect Of Gifts On Physician’s Decision For Prescribing Specific Drugs: Evaluation Of Ethics Within The Pharmaceutical Industry

The Role of Pharmaceutical Companies in Promoting Drugs

Discuss about the Impact of Gifts on Physician decision on Drug prescription.

The pharmaceutical organizations have an intrinsic role to play in case of the particular medicines getting advised towards large scale patients.  It is the doctors who are treated as intermediate channel to be able to sell the customers with the medicines which shall be suggested by the pharmaceutical companies. In order to establish their influence in a strong manner the companies need to ensure the process of transfer (Agarwal and Kaur, 2017). However the process of ensuring is necessary to embody the process of offering gifts towards the doctors. The pharmaceutical companies strive hard to make their products get endorsed among the public mostly. This can be done by taking the doctors into confidence. The doctors are hence offered with a wide range of gifts so that they feel compelled to suggest the medicines of the companies who offered the same. The pharmacy companies have established a strong marketing strategy to get their products in the form of medicines get popular and sold the most among general public. However their reach is confined to get hold of the people in direct and influence them to take medicines of their respective company. However they have treated the doctors as the intermediate channel who can act as the mediator to spread the medicines generating from their companies (Datta and Dave, 2017). The pharmaceutical organizations are well aware that the trust and faith that patients will automatically build upon a doctor shall never be developed by them towards their target customers. However, their strategically try to implement their business plan by taking the intermediate force into their influence. By offering such gifts and luxuries they make the doctors comply towards their respective brands. The doctors are hence served with perks which are sometimes of financial nature and sometimes devoid of financial kind.

The gifts that are offered towards the doctors are likely to encompass a wide range of items. The promotion of the pharmacy products are ensured using these perks, which can be also termed as bribe and hence viewed as corrupt practices. Such a practice prevailing within such a noble profession as medical profession is most likely to give rise to a number of questions. The ranges of the gifts tend to differ with regard to the choice of the physicians (Jin, 2016). There is a huge question that arises upon the ethical basis associated with the profession and the pharmaceutical companies. The decisions and the choices that are taken by the doctors are reflected upon the prescriptions prepared by them. Hence the influence of the pharmaceutical companies falls directly upon the purchase of the customers or patients. It is under the research paradigm that whether the doctors’ choice or preference depend upon the perks offered by the specific pharmaceutical company or not. Without considering the quality and the value of the medicines of same range the company shall be preferred just on the grounds of the amount and quality of gifts and perks provided towards the doctors. Moreover, even if the extent of influence might not spread as far as getting compromised in terms of medical value (Larkin et al. 2016). However, there is a significant amount of question being raised on the ethical spectrum whether such an act hold justice towards the medical profession. The decision making process of a doctor is likely to be governed by the quality value associated with the medicine. However, the subsequent influence of the pharmaceutical companies tend to have a large and strong impact which can change the decision making process. The determinants of the selection process are necessary to follow the ethical grounds. However it has been a matter of question towards the entire practice as it has been a predominant one. Instead of preferring the companies with loyalty the doctor now tend to prefer the brands offering greater amount of gifts, luxuries and perks to them (Chimonas et al. 2017). This practice certainly makes the profession be diminished through the grade of value and ethics.

Influence of Gifts and Perks on Doctors’ Prescription Behaviour

Aim

This very research proposal focuses primarily in investigating the effect of gifts on Physician’s decision for prescribing specific drugs: Evaluation of Ethics within the Pharmaceutical Industry

Objectives:

• To evaluate the different gifts considering their sizes which are received on being prescribed by the doctors
• To assess if the exchange of gifts taking place between the different pharmaceutical companies and doctors are ethical or not
• To analyse if financial or non financial gifts make any difference when offered towards doctors by the pharmaceutical companies
• To assess if the ethical foundations are threatened by accepting these gifts against the prescriptions given by the doctors (Fickweiler et al. 2017)

Research questions

• Does the worth of the gifts that are received by the doctors make a significant difference in the particular medical company getting chosen?
• How much ethical can such a practice of offering gifts against getting favored through suggestion of company name in the prescription be considered?
• How does the form of gift being a financial one or a non financial one get impacted to be preferred by the doctors?
• Does such practices support the ethical basis tied along with a noble profession as medical and pharmaceutical kind?

