Take a look at this article that expands our discussion from last week into territory beyond samples.
Where should healthcare providers draw the line? Is it where we recognize that there may be a conflict of interest? Or is it where our patients perceive that we may have a conflict?
What
do you think of the article's stance? Should all gifts, no matter how
small, be denied to providers? Should this be an individual decision,
or should it be an organizational or institutional policy?
In what situations should we be required to declare a potential conflict of interest, and to whom should we declare them?
39 comments:
The tone of the article is very cold, condescending, unrealistic, and does not seek a middle ground. The article says that the goal is to better the care of the patient. However, the article only offers one very stringent solution. The article basically says that there needs to be an institution which polices the relationships of drug companies to doctors and medical schools. While I do believe that it is important for a doctor not to be too bias toward a certain drug, I also believe that it is important for doctors and drug companies to have good relationships so that the doctor can be educated about certain drugs. If there are no relationships between doctors and drug companies then there will not be the level of communication between doctors and drug companies, and the drug companies may not receive the feedback about their products that they would vs. if that relationship was there. I also do not like the fact that the people who wrote this article want to set up an institution to control the funding to medical programs and to doctors. They are basically taking away the free enterprise system and making all the decisions if they do this. Who is to say the institution, which they speak of in the article, cannot be swayed by bias? In conclusion, yes there may be some bias as to which drugs doctors use and med schools may be affected as well. However, bias is human nature to a certain extent. I don't want doctors to become automatons. I want doctors to have some human qualities to them, especially if they are examining me. In the end, developing an institution to distribute funds to doctors and medical schools will do more harm than good to the profession, and may indeed push some doctors to become more robot-like, and lose their empathy.
Joseph Helms
WUSOP Doctor of Pharmacy Candidate 2017
As I read the article, I began to question the objectivity of the study. They are expecting a problem and unsurprisingly find one. I would call this a witch hunt.
They show that physicians who attend events, accepted samples, ect have been more likely to request drugs be added to the formularies and increase prescription. Is this a result of reciprocity or just awareness. The companies need physicians to be aware of their new products, and they will do so in a way that is most effective. That there is a response could just be properly pitching their product. We are all busy and they need to get our attention, otherwise we may never take the time to learn about their product. That they give an incentive to get us to learn is not a surprise, there is always some incentive that drives us to learn. Why for instance are in pharmacy school at the moment.
There is of course, need for regulation because there is incentive and no doubt some corruption, but stopping all such practices seems extreme and I think counterproductive to the flow of information on new drugs.
Ben Roseberry
Doctor of Pharmacy Candidate
WUSOP 2017
Healthcare providers should draw the line if they feel their practice and patients may be compromised. I don’t think there is anything wrong with learning about a new drug, even if it is being paid for by a rep, as long as the doctor stays unbiased and truly pays attention to the content he is learning. Of course the pharmaceutical company is trying to sell to you, but is the drug something you really see as helpful to your practice and patients? Doctors need to recognize when there is a conflict of interest within themselves AND to their patients. Most people enter the health field because their main goal is to help the lives of other people…money should not blind health professionals to this. Unfortunately, it does happen.
I think the article’s stance is a little dramatic. They say regulation should prohibit everything, like gifts and drug samples. I can understand where they are coming from, but America is a country of business no matter where you go. Companies and businesses are always trying to have a leg up on one another. Even within the health field it is a business; pharmacies and doctor’s offices are always competing to be better than the other, trying to get patients to go to theirs. I wish it would be easy enough for individuals to be able to decide if they want to accept a gift and keep it from getting out of control once the money starts rolling in. I don’t think this should be an organizational policy because it would be too cumbersome to regulate. Plus, new drug companies are trying to get their product heard just as a new doctor’s office is trying to get heard of. Who knows, the drug may prove to be more beneficial than anything that is already out there.
Employees who work within an office and believe there is a potential conflict of interest should be able to report the issue, and I would assume to the board that certified the doctors, because they may potentially be harming patients. There would have to be something implemented to make the process organized, so that all reports are read, checked up on, and even possibly followed up with if there are warnings/recommendations to a provider. But hey, what do I know.
