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Markkula Center for Applied Ethics

Drug Pushers

The Ethics of Pharmaceutical Marketing

Peggy Connolly, Ruth Ann Althaus, Robert Boyd Skipper

Pharmaceutical companies spend billions of dollars annually to research, develop, and market drugs. According to the Pew Charitable Trust, the pharmaceutical industry spent over $27 billion on marketing alone in 2012, with $24 billion of that devoted to marketing to physicians. The Economist (3/2/13) reported a Deloitte survey showing that 35 percent of doctors accept food, entertainment, or travel from the pharmaceutical industry, and 16 percent accept consulting or speaking fees. The Accreditation Council for Continuing Medical Education reports that pharmaceutical and medical device companies sponsored almost one-third of continuing medical education (CME) opportunities for doctors in 2011.

Observers worry about whether physicians can be objective in selecting and prescribing drugs when they are plied with free samples, gifts, speaking and consulting fees, and free CME. PewHealth reports that distribution of a sample drug results in doctors prescribing that specific drug more often. Drug costs for patients who receive a sample are higher because doctors tend to prescribe that drug instead of a less expensive generic once the sample is used up. Further, most samples are given to insured patients, rather than to those in need, as the industry claims. Critics also worry that persuasive and persistent sales representatives (who are not trained in medicine) have highly sophisticated marketing techniques and strong financial motivation to sell their company's drugs. The Pharmedout project of Georgetown University Medical Center reports that 16 percent of doctors change their prescribing practices after one minute with a sales rep and 52 percent change after three minutes. Doctors' insistent denials of being influenced by drug reps are belied by the success of the industry's marketing efforts.

Given the complexity and ever-changing nature of medicine, some experts assert that information doctors gain from pharmaceutical companies' efforts is valuable enough to outweigh the documented higher cost to consumers and the possibility of bias in doctors' prescribing habits.

A number of health systems, including the Veterans Administration, have prohibited visits by drug reps and financial relationships between doctors and the pharmaceutical industry. The Affordable Care Act (commonly referred to as Obamacare) includes a "Physician Payment Sunshine" provision requiring doctors and hospitals to reveal all financial relationships they have with the pharmaceutical industry. Some critics of pharmaceutical marketing tactics believe even stronger limitations should be imposed.

The Intercollegiate Ethics Bowlsm cases are published by The American Association for Practical and Professional Ethics and may be used only with permission. For further information contact: APPE, Tel: (812) 855-6450; E-mail:

May 1, 2015