Conceptual Framework

It is widely popular across the world that pharmaceutical companies interact with the doctors for the purpose of promotion of their products. After the discovery of a new drug or after rebranding of a drug, many pharmaceutical companies try to influence the doctors by proving them expensive gifts (Evans, 2018). Doctors get influenced by those gifts and they often end up prescribing unnecessary medications sold by those pharmaceutical companies. Most of the doctors accept the visit and free lunch offered by the pharmaceutical companies and in return their prescription is heavily influenced by the drugs manufactured by the same company. From a report of Washington post, the year 2012 saw the pharmacy industry saw a total expenditure of $24 billion for the sake of selling its products to the clinicians and the medical professionals, which was calculated to be almost 8 times the total amount spent on customer promotion (Subedi, 2018). This huge sum of money is invested almost every year and the number is growing with every passing years. Such phenomenon is hugely impacting the volume of medicine prescribed to the patients by those doctors (Skandrani & Sghaier, 2016). A patient is mostly unaware of this fact and they blindly follow the instruction of the doctors or follow the prescription. This is how the pharmaceutical industry is growingly expanding their influence on the doctors.

With the increase in the incident of influencing doctors, many hospitals have started banning the visit of pharmaceutical representatives in order to resist their influence on the doctors. The steps are being taken to limit the influence of the pharmacy industry to the prescription made by teh doctors. To enact this change, he California Senate passed a bill which will ensure that no doctors are receiving gifts from the representatives of the pharmaceutical companies.  This act by the California senate proves that the incident if getting huge amount of gifts from the pharmaceutical companies by the doctors is a real issue and it has been affecting the health and finance of many patients across the world. The practice can potentially harm the physical condition of the patients as taking multiple drugs may give rise of drug interaction in the body of the patients. Two drugs can interact with each other and this will harm the patients (Zehra et al. 2017). With the synergistic effect of drugs, many cases of drug induced infection are being reported in many hospitals these days. Patients suffer from drug overdose and they may generate drug resistant property with drug overdose. When doctors prescribe more drugs than required after getting influenced by the gifts and bribes by the pharmaceutical companies, it affects the health condition of patients. In some cases, it can be seen as an immediate action and the action can be seen after long term. But it is proven fact the drug overdose or unnecessary taking of drugs would give rise to many hazards.

Impact of Pharmaceutical Companies on Patients’ Health

A study published in JAMA say that it has been seen that those hospitals restricting representatives from pharmaceutical companies to meet or visit doctors are prescribing much lesser drugs than the ones which are not restricting the representatives (Oral & ÖZÇEL?KAY, 2017). This study sheds significant amount of light to the fact that gifts are bribes are having significant activity on the behavior of the doctors towards their patients. Doctors are often ignoring the benefits of the patients are they are acting for the benefit of the pharmaceutical companies. In the study by JAMA, it has also been seen that doctors from the hospitals which have restricted the visit of representatives from pharmaceutical companies, are prescribing those drugs which are less costly and as effective as expensive drugs (Khan et al. 2016). This has been regarded as a milestone in the research as it can clearly explain the fact of effect of bribe or gifts to the medical professionals (Hajjar et al. 2017).

Another study conducted by ProPublica analysis says that the doctors who get payments from the pharmaceutical companies are more prone to prescribe drugs which are costlier than the other drugs (Egharevba & Atkinson, 2016). Many drug and medical device companies are offering payments, expensive gifts like car or holiday packages to the doctors to promote their brand and to prescribe medicines of their brand.  These doctors are more likely to prescribe expensive brand name rather than mentioning the generic name of the medicine. In the name of educational dinner, many pharmaceutical companies try to influence doctors by taking them to dinner (Zetterqvist et al. 2015). In such diner the companies try to promote their drugs and they try to make sure that the doctors will certainly prescribe drugs from their company in futur

Introduction

To carry out any research oriented study in a seamless fashion, it is highly crucial to strategically implement the appropriate methodology by the help of which, the research approaches and the data collections techniques can be interpreted. This helps the researcher in taking a positive aspect regarding the research review and the outcome. This chapter of methodology needs to be employed and scrutinized intricately by the researcher in order to carry forward the research work that shall be mentioned as follows.