I believe a line should be drawn once the health provider is starting to form a true friendship with the drug representative. I believe it is then that bias can occur and doctors may start pushing drugs on patients to help their "friend" instead of doing what is best for the patient. I think the article was very over-the-top with their stance and the idea that the drug companies should be closely monitored. I do agree that these relationships should be watched in the sense that if a doctor is over-prescribing a drug it should be looked into but I don't think it should be tightly regulated. I think that drug representatives offer the opportunity for doctors to learn about new drugs and personally I don't think gifts such as a Starbuck's coffee or Panera sandwich is going to change the doctor's mind on doing what is best for the patient.
I think it should be the individual's decision whether or not they want to deny the gifts. Healthcare providers are individuals that know right from wrong and drug representatives should have their right to use some sort of tactics to get the provider's attention. However, I do agree with Tricia that these things should be reported if an employee or fellow healthcare provider notices a potential conflict of interest.
Whitney C. Smith
Wingate University School of Pharmacy
Doctor of Pharmacy Candidate, Class of 2017
I have to agree with Whitney and what she said. I think there should be a line drawn. If there is a really close relationship with the drug rep and the doctor, I do not think that the patient would be the one to benefit. The doctor will try to help the drug rep in any way possible and not be thinking about the patient at all. I do think that drug reps should be monitor. The question is where do you draw the line though. The rep needs to earn the trust of the doctors but needs to know where to draw that line. The health care providers should use their best judgment and think of the patient first and know what is best. The bribes that the drug reps do should not affect the doctors opinion. The gifts will not make him use the drugs if it is not in the best interest. The rep should not be trying to get their attention in that way. There are better ways. I also agree with Tricia that the healthcare providers should report if they suspect any suspicious activity.
Rebecca Giannetti
Wingate University School of Pharmacy
Doctor of Pharmacy Candidate, Class of 2017
Healthcare providers should draw the line when they sense it is becoming a detriment to their patients and their credibility. Learning about new drugs is essential to the medical field advancing. This article is correct in that some physicians are blinded by the money aspect of the health field and there are usually other reasons for this. However, I do not think that there needs to be a regulatory institution set up to monitor all doctor - pharmaceutical company interactions. This would lead to too much control. While I do believe in a checks and balances system, I think that this article is taking too much control from doctors and pharmaceutical companies.
I tend to get tired of reading articles that have strong one sided stances like this because they are very dramatic and assume people cannot make decisions for themselves (as a whole). I think articles like have a tone of "we know what's better for you than you do". That being said, I would draw the line if the relationship became unprofessional, for example if I became friends with the rep or if alternative motives could become a factor in my decision making.
Jacob Gibson
WUSOP
PharmD candidate 2017
Physicians should draw the line between patient’s wellness and personal gain. There are healthcare providers that would only prescribe a certain medication that they would get some sort of personal gain, but sometimes those medications are actually the best one for the patients. I believe that there is nothing wrong with receiving incentive for prescribing a drug that actually works and will improve the patient’s daily life. Of course there are prescribers that should be frown upon for exploiting this opportunity for personal gain. We have been thinking like the government that wants to regulate everything, but if we think as pharmacists in which we will be, then wouldn’t you want the drug that you spent years of research to reach the patients. I believe that all of the medications that are new to the market should have the chance to advertise and showcase their drugs which can or cannot benefit people’s lives. For the students that love research like myself, I would want the drug that I contribute in the process of making that drug successful to reach the patient’s hand, and the only way to do that is through advertising and educating the physician. If nobody knows about the drug, then it would have been just a waste of resources and efforts in manufacturing it.
The article actually shows a lot of good guidelines and I agree with some of them. I agree with gifting should be regulated and all payments should be prohibited, but that would be up to the manufacture in the decision making. I like the idea of replacing pharmaceutical samples to a system of vouchers for low-income patients. Samples provide company representatives and that is the best way to advertise a new drug.
Jacqueline Luu
WUSOP 2017
In a agreement with a few of my classmates, I do not think that placing tight regulations on the drug companies will be beneficial. They are using sales tactics that any other sales representative would use, therefore the same norms should apply. This is not to say that the situation could not arise where there is an unprofessional relationship between a doctor and a drug company, but just looking for red flags and knowing some of the normal signs of bias should be sufficient in avoiding this problem. As Whitney said, all of the players in this situation are professionals, so the majority of them will handle the situation with integrity.
