Extensively, and more so than most people, including practitioners, realize. The pharmaceutical companies have a financial interest in seeing their drugs prescribed. These are for-profit corporations that invest heavily in bringing a new medication to the market; it’s estimated that the cost of developing a new drug is between $100 million to $800 million.
To insure profitability, the drug companies market extensively to physicians and, more recently, the general public through television and other forms of direct-to-the-consumer advertisement. In addition, the drug companies sponsor numerous events, often under the guise of providing continuing medical education (CMEs). Up until the federal government began to scrutinize some of these practices, it was common for drug companies to sponsor “educational” cruises, trips, and other expensive promotions for physicians and their spouses.
While the rules on what drug companies can offer to prescribers have become increasingly stringent thanks to the Office of the Inspector General (OIG), there are still an incredible number of free dinners, lunches, and tickets to sporting and cultural events and sponsored symposia, where speakers, paid for by the drug company, will present material often prepared by the drug company. Many universities, healthcare organizations, and state agencies are drafting, or have implemented, ethics policies to put caps on what can be accepted from the drug companies.
This is just the tip of the iceberg. Most professional journals are indirectly funded by the pharmaceutical companies, often in the form of multipage advertisements. When you read the articles in those journals, it’s clear that the bulk of new research is funded by the pharmaceutical industry. The influence doesn’t stop there, and recent court cases have brought to light disturbing practices wherein results of entire studies have been suppressed because they did not support a particular medication’s usefulness. To address this practice, new guidelines for research have gone into effect, requiring that all drug studies be registered and the results be made available. Additionally, all professional authors and speakers must disclose any/all financial ties to pharmaceutical companies.
Another factor that influences prescribing patterns has to do with not just what is being aggressively marketed and promoted, but what is not. Drugs that are no longer under protection of patent (a patent generally runs out after twenty years) are less likely to be funded for study and promoted. In bipolar disorder this raises interesting questions regarding older medications, such as lithium and the first generation of antipsychotic medications. Lithium in particular has an extensive literature with proven benefits, yet its use has been declining in recent years to where many new trainees no longer view it as a first-line strategy in bipolar disorder, opting instead for newer and less fully understood treatments.
Finally, most pharmaceutical companies provide physicians with free samples of newer medications to give to their patients. On the surface this appears to be a win-win-win situation. But again, if there are two, or more, drugs of equal merit and you don’t have free samples of both (and no one is giving away samples of older and off patent medications) then it’s more likely that the newer and more costly medication will be the one prescribed.