Research outline

The most crucial aspect of research methodology is to identify and diagnose the most appropriate research paradigm in such a way that it suits the entire methodology from every aspect. The two attributes that is, research approach and paradigm needs to be constructed in such a way as well as on a prior basis that the research goes on a smooth and seamless fashion without the researcher stumbling on to any kind of hurdle. Hence, the research outline that needs to be planned on a prior basis and planned effectively with considering all the nook and corners of the research enables the researcher to commit fewer errors while carrying out the research. This leads to a transparent forwarding and effective showcasing of the research approaches and other methodological prospects and hence the research takes a rather fancier yet structured way. The methodology employs the quantitative approach of data collection that shall employ appropriate research design with synchronized approach and data collection technique and analyses so that the aims and objectives that had been set on a prior basis before starting the research gets defined with ease (Silverman, 2016).

Banning of Pharmaceutical Representatives by Hospitals

Research philosophy

Research methodology always employs the consideration of research philosophy that needs to be planned on a prior basis so that the research does not face any intervention in between. The appropriate structure of the research methodology that can only be attained with a proper research philosophical output provides the researcher enough area to draw critical inference on the project report. In order to conduct this research related to the project which is in accordance to the ethical implication on pharmaceutical industry where, the relaying of gifts to the doctors implicate the extent of drug prescription thereby enduring profitability to the pharmacy companies, positivism approach needs to be considered by the research worker.

Research approach

Every research topic during its manoeuvre and processing requires the construction of framework, based on which the entire research will be carried forward. After the effective identification and selection of the research topic and setting up its goals, the research needs a way to progress/advance further to reach the ultimate outcome. This research shall primarily make the researcher to employ the top down or deductive research approach. The research study and the research question deem suitability towards a unidirectional mode of progression and hence, deductive research approach seems more feasible. This shall help the researcher to gain a positive and constructive framework of the study.   

Research design

Research design is important in providing an accurate layout and appropriate structure to the research in addition to providing an overall view on the total implication and the extent of research impact. In order to carry forward this specific study, the research needs to opt for the explanatory research design so that appropriate deduction of the research topic and its association with the impact on the pharmacy companies can be effectively identified and explained.  

Search strategy

Boolean search method needs to be implemented in order to search the books and journals from where the relevant evidence based data will be available with regards to this topic. The following needs to be implemented for the search result;

“Pharmacy companies” AND “medical representative”; “Pharmaceutical ethics” AND “physician’s decision”; “Physician’s bribery” OR “Medical representative’s act”; “Australian Pharmacy ethics” NOT “drug therapy”.

The search strategy will also incorporate searching of journals and relevant articles from databases such as PubMed, Embase, Cochrane Library and Google Scholar. The search engine on the database needs to be prompted from 2010 till date. The search engine will be provided with key words that shall revolve around physician’s impact of decision on drug prescription and impact of gift on decision making. The search terms should include both free-text words as well as medical subject oriented headings that shall deem relevant to the topic. Additional search strategies that will revolve around the search of the grey literature such as thesis and dissertations on the said topic also need to be ascertained for relevant quantitative experimental data.  

Studies on Effect of Gifts and Bribes on Doctors

Data collection techniques

Literature Review. Review of already conducted research topics and literatures shall be attempted to gain further insight into the research topic. The search engine will be narrowed down for searching articles published in between 2010-18.  

Secondary Source. The pharmaceutical web database www.pharmacyboard.gov.au shall be used to gain further information on the said topic.

Primary Sources. The researcher needs to implement a primary source of data collection technique where approximately 100 physicians  will be selected and they will be introduced with questionnaire-based survey reports and depending on the pattern of their responses, the data analyses will be performed.

Subject demographics

The target populace and the respondents for this study will be from India.

Data analyses techniques

The researcher shall mainly emphasize on the calculation of the term “beta” with the help of regression analyses which shall identify the exact effect on the research prospect on its outcome. Moreover, the employment of linear method needs to be done so that a moderation test for the prospect of ethical consideration can be carried out. The parametric measurement of the research shall also employ the use of ANOVA and descriptive statistics.

The overview of the literature shall be effectively synchronized with the aims and objectives and research questions so that the research outcome can be interpreted with ease (Flick, 2015). The conclusion and discussion will eventually explain the nook and corner of the research findings in a vivid way so as to draw clear interpretation.  