Kristen Doster
WUSOP Doctor of Pharmacy Candidate 2017
The article provides some data on why and how small gifts can in the end influence big decisions. At the same time I don’t think that all gifts should be denied to providers and even if there was a restriction of gifts I don’t think anyone would really follow through abiding the law about something so miniscule. I think accepting of denying gifts should be an individual decision. There are bigger problems that organizations can deal with than the topic of placing restrictions on presents. The article is a bit too strict and biased I think. Healthcare providers should consider if patients are being compromised. It is good that physicians learn a bit about possible new drugs through drug representative but they shouldn’t be influenced by incentives such as money or presents to use the drug and prescribe it.
Pooja Duggaraju
WUSOP Doctor of Pharmacy Candidate 2017
I believe there comes a point where a line must be drawn if a conflict of interest is occurring. It is one thing to know and be friends with drug reps, but it is another to sacrifice your patient's health in order to benefit a friend or drug company. Many drug reps are marketing brand name, expensive drugs that your general population cannot afford. Many of these medications have alternative drugs with generics that would work just as well for a patient and cost them much less. So, unless this drug is the only thing that works for a patient or they have great prescription coverage or a discount card from the manufacturer, an alternative would probably be in the patient's best interest. It may not be in the best interest of the drug rep, but our concern should be our patient. That is where the line must be drawn.
Drug reps are salesmen and make their living off of doctor and pharmacy calls, but I do believe there should be limitations on their relationships with healthcare providers. Most pharmacies will speak with drug reps, but many are not allowed by company policies to accept gifts. I think this should be the case for physician offices as well. That way it won't seem as if a prescriber writing for a rep's drug is due to any sort of bribery, but because they believe in the usefulness of their drug.
As health care professionals, it is our job to look after the patient and ensure that their needs are met. I totally agree with what Tricia Tran said in that it is good for a physician to learn about a new drug on the market and to even take samples of them back to their office. However, it is completely wrong when the physician allows this to effect what drug he prescribes to a particular patient. If the new drug will truly benefit the patient and help their problem, then by all means I do believe that the doctor should prescribe that medicine. On the other hand, if a drug that is cheaper will be just as effective then I do believe that the doctor should prescribe the cheaper one. I think that it is sad that doctors would allow gifts to sway their opinion on which drug a doctor will prescribe. I also believe that the amount of money that drug companies spend on physician related gifts and incentives is extremely sad. The amount of people in the world who can't afford their medicine is tremendous. It would be nice to see drug companies put forth a little bit of that money towards helping the consumers rather then persuading the doctors to prescribe that medication.
Amanda Bradsher
WUSOP Doctor of Pharmacy Candidate 2017
After reading the article, I feel that healthcare providers should draw the line when they are no longer practicing patient-centered healthcare. The main role of healthcare professionals should be to improve the patient's quality of life. I believe that it is fine for pharmaceutical companies to come out and promote their product because this may be a product that the health care professional is not aware about. I think that it becomes a problem when the healthcare professional falls into the trap and starts to only prescribe the medications that the drug represents comes out to promote. It also becomes a problem when the patient is not the reason for why you choose to prescribe a certain medication, but rather you prescribe it for personal gain. I believe that drug represents will not go away and they will continue to try and bribe healthcare professionals to get there product out. It comes to the integrity of the healthcare professional and making sure they are practicing medicine to improve the quality of life for the patient.
Melissa Janis
WUSOP Doctor of Pharmacy Candidate 2017
I feel that as humans we do participate in "profit-seeking behavior." The fact of the matter is we typically do things for gain. It is simply motivational. In the field of health I believe these notions should be avoided and the patient's benefit should be top priority. It is not commendable to be in a medical profession for selfish reasons. Most would say they are in the profession to help others. Obviously that is not always true. Yet, this article does not appear extremely credible. Prescribers should retain with benefiting the health of their patient rather than seeking personal gain via gifts and monetary profit to promote a product. Therefore prescribing should depend on knowledge of the patient and not promoting profit gaining drugs.
