Our speaker on January 7 was Dr. Eike-Henner Kluge on the topic of “Physicians and the Pharmaceutical Industry”.
Dr. Kluge spoke to us about the close relationship between the pharmaceutical industry and physicians, with an emphasis on the distinct ethical obligations of each. From his perspective, as a professor specializing in applied biomedical ethics and health information, Dr. Kluge explained the obligations of each party. A drug company is a corporation with a primary duty to maximize shareholder’s investment (i.e., make a profit). A physician is a health care provider with a primary responsibility to provide appropriate care for patients. When these two differing goals collide vigilance is required to maintain “best practice,” because even innocuous incentives can lead to conflicts of interest, affecting health outcomes.
Examples where ethical questions arise are:
- Drug companies providing free samples to doctors: Does this affect prescribing behaviour?
- Drug companies providing physician-gifts in the form of free trips to conferences, dinners, etc.: Do physicians feel obliged to reciprocate the kindness by prescribing drugs manufactured by the drug company?
- Drugs are developed to make a profit: Should governments fund orphan drugs or vital drugs (such as vaccines) to ensure drug availability for the public?
- Access to drugs: Should drug companies have an obligation to provide affordable drugs to low income countries?
- Advertising of drugs: If drug companies advertise (prescription) drugs directly to the Canadian public (as in the United States), will it pressure physicians to prescribe a drug to please a patient, even though it might not be the most appropriate treatment?
Dr. Kluge also expanded his discussion to include society’s ethical obligation to protect people. This includes “Health Canada,” our federal department responsible for the health of Canadians, which ensures drugs are “fit for their purpose.” After reviewing safety and efficacy data to ensure they are fit for the purpose they are designed for, drugs are licensed for sale. As a society, our obligation is to be aware of best ethical practices at both the government level and at the physician/pharmaceutical interface.
Dr. Kluge provided a broad overview of a complex topic, so there were several questions at the end and, no doubt, some spirited arguments between members afterwards. Some of the questions we asked were whether or not Purdue Pharma (the makers of Oxycontin) misled physicians or whether physicians were just poor gatekeepers; can physicians (i.e., ophthalmologists) prescribe a drug solely available through that physician; addictiveness of opioid drugs when taken for (long-term) pain control; etc.
As Dr. Kluge cautions us regarding the pharmaceutical industry/physician interface, “it takes two to tango.”
If you would like to explore some of the references Dr Kluge used as a basis for his key points, click here.