by Sunita Sah and Adriane Fugh-BermanJournal of Law, Medicine and Ethics. 2013 14:–
Pharmaceutical and medical device companies apply social psychology to influence physicians’ prescribing behavior and decision-making. Physicians fail to recognize their vulnerability to commercial influences; due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias. Six principles of influence — reciprocation, commitment, social proof, liking, authority, and scarcity — are key to the industry’s routine marketing strategies, which rely on the illusion that the industry is a generous avuncular partner to physicians. In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias, and have both the motivation and means to resist industry influence. A culture in which accepting industry gifts engenders shame, rather than gratitude, will reduce conflicts of interest. If greater academic prestige accrues to distant, rather than close relationships with industry, a new social norm may emerge that promotes patient care and scientific integrity. In addition to educating faculty and students about the social psychology underlying sophisticated, but potentially manipulative marketing and about how to resist it, academic medical institutions should develop strong organizational policies to counteract the medical profession’s improper dependence on industry.
Dr. Adriane Fugh-Berman of Georgetown University is one of the good guys. Her web-site and project, PharmedOut, is a strong force working towards reform of the Pharma influence in Medicine, a particular resource for industry-free CME programs. This article makes some strong points about the susceptibility of physicians to PHARMA marketing techniques. And suggests some well informed policies about how academic medical institutions might approach making the needed changes. So if I’m so taken with what they have to say, what can I add to that? Admittedly, I’m a psychiatrist looking primarily at my own specialty, so my perspective might be skewed. I think the people they are advising on how to solve the problem are, in fact, the source of the problem. I would see this as a top-down problem, not a bottom-up problem. The academic medical institutions, the medical school administration, and the chairmen of the departments are the center of this mess, not its solution – those in need of reform, not the reformers. At least that’s true in psychiatry and to a lesser extent, it’s a factor in the rest of medicine I’d wager.
Back in the lead-into the 1980 revolution in psychiatry, there was a firestorm swirling around every corner. I won’t even list them because just the ones you know about are enough to paint the picture. But there was one that you may not have on your list. Academic psychiatry was broke. Medical departments mostly support themselves, and all of psychiatry’s resources dried up. Hospitals were closing almost daily. Third Party payers were cutting psychiatric reimbursement, in part because they could. Public funding was quickly evaporating from both State and Federal resources. The rest of medicine had ways to support itself, but we didn’t. So when I say broke, I mean flat broke. In fact, one of the forces driving the medicalization of psychiatry appears to have been a need to insure that third party reimbursement didn’t disappear altogether.
The solution to the funding of academic departments in psychiatry was funding from Pharma. The departments desperately needed support. Pharma needed academicians to author articles, be PIs for Clinical Trials, act as KOLs, etc. The trajectory of things moved in an unspoken straight line as the years passed, and the academic-industrial complex emerged in its current form by the late 1980s – a prelude to the Decade of the Brain. Medical Institution Administrators may speak in lofty terms, but when there’s a Chairman search, they go for the candidate that can bring in the dough. So in psychiatry, the pharmaceutical academic relationship felt at times more like a merger than anything else. In that climate, this article is more dream than plan because the higher up you go in psychiatry, the worse it gets eg the President of the APA writes articles like "Time to re-engage with Pharma?" [as if we ever disengaged].