Monica White
WUSOP 2017
All gifts should not be denied, no matter how big or small. But some gifts, depending on how big or small, should be denied by providers. All samples should be accepted. Samples help patients. Samples are beneficial to both the provider and the patient. A patient does not have to waste money on a prescription that doesn't work. Instead they can try out a medication through the sample, then if it is effective, they can buy the full prescription. If you cut out gifts completely, this process of trial and error (leading to purchase of the prescription) would not be possible. Big gifts that do not pertain to samples should not always be accepted by providers. For example, materialistic items used for bribery should be denied. A provider should not be bribed by the drug rep to then go bribe the patient or manipulate the patient to choose this particular drug. This should be an individual decision. A conflict of interest should be declared to the institution when the patient's best interest is compromised for bribery.
I believe healthcare providers should draw the line when it doesn’t affect the patient in a positive manner. If the drug doesn’t help the patient, even though the drug rep has a great relationship with the doctor, then I believe the physician should step up and discontinue the drug use. The patient is the focus in the whole situation, so their health is the main focus. Once there is a conflict of interest that does not benefit the patient then the physician should step in. I believe that gifts shouldn’t be allowed. These monetary factors shouldn’t the be reason why a physician prescribes a drug. The physician should prescribe the drug if it actually has benefits and can treat the patient. I believe the hospital can regulate this policy, since it might be too board for the government to handle. I believe that the line should be drawn once in the work place. If a physician and drug rep are friends then it should be outside of the healthcare system. This brings up the idea of being professional.
Chris Chu
WUSOP
After reading this article, I do believe that gifts to the physicians should be eliminated altogether. In my opinion I believe that there is a huge conflict of interest in this type of practice because basically the amount sample medications and incentives given out are based upon how good the “gifts” are to the physicians. The main concern of the physicians should be providing the best care to their patients and endorse sample medications without the incentives of be given something in return.
I agree with the articles stance on how studies have proven that when given incentives, the profitable margins have gone up. As we are all human, and there would be a bias toward a drug representative after given a gift in return for using their samples. If physicians were to develop biases then I believe that some medications will be pushed onto patients even though they may not necessarily need it. This may not always be the case with all providers, but then again we cannot account for everyone.
There is a grey area within this particular study and practice of incentives given in response of prescribing the certain pharmaceutical companies medications. This grey area makes it harder to make an executive decision about what to do, but if the gifts were eliminated in the beginning then this unknown area would cease to exist.
Dustin Webster
WUSOP Doctor of Pharmacy Candidate Class of 2017
Drug reps should make their products known to whoever needs to know and advertise as they must but I do not think they should be giving free gifts in order for their drug to be prescribed. If anybody involved recognizes there is a conflict of interest then the line should be drawn right there. Many gifts given put a pressure on the healthcare provider to make use of their drug and, if they don’t use it, then there could be a problem. Drug reps shouldn’t create this problem in the first place by pressuring people to use their products. Yes, new products can be great, but if they are so great then drug reps should let the drug be prescribed as it needs to be prescribed. It is for the care of the patient, not for their own personal gain in profit—which is what giving gifts is. I think that it is great to give information on their drug but they should not use gifts to sway one’s opinion.
After reading a greater portion of the article I think that gifts should be eliminated all together. But I do believe that corruption will still exist in the field. In some form of informational message or tangible object, a physician will always be exposed to some form of persuasion. It is our professional obligation to make the right choice for "patient centered care' and to initiate a trustworthy relationship with our patients. So in the end a grey area will always exist even if it is not seen by the naked eye, but we must learn to do what is moral and ethical for the community as a whole (based specifically around the health of patients).
Charles Whisnant
WUSOP PharmD Canidate 2017
I think that healthcare providers should draw the line where patients and unbiased, unassociated individuals would determine there to be a conflict of interest. I understand that in order for new medications to be used and promoted drug reps must work to distribute knowledge about the new medication to physicians and other healthcare providers. Yet, I don’t feel that it is appropriate for drug reps to become close friends with physicians and persuade doctors with gifts and bribes. Furthermore, it’s important for doctors to be well educated about new drugs, which is one benefit drug reps provide. I think that drug reps should not offer any sort of special gift that could potentially sway the opinion of the doctor. Moreover, it seems a good idea for institutions to put restrictions on gifts from reps, as well as the relationship between reps and doctors. However, physicians should be altruistic and unbiased, thus allowing them to gain medication education from the drug rep without agreeing to any actions that would be deemed a conflict of interest. The purpose of the drug rep should be educating and advertising drugs on a professional level rather than manipulating physicians. Physicians should not be “pushing for” or prescribing a drug for any reason other than to benefit the patient and achieve optimal health outcomes.
