LCHM Summer 2017 - 29

L C M E D S O C .O R G

In 2012, pharmaceutical companies spent a total
of $27 billion on marketing and of that, $24
billion went to advertising to physicians while
$3 billion was spent on consumer marketing8
(with an increase to $5.4 billion in 20159).
Putting aside the ethical issues of drug company-sponsored meals for a minute, the US and
New Zealand are the only two countries in the
world that allow direct-to-consumer advertising,
a practice that has the potential to compromise
quality medical decision-making and one that
definitely increases costs for the consumer. A
study done in New Zealand showed that when
a patient specifically asked for a medication,
they received it more often than not.10 This in
turn usually results in unnecessarily high costs
for the patient as the medications that they
ask for are expensive brand name drugs that
may not be significantly more effective than
a cheaper alternative. Of course, physicians
have an additional incentive to give into such
patient demands when they are being courted
by the drug companies themselves. Most of
us would like to believe that we are still doing
what is best for the patient, but can we really
be confident in the objectivity of our decisions?
And most importantly, what effect is this having
on our patients? A recent Consumer Reports
study showed that as a result of the increase in
medication prices, many patients are resorting to
unsafe practices such as not filling a prescription
(24%), taking expired medications (17%), and
cutting pills in half (16%).11 Furthermore, when
patients do get their medications, they often
have to cut expenditures elsewhere, such as not
paying other bills, groceries, and entertainment.
Ultimately, this also comes back to hurt our
economy if people are spending less money,
especially since almost 60% of Americans take
at least one prescription drug.12 Thus, fulfilling
the obligation to put patient needs first benefits
society as a whole.
What exceptions exist to
this obligation?
I understand that pharmaceutical companies
are a business and profits are what drive people
to enter the field and do the innovative work in
the first place. Dr. Wayne Riley, immediate past
president of the ACP, said it best when he said:
"Pharma has a right to make a profit," however,
transparency about the drug pricing practices is
also a "moral obligation," especially as pharma

takes advantage of government-funded research. of our voices, especially when we stand together.
"The American taxpayer has been providing the Sitting silently on the side while our patients
venture capital to fund their products," Riley suffer is no longer an option.
says. "The public deserves to realize a return
on that investment in the form of medications Aleesha Shaik is a rising fourth year medical student
they can afford."13
at Drexel University College of Medicine. She will
be completing her MPH in 2018 at the Harvard
From a business philosophy perspective, T.H. Chan School of Public Health.
Edward Freeman's stakeholder theory emphasizes
two points: that a business's obligation is to create
value (as opposed to simply profit) and that Resources
the success of a company is dependent on its 1 Lorenzetti, Laura. This 62-year-old drug just got 5,000% more
expensive. 21 September 2015. .
customers, suppliers, employees, communities, 2 Rockoff, Jonathan D. Mylan Faces Scrutiny Over EpiPen
and financiers.14 In order for a business to remain Price Increases. 24 August 2016. .
satisfied and be allowed to have a voice. When 3 Our Values. n.d. .
4 About Us. n.d. .

While it is understandable that pharma wants
to make some profit, it is inexcusable that, in
2013, they were tied with banks for the highest
average profit margin, 19%, and that the CEO of
Mylan made a salary of $25.82 million in 2014
while people struggled to purchase life-saving
EpiPens.15 I don't know if it's possible to draw
a definitive line for profit margins, salaries, or
even drug prices, but at some point we collectively need to hold pharmaceutical companies
accountable on behalf of our patients and say
enough is enough.
Throughout my medical education, especially
now that I have started my clinical years, I have
personally witnessed numerous patients overtly
informing physicians that they cannot afford to
take a certain medication, either because they are
uninsured or because it is not covered by their
policy, despite the medication being the most
effective for their condition. Countless more
are probably too embarrassed to confide their
financial troubles to their physicians and so just
fail to get their prescription filled. When we talk
about pharma's moral obligation, we must also
realize that our moral obligation as physicians
is inextricably tied to theirs. We are one of the
stakeholders, often more powerful ones than our
patients. There is much we can do legislatively
to terminate unethical, but legal, practices that
pharmaceutical companies employ to maximize
profits. But first, we must recognize the power

5 Johnson, Carolyn. These researchers think they have a solution
to the global crisis in drug prices. 4 November 2016. .
6 Health Expenditures. 7 October 2016. .
7 Swanson, Ana. Big pharmaceutical companies are spending
far more on marketing than research. 11 February 2015.
8 Persuading the Prescribers: Pharmaceutical Industry Marketing and its Influence on Physicians and
Patients. 11 November 2013. .
9 Knoer, Scott. How to Stop Immoral Drug Price Increases. 7 September 2016. .
10 Humphreys, Gary. Direct-to-consumer advertising
under fire. August 2009. .
11 Are you paying more for your Rx meds? 13 August 2015.
12 Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL.
Trends in Prescription Drug Use Among Adults in the United
States From 1999-2012. JAMA. 2015;314(17):1818-1830.
13 Is There a Cure for High Drug Prices? 29 July 2016. .
14 R. Edward Freeman, "Managing for Stakeholders." In
Ethical Theory and Business 8th Edition, edited by Tom L.
Beauchamp, Norman E. Bowie, and Denis G. Arnold (New
Jersey: Pearson, 2009), 56.
15 Gibney, Michael. Heather Bresch, Mylan. n.d. .

SUMMER 2017 | Lehigh County Health & Medicine 29

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Table of Contents for the Digital Edition of LCHM Summer 2017

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