Is Big Pharma influencing your drug choices?

pharma influences

It just may, even and especially if you think it doesn’t. As a doctor, you may have noticed that sales representatives for drug making companies do not visit your office, clinic, or hospital as often as they used to do. In fact, according to a recent article published in the New England Journal of Medicine, those visits have dropped to 55% in 2013 from 77$ in 2008. However, that doesn’t mean they are not pulling the strings anymore; like that movie in which Johnny Depp’s consciousness is uploaded into a computer, pharmaceutical companies have opted for the digital approach.

Going digital can allow them to influence the way you prescribe medications even more so than they could personally. “We do know from traditional marketing tools that their impact can be harmful,” article author Dr. Christopher Manz from the University of Pennsylvania said. “But this digital marketing today has much more breadth and depth than the previous kinds of marketing. Now it's like having a sales rep in the exam room with you.” Electronic health records (EHR), and social media and medical apps are three new methods available to Big Pharma to sway your prescribing decisions.

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·         Electronic health records. They are the flagship of health information technology, allowing you to store, access, and share your patients’ information from anywhere at any time. However, they can also provide drug companies with inside info on your behavior and the demographics of your patients. “EHRs are digital marketing tools. For decades, companies have been able to tell which drugs I prescribe but with EHRs they can tell when and why I prescribe. This is like personalized marketing aimed at physicians,” Manz said. “Before industry might have just my prescribing data, but now they have data for all my clinical encounters for my whole practice. This advertising can occur at the moment you're making prescribing decisions,” in the form of banner advertisements, e-coupons, and curated drop-down menus. Manz suspects this may lead to over-prescription.

·         Social media apps. Healthcare practitioner-oriented social media networks allow you to be up to date on the most recent health news as well as connect with fellow providers. But they also are recruitment sites for key opinion leaders and focus groups. Other ways drug companies use these networks include sponsored discussion forums and targeted advertisements. “One recent example was an 'Alzheimer's Challenge' that allowed physicians to read through clinical trial data (in a format similar to print journal advertisements) for a brand-name medication and answer questions about its indications to earn points redeemable for cash,” Manz wrote about one of these social media hubs called Sermo. Even traditional social media is not safe. Pharma companies uses technology such as Peerin, which monitors Twitter to develop interaction maps that show how doctors connect, who starts viral conversations, and who responds to those conversations.

·         Medical apps. You may have heard about Epocrates, a company that develops free smartphone applications for physicians. You may even use some of those apps, which allow you to research drug dosing information in seconds. Every time you do that, however, the information is sent to drug firms which in turn target ads at you based on your profile and past searches. “Few physicians know that every time they look something up on Epocrates, information gets sent back to a pharma vendor,” associate professor of medicine at Georgetown University Dr. Adriane Fugh-Berman said. “All of this information is used to sell specific drugs that may not be the best drugs for patients. Affecting information flow is pharma's best covert strategy.”  

To make matters worse, regulations seem to be one step behind Big Pharma. For instance, the Sunshine law was passed in 2010 requiring that every pharmaceutical and medical device company in the reveal payments of at least $10 made to doctors and teaching hospitals for a variety of activities. In the meantime, though, drug companies made the digital leap. “In the back of your mind, there's a concern that if you shed some light on one aspect of pharma marketing, that there will be ways, people will try to skirt or game the system to try to avoid the sunshine,” associate professor of medicine at Harvard Medical School Dr. Aaron Kesselheim told

There is reason to worry, too. “Drugs have risks and they have harms and they interact with other drugs. And one doesn't want to be on more drugs than are needed. Pharma companies control the discourse on drugs and diseases in both the medical and consumer communities,” Fugh-Berman said. “This means that health-care providers don't know about non-pharmacologic therapies, doctors over-treat, and that they are much better versed on the benefits of drugs than they are on the harms.”

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