Investigative Report

Under the Influence: How Doctors Are Courted By Drugmakers

Prescription-drug companies spend billions of dollars each year to influence which medications doctors and hospitals give to you. That creates a serious problem, because it can be difficult for you to tell whether a doctor is doing what’s best for you or what’s best for the drugmaker.

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When patients who were in pain walked into the Maryland offices of Dr. Mark Coleman, they likely believed that the advice and treatment that their doctor dispensed was based on good clinical judgment, years of experience and a careful evaluation of current science. It’s likely that few patients imagined that golf and cash also might have explained why they walked out of the office holding a prescription for the pain medication Kadian. According to allegations that were made in a whistleblower lawsuit that was settled in 2010, a representative from Alpharma, which is the prescription-drug company that makes Kadian, paid Coleman to go on a bogus junket to Pebble Beach, Calif., where he enjoyed three rounds of golf on a course that overlooked the Pacific Ocean and after which he collected a cash stipend for being part of a so-called advisory board. All that Coleman had to do in exchange was promise to prescribe Kadian.

Alpharma, which eventually settled with the federal government for $42.5 million, is merely one of at least 11 drugmakers in the past 2 years that reached settlements over allegations of paying kickbacks to doctors. Unfortunately, kickbacks are only part of the problem. Drug companies attempt to influence doctors on so many levels that it’s both dizzying and potentially dangerous to consumers. Drug companies sponsor continuing-medical-education (CME) courses for doctors, help to bankroll professional medical societies to which doctors belong and provide 65 percent of the funding for medical research. Drug-company involvement in these activities erodes the integrity of medical knowledge and instills in doctors a bias in favor of medications, independent experts tell Consumers Digest.

The consequences for consumers can be terrifying. Not only is it possible that your doctor takes money from drug companies that could affect how he/she practices medicine, but also