Doctors were recently surveyed, and researchers found they are opposed to the idea of centering their practice of prescribing in favor of companies the give them money. However, they still regularly take in big bucks in the form of honoraria, speaking fees, research grants, and other gifts from pharmaceutical and medical device suppliers. Therefore, while it may be against their morals and values, doctors continue to fall prey to the marketing tactics of these companies and are routinely influenced by them.
Psychologists George Loewenstein and Don Moore argued in a 2004 research paper that while people consciously think about their professional obligations, self-interest is “automatic, viscerally compelling and often unconscious.” And, as Sunita Sah of Georgetown University concluded, even if physicians don’t recognize it, those in the pharmaceutical industry understand social psychology and know what works. They understand that reciprocity is a part of human nature, and studies have demonstrated doctors tend to change their practices in order to receive certain incentives.
In fact, conflict of interest is the norm in medicine, research has found. According to a 2007 survey, 94 percent of physicians had some sort of industry ties, and these connections can bias their behavior even if they believe they’re above being influenced. It all comes down to a sense of entitlement. In another study co-authored by Sah and a colleague, doctors were more likely to agree they would accept industry payments when they were reminded of the sacrifices they’ve made — years of medical school, debt incurred, and sleep deprivation when on call.
A study from Boston Medical Center’s Grayken Center for Addiction conducted earlier this year found a link between the perks that drug companies give doctors and opioid prescriptions. Researchers discovered that doctors prescribed an average of nine percent more opioids when they’re offered attractive incentives, showing that money and perks influenced prescribers.
Companies also appeal to physicians’ egos by labeling them as “key opinion leaders.” Sah quotes a psychiatrist, saying, “It strokes your narcissism…The first thing they do is take you to a really nice hotel. And sometimes they pick you up in a limo, and you feel very important, and they have really, really good food.”
In interpreting the findings of other studies conducted to determine whether there is a difference in offering opinions to named individuals rather than to groups, researchers found that in doctor-patient relationships, empathy often guides decision-making. But people have more trouble feeling empathy toward nameless groups. Therefore, doctors tend to be more cautious when offering advice to individuals.
Yet another study showed that there is some hope that doctors can be more principled than advisors in other industries. In a recent study, volunteers were asked to play the role of either doctors or financial advisers and were placed in a situation where they could make money at the expense of advisees. Those who were reminded that they were playing the doctor role gave less selfish advice, and those reminded of their role as financial advisers gave more selfish advice. When the same experiment was carried out with real doctors and financial advisers, Sah said, they got pretty much the same result.
The moral of the story? Perhaps doctors do truly care about the well-being of their patients and feel compelled to provide honest, helpful advice and treat each appropriately. However, drug companies are continually trying to persuade them otherwise and they are still taking the bait, whether they’d like to admit it or not.