Drug Overprescribing by Physicians: Are Marketing Practices or Prescribers to Blame?

The pharmaceutical industry has primarily targeted consumers and physicians through many media platforms. In addition, these companies target physicians by other means to enhance prescribing, including offering physicians’ various incentives including advising and consulting payments, payments as acting on speakers bureaus’ and other meals and travel costs.

Recently, a paper published in JAMA Network Open, discussed how marketing opioids to physicians has resulted in higher opioid prescription death rates. From August 2013 through the end of 2015 shows that pharmaceutical companies spent $39.7 million to marketing opioids including speaker, consulting and other fees. ¹

Based upon the significant increase in deaths from opioid prescriptions over the past 5 years, there has been much attention focused on pharmaceutical companies marketing these products to physicians. However, what about the overprescribing of other drug therapy by physicians? An example is antibiotics. We are all aware of the overprescribing of antibiotics and the significant impact of this practice on drug resistance resulting in an increase in death rates. I assume overprescribing of antibiotics does not have a more immediate impact on saving lives compared to overprescribing of opioids.

A recent story quoted a physician in discussing the overprescribing of opioids. The physician stated “I don’t think this is intentional on the part of doctors. These marketing practices and the effects they exert on doctors is quite subtle. Doctors are only human, and they are subject to the effects of marketing, just like anyone else.” ² Really??? What do you think a physician is going to say about his/her colleagues?  I’m sorry, should physicians be held to a higher standard by upholding ethics and not being swayed by marketing strategies and or financial incentives. Maybe my expectations are set too high.

As Americans we are constantly bombarded by marketing in every aspects of our lives in all social and communication media platforms. However, we CHOOSE to be influenced (financially or otherwise) or simply ignore our ethical obligations to our profession. Maybe physicians should not simply say “we are subject to marketing like anyone else” and hold themselves to a higher standard as they should be.

References

1. Hadland SE et al. Association of pharmaceutical industry marketing of opioid products with mortality from opioid-related overdoses. JAMA Netw Open. 2019;2(1):e186007. doi:10.1001/jamanetworkopen.2018.6007
2. US News and World Report. When opioids are pushed on doctors, death rates rise. https://www.usnews.com/news/healthiest-communities/articles/2019-01-18/marketing-opioids-to-doctors-associated-with-higher-overdose-rates. Accessed January 14, 2019.

Michael J. Cawley, PharmD, RRT, CPFT, FCCM, is a professor of clinical pharmacy at the Philadelphia College of Pharmacy, University of the Sciences. He has more than 25 years of experience practicing in the areas of medical, surgical, trauma, and burn intensive care as both a critical care clinical pharmacist and registered respiratory therapist.

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