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On the undue influence of pharmaceutical companies


At the end of this past year, Gov. Gretchen Whitmer signed a piece of bipartisan legislation, SB 410, aiming to hold drug companies accountable for cases of wrongdoing. 

“By fighting for consumers, we will also ensure that companies doing good work can outcompete and outperform companies that prioritize padding their profits over delivering quality products for people,” Whitmer said, according to a recent press release

A previous Michigan Daily article indicated that SB 410 was an interesting bill to watch, especially considering the 19 unsuccessful attempts to overturn the original 1995 drug immunity law. Lawmakers and advocates have been vocal in expressing that Michiganders should have the right to receive justice in cases of harm caused by drug manufacturers. Michigan was the only state in the nation — before the passage of Senate Bill 410 sponsored by state Sen. Jeff Irwin, D-Ann Arbor — that prevented state lawsuits against drug manufacturers. For many years, pharmaceutical companies have exhibited undue influence on medicine and the lives of many Michigan residents — this new legislation must be acted upon. 

The University of Michigan itself is no stranger to relationships with the pharmaceutical industry. In 2008, it negotiated with Pfizer to repurchase the land for its former Ann Arbor site and convert it to the present-day North Campus Research Complex. It has formal and informal partnerships with several pharmaceutical companies, including the Sun Pharma Advanced Research Company, Thermo Fisher  and Johnson & Johnson. According to U.S. News & World Report, the University is also home to the third-best pharmacy school in the nation; robust partnerships — especially in the realm of research and direct student recruitment for employment — are critical to this success. 

Pharmaceutical company interest advocacy often happens behind closed doors. It is no surprise that the average person knows little about the flow of money between health insurance carriers, pharmaceutical companies, political lobbies, consulting conglomerates and pharmacy benefit managers. What they might know, however, is that the United States spends more than $600 billion per year on pharmaceutical expenditures. Despite this high spending, three out of every 10 U.S. adults taking prescription drugs have stated they are unable to take their medication as prescribed due to cost. 

One way in which pharmaceutical companies influence physician prescribing and patient purchasing habits is through drug samples and direct-to-consumer. In 2016, pharmaceutical companies invested nearly $13.5 billion into free sample distribution throughout the United States. While physicians may strive to educate and empower patients to make informed decisions, pharmaceutical influences cloud this goal through company-provided free drug samples. Physicians may provide patients samples for more expensive drugs, thus marketing those drugs to them. Free drug samples are a type of promotional tool that shapes, consciously and unconsciously, the decisions of providers and patients. Many pharmaceutical representatives distribute samples during face-to-face visits known as pharmaceutical detailing, to encourage physicians to prescribe specific drugs. 

Coupled with drug samples, many pharmaceutical companies also invest in direct-to-consumer marketing through drug advertisements, an approach that has been met with mixed reviews. Proponents of DTC drug advertising suggest that they increase patient education of treatments they may be unaware of, raise awareness for conditions and potentially lessen stigma for seeking treatment. However, DTC ads may introduce biased information, promote medications that may not be safe in the long-run and drive up health care costs. Most importantly, many patients are not aware of the extent to which DTC ads may be impacting their health care decisions. 

However, there have been recent and promising steps in the right direction. After the introduction of the Physician Payments Sunshine Act in 2010 and the OpenPayments system, there is now more transparency in relationships between health care providers and the pharmaceutical industry. Anyone, at any time, can search a provider’s name on the OpenPayments database site and see whether they have received funding in the form of gifts, speaking engagements, research grants and other categories.

There are also several initiatives aimed at tackling this pressing issue. The American Medical Student Association’s PharmFree committee publishes research examining conflict of interest policies, pharmaceutical company influence and impacts on medical education. This committee’s previous publications catalyzed the revisions of many conflict of interest policies at U.S. Medical schools. The most recent assessment of these policies was published in 2016, so it is critical that an updated version of this work is published. 

Patients, including the many students on campus who take prescription medications, should be able to know what their rights are and whether or not their medical advice is thorough and unbiased. Several of the major pharmaceutical companies operating in the U.S. have been immersed in controversy regarding unethical practices and their attempts to exert influence over healthcare providers, institutions, direct-to-consumer content and even the political arena. This controversy can and will only cease to exist as legislation, coupled with awareness, continues to be at the forefront of our state and national agenda.

 Magda Wojtara is a graduate student and can be reached at wojtaram@umich.edu



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