Kimberly Pullium
Doctor of Pharmacy Candidate 2017
WUSOP
I believe it would be very difficult to define exactly what gifts and favors are taking it too far. For now, it is ultimately up to the prescriber what they consider a conflict of interest, but I believe that patients have the right to know if a prescriber has reasons beyond health to choose a certain drug. Although the article states that gifts should be eliminated altogether, I don't really see the harm in giving pens, notepads, etc. to spread the word about a new drug. However, I agree that the extravagant gifts should be eliminated. Pharmaceutical companies should shift their focus from bribing to education. I believe it is very important for prescribers to be educated about new drugs and studies. Pharmaceutical companies can make it easier for prescribers to be aware of new things, and then educate their patients.
Conflict of interest is a gray area, and it would be difficult to regulate and enact new laws. At the very least, prescribers should be trained on how to recognize when there is a conflict of interest, and they should have an easy way to report something that they believe is a conflict of interest.
Mary Parsons
PharmD Candidate
WUSOP Class of 2017
I believe that the line should be drawn when we recognize a conflict of interest. Once the healthcare provider and the drug representative form a relationship, the provider is going to be more willing to help out the drug representative for free gifts, rather than doing what is best for their patients. Drugs should not be forced upon patients when they are not necessary. I think that these drug companies do not necessarily need tighter regulations, but just need to be monitored in order to cut down on bribes and their influences over what physicians prescribe. Drug companies do provide useful information to educate physicians about new drugs, but they should not be providing information and incentives that influence the prescriber to only prescribe that medication, when there is actually another medication that is more beneficial for the patient. The quality of care provided to the patient should not be jeopardized due to receiving gifts, such as coffee and food. I do think that providing samples is a good thing because it can spread awareness about a medication by having people try the medication before actually buying it. The acceptance of gifts should be determined by the individual, because they do have a sense of right and wrong and should be able to make sound judgments. I do agree with several other people in that if a conflict of interest occurs or potentially arises, then it should be reported by whoever witnesses this conflict.
Summer Powell
Doctorate of Pharmacy Candidate
WUSOP Class of 2017
Pharmaceutical manufacturers and medical device companies pursue their profits while they contribute to the patients’ quality of medical service with their own products. Therefore, it is natural for them to maximize their companies’ profits. Public health professionals such as physicians, nurses, and pharmacists also get their incomes through their professions, but their primary interest is for their patients’ benefits. Conflict of interest is necessary and happens all the time in our current health system.
Suggested stringent regulations on gifts, pharmaceutical samples, education, conference travel, and so on, are crucial for protecting patients’ ultimate benefits. Those regulations should be kept and strengthened both at individual and institutional levels. The suggested policy is much beyond individual ethical issue. It should be the organizational policy with more concrete and transparent regulations in order to prevent healthcare providers from being tempted. It will eventually protect healthcare providers as well as give fair competitions among pharmaceutical and medical device manufacturers, enhancing patients’ benefits.
Ae kyung lee
WUSOP Doctor of Pharmacy Candidate 2017
I think that physicians should check themselves once there is some sort of friendship developing between them and the drug rep. I believe that this is where a conflict of interest comes into play. The article was a little extreme with their stance. I don't think that small gifts are that bad of a thing especially if that's a free dinner to learn about a drug. A nice free meal and a learning opportunity doesn't sound that bad at all. I think that this is an individual decision that the doctor should be constantly aware of.
Mitch Speer
I appreciated the article detailing a policy proposal to end health Industry Practices that create conflicts of Interests. What surprises me is that no true ironclad polices are already in place to ensure that patients’ needs and interests are prioritized. In many professions, there are policies, rules and regulations that ensure that customers, in our case patients are not taken advantage of in any way. For instance, in real estate practices, a broker or licensed real estate agent’s license will be suspended if they dared deposit a client’s/ buyer’s down payment into their personal account, even for a few hours. Many agents have had their licenses suspended, even when they didn’t spend or use the money in question.
I believe that the sales reps and pharmaceutical industry realize that their fine-tuned and delicate method of getting the physicians to do their bidding is indeed a conflict of interest. This is the reason their approach is careful and subliminal. They use friendship as a vehicle to pave their way into the minds and hearts of the doctors. This is more dangerous than a clear cut bribe or demand, simply because nothing can be proved. If a sales rep is confronted, they could always feign ignorance passing off their extraordinary overtures of friendship as them having a vivacious personality. I believe it is time that these problems are nipped in a bud, before patients’ rights become truly violated.
Adaobi Obika
WUSOP
Doctor of Pharmacy Candidate
Class of 2017
I do not think that it is right for a physician to be bribed to give their patients a medication. If that is the case, the patients may not be getting the best treatment for them. The physician needs to remain professional and make sure that the health and care of the patients are the number one concern. They do not need to put their wants before the patients’ needs. Big materialistic gifts like trips and different things should not be allowed. It makes it hard for a physician to deny such things when the bribes are that high. I do not see anything wrong with dinners between physicians and drug reps where the drug reps tell the physician about medications.
Courtney Harrell
WUSOP 2017
I agree that there should be a line drawn to distinguish what is appropriate and what is not. When prescribing a medication, a physician should not consider prescribing a specific drug just because they have received a gift from a specific drug rep. They should do what is best for the patient in all circumstances. I feel that it is okay for a drug rep to educate the patients and even the physicians on new drugs. However, that should not be the only way that a physician will learn of the new medications. A relationship between drug reps, pharmacists, and physicians is important. By giving gifts to advertise your drug, you are educating as well as establishing that relationship. However, by giving expensive fancy gifts, the drug rep is implying that they want to persuade the physician to use their product. When you're given a gift, you feel the need to give that person something in return. Therefore, those types of gifts should not be given. The line should be drawn when we see that conflict of interest. When the drug rep is no longer building a relationship or advertising, but they are working to get something in return for their gifts. This is a gray area because it is not easy to interrupt someone else's goals or intentions.
This article points out some problems that can occur based on conflict of interest. The article may be a little excessive, but I can understand their point of view. Drug companies should not be allowed to give extravagant gifts for the sole purpose of influencing a physician to prescribe a specific drug. However, even if gift giving was banned, it would likely happen anyways. Physicians should be competent enough to make a decision on medication based on the best outcome for the patient, not who gives the best gifts. I do not think all gifts should be banned, but I think providers should make reasonable decisions on whether or not they accept gifts. As healthcare providers, we should be making decisions based on reason and knowledge, not influenced by fancy dinners or extravagant presents. I do not think it is a big enough problem to involve an organization that would control the policy. The organization could make rules about it, but unless it is enforced, it would not solve the problem. As long as the patient is getting the best healthcare possible, I do not think it matters whether a provider gets free coffee or a free notepad.
Jordan Richmond
Doctor of Pharmacy Candidate 2017
Wingate University School of Pharmacy
I agree with Tricia. There is nothing wrong with learning about new drugs even if it’s paid for by a representative as long as the physician has the patient’s interest in mind. Healthcare should be patient centered; this means that the wants and needs of the patient should be addressed first. If the new drug can benefit the patient, then the physician should give it; however, if there is another drug that will work just as effective and is less costly, then the physician shouldn’t feel obligated to prescribe the new drug instead. Receiving gifts from sales representative does not pose as a problem. The problem arises when physicians become bias and feel obligated to choose that drug over other drugs. Banning gift giving will not give the wanted result because there is always a loop hole. So I think that it is up to the individual whether or not to accept gifts and it’s up to them to decide whether to keep the patient’s best interest in mind or not.
Sheng Vue
WUSOP
DOPC 2017
As a healthcare provider, we are one of the most trusted people in the US. The public trusts us to have their best interest at heart and to give them the best care that we possibly can. This being said, we should hold ourselves to a standard to where we are always giving our patients the best possible care that we can. As a physician or pharmacist, you should be able to receive gifts from a drug rep and keep in mind that they are simply doing their job, as you are. Your job is to give patients optimum care; their job is to promote a drug. As a healthcare professional, we should recognize that and not be swayed to use a drug just because of incentives from drug reps. If you feel that the gifts given will sway your prescribing or recommending habits, you should not take them. Receiving gifts from a drug rep should be a personal decision and should not interfere with patients’ care. If one sees a conflict of interest, they should just turn down whatever the gift or proposition is. They should be strong enough to do that as a trusted professional in our society. They should not have to report it to someone.
Andrea Huneycutt
Doctor of Pharmacy Candidate
WUSOP Class of 2017
I believe that healthcare professionals should draw the line when they stop practicing patient-centered healthcare. The patient should be the center of healthcare and we as healthcare professionals should aim to improve the patient’s quality of life. I do not think that pharmaceutical representatives should not be banned from giving gifts, dinners, and samples because I do not believe that will happen and even if it does get banned it will still happen under the table. Therefore, I believe that it comes to the integrity of the healthcare professional. I believe there should be somewhere to report suspicious activity if you notice other healthcare professionals around you that are out right only prescribing medications that drug representatives are coming to promote. Then that healthcare professional could be monitored and possibly lose their license from prescribing medicines soley out of self greed. I believe it draws the line when you are not practicing medicine to improve the patient’s life, but rather out of self greed.
Melissa Janis
WUSOP Doctor of Pharmacy Candidate 2017
Gifts provided by pharmaceutical representatives may or may not persuade physicians to accept. Pros of accepting gift is that it gives healthcare provider an opportunity to learn more about new drugs in market, at the same time, cons of accepting gift is that healthcare providers is not only accepting gift, but also accepting the terms and conditions that the representative have set for them. In other words, healthcare providers have to prescribe more drugs that comes from that pharmaceutical industry. Therefore, I believe it should be an individual decision whether to accept it or not. Because if I look at from pharmaceutical industries' side, they are only thinking about what benefits them financially. They do not care about patients, so it is our responsibility as healthcare provider to examine what is right and wrong. In conclusion, I believe there should a line drawn to where they sense it would be detrimental not only to patients' health, but also detrimental to healthcare providers' status and credibility. There should be threshold between the string that connects healthcare providers to both pharmaceutical representatives and patients.
Shruti S. Desai
PharmD Candidate 2017
WUSOP
I believe that there should be regulations to enforce the limitations of giving and receiving gifts. Many gifts, such as medication samples, pens, and notepads can help to advertise the medication, and do not have a major impact on the physician’s support or readiness to prescribe. The gifts that are more extravagant, such as payment for travels or attendance at meetings, continuing educations, or even funding for research could have a major impact on the decision of the physician. This may alter the thinking of the physician to prescribe that medication more often as a “reimbursement” for the gifts even if it is not the best medication for the patient’s condition. The line is difficult to draw in many cases because the gifts can also be more of an educational experience, such as a dinner meeting during which the sales representative informs healthcare providers about the medication.
Maegan Wells
Doctor of Pharmacy Candidate 2017
WUSOP
I do not think that all gifts should be totally banned. I believe that gifts are fine as long as they are not extravagant or expensive gifts (less than ten dollars). This allows an appropriate level of marketing without the pressure of returning the favor; if someone gives you some pens with a drug name on them, then you do not feel the pressure to give them something in return because the pens are not an extravagant item. Also, I believe that things like large dinners with many people can be a good thing because they can be used to educate pharmacists on a certain drug. Overall, I believe that it all comes down to the motives of the drug reps and our responsibility as professionals to our patients. If drug reps are giving gifts expecting something in return, then I think that this is a problem and should be frowned upon. In addition, it is also our responsibility as professionals to look past the incentives and gifts and make the best choice for the benefit of the patient.