Ethical consideration

The research shall be undertaken using peer reviewed journals, with respect to proper permission seeking in case they are close access ones. Proper citation needs to be given to the authors whose data are to be used. The aspect of plagiarism will be nullified and looked on to.

Research timeline

References

Agarwal, P. and Kaur, S., 2017. Pharmaceutical Promotion and Its Influence on Prescription Behavior: Ethical Issues and Legal Framework in India. Asian Bioethics Review, 9(1-2), pp.73-85.

Chimonas, S., DeVito, N.J. and Rothman, D.J., 2017. Bringing transparency to medicine: Exploring physicians’ views and experiences of the Sunshine Act. The American Journal of Bioethics, 17(6), pp.4-18.

Datta, A. and Dave, D., 2017. Effects of Physician?directed Pharmaceutical Promotion on Prescription Behaviors: Longitudinal Evidence. Health economics, 26(4), pp.450-468.

Egharevba, E., & Atkinson, J. (2016). The role of corruption and unethical behaviour in precluding the placement of industry sponsored clinical trials in sub-Saharan Africa: Stakeholder views. Contemporary Clinical Trials Communications, 3, 102-110.

Evans, W. C. (2018). How full disclosure of clinical trial data will benefit the pharmaceutical industry. Depression, 14, 49.

Fickweiler, F., Fickweiler, W. and Urbach, E., 2017. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: a systematic review. BMJ open, 7(9), p.e016408.

Flick, U. (2015). Introducing research methodology: A beginner’s guide to doing a research project. Sage.

Hajjar, R., Bassatne, A., Cheaito, M. A., El Dine, R. N., Traboulsy, S., Haddadin, F., … & Akl, E. A. (2017). Characterizing the interaction between physicians, pharmacists and pharmaceutical representatives in a middle-income country: A qualitative study. PloS one, 12(9), e0184662.

Jin, M., 2016. Do consumers really trust their doctors’ suggestions and drugs they prescribe?: the relationship between perceived risk and trust in consumer buying decisions on prescription drugs, and how pharmaceutical companies can improve consumer’s trust through marketing activities in China (Master’s thesis).

Khan, N., Naqvi, A. A., Ahmad, R., Ahmed, F. R., McGarry, K., Fazlani, R. Y., & Ahsan, M. (2016). Perceptions and attitudes of medical sales representatives (MSRs) and prescribers regarding pharmaceutical sales promotion and prescribing practices in Pakistan. Journal of Young Pharmacists, 8(3), 244.

Larkin, I., Ang, D., Steinhart, J., Chao, M., Patterson, M., Sah, S., Wu, T., Schoenbaum, M., Hutchins, D., Brennan, T. and Loewenstein, G., 2017. Association between academic medical center pharmaceutical detailing policies and physician prescribing. Jama, 317(17), pp.1785-1795.

Oral, M., & ÖZÇEL?KAY, G. (2017). Ethical Overview of Pharmaceutical Industry Policies in Turkey from Various Perspectives. Turkish Journal of Pharmaceutical Sciences, 14(3).

Silverman, D. (Ed.). (2016). Qualitative research. Sage.

Skandrani, H., & Sghaier, M. (2016). The dark side of the pharmaceutical industry. Marketing Intelligence & Planning, 34(7), 905-926.

Subedi, M. (2018). Trade in health service: unfair competition of pharmaceutical products in Nepal. In State, Society and Health in Nepal (pp. 170-185). Routledge India.

Zehra, F., Naqvi, A. A., Tasneem, S., Ahmad, R., Ahmad, N., Shamsi, A. Z., … & Khan, G. U. (2017). Brand versus generic dispensing trend for ciprofloxacin 500 mg, levofloxacin 500 mg, and moxifloxacin 400 mg (oral dosage forms) among pharmacies of Karachi, Pakistan. International journal of pharmaceutical investigation, 7(2), 70.

Zetterqvist, A.V., Merlo, J. and Mulinari, S.(2015) Complaints, complainants, and rulings regarding drug promotion in the United Kingdom and Sweden 2004–2012: A quantitative and qualitative study of pharmaceutical Industry self-regulation. PLoS medicine, 12(2), p.e1001785.

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