Trent Tysinger
WUSOP
Doctor of Pharmacy Candidate 2017
I think that the incentives given by the drug companies are a good way to get their products out there and if the physician chooses to use it then it’s under their digression. I feel that if they companies take the time, money and effort to produce products with the potential to improve healthcare then they should be able to market it however they see fit. Saying that, if it takes using Starbucks coffee or even a free trip to get attention placed on their product then do it. But, going from the incentive part, I think that healthcare providers should not feel pressured to use the products because of this. I think that if they choose to or not, then the marketer of the product is just taking that risk when giving incentives. I think that the article takes a strong stance to eliminating the incentives due to the fact that healthcare may become focused more on the manufactures than on patient care. Even though research shows that persons who receive gifts feel the need to reciprocate the generosity by being obligated to the gift giver, I think that as professionals we have to use our better judgment when making decisions. In spite of the psychological research, I have to disagree with article because ultimately it is the physicians’ decision to use the product or not. The only objection that I would have with this is if the marketing interferes with the care of patients such as interrupting the healthcare providers’ duties. Disrupting health care would definitely be a reason to inhibit the marketing of new products, but I feel that overall, marketing is a great way to not only put new products on the market, but to also educate physicians and other healthcare providers about new medical discoveries. The new products could potentially improve the level of care that they can provide for their patients and they won’t be able to learn about them without the marketing from the developing companies. Also, as long as the healthcare providers still adhere to the ethical and moral responsibilities, the gifts will not interfere with the level of care that they provide for their patients.
I believe it is the individuals’ decision as to whether or not to accept these gifts. It is not wrong to give someone a gift; however, physicians should draw the line between patient’s wellness and personal gain. We talk about healthcare where provides the best quality for patient’s life, so that I think all of the new medications that advertise on the market should have the chance to reach physicians or pharmacists which can benefit patient’s health. If a new drug brings benefit the patient, physician should give it without thinking about receiving gifts from sales representative. On the other hand, I also think about healthcare business, which related to marketing, gaining relationship or advertising. And this is a total different story that is nothing to do with medication regulation. I believe that Healthcare providers have the final decision to draw the line if a conflict of interest arises and it should be declared where the healthcare professional sees fit.
Thuy Nguyen
WUSOP
Doctor of Pharmacy Candidate 2017
I think that free samples and other initiatives should be allowed in the pharmacy. This could be a chance for a patient to try a drug with little or no cost to them. Also, there are discount cards that can be used to save the patient money on their monthly co-pay. The main thing that is negative about this is if the system is abused. An example of this would be if a doctor prescribed a drug for a patient just because they would receive a bonus for doing so. It is a doctor's job and a part of their oath to prescribe what is necessary for the patient to improve their health, not prescribe something that will get them paid. With any initiative system there will be some sort of abuse, but for this I feel like the pros outway the cons. Also, there wouldn't really be a way for them to regulate initiatives. Initiatives are a part of all different types of sales, so why should pharmacy sales be excluded?
Jamie Warren
WUSOP Doctor of Pharmacy Candidate 2017
A gift, however small it may be is always an attempt to gain favor. I don't have a problem with gift giving at all, no matter how big or how small. Medical related gifts, such as free samples are necessary evils,as they allow both the provider and patient to try out a new medication before spending in any money. Having an organization setting up the minimum amount or deciding what providers should or should not take is tantamount to saying healthcare providers have compromised critical thinking as to what constitutes an attempt of bribery. I think it should be left to providers to determine where to draw the lines. We are all in for the patients, and, I, would love to actually see stronger relationship between Pharmacists and Pharmaceutical companies. Let just use our best personal judgement as to what is acceptable rather than caving out to the pressure of an organization. After all, we're all going to be "Doctors," so the decision is our own.
I think that not all gift giving are meant to be reciprocated. Sometimes those gifts are a way for the drug company to advertise their medication and their products. For example, gifts such as the clock on the wall, notepads, writing pads, pens and counting trays are just to raise awareness for the new medication. Although, a pharmacist can recommend medications, the drugs representatives know that a pharmacist doesn’t have much prescribing rights to influence the rate of prescribing a new drug. It is hard for a pharmacist to call a doctor’s office and tell him to switch a generic citalopram to a brand new named brand medication that is not covered by the patient’s insurance. Hence in some of those instances, those gifts have no strings attached.
However, those expensive gifts and holiday packages that are offered by some of the drug companies are to be regulated at least if not banned. These gifts really brings about the question of conflict of interest.
Healthcare providers that feel that they have to ask if a certain activity is questionable should probably just not engage in said activity. Because the perception someone holds is their reality, any time that something appears to be a conflict of interest, to that person, it is. This may sound a bit too careful, but it could possibly save our reputations that are so valuable in today's healthcare field.
Michael Russell
WUSOP Doctor of Pharmacy Candidate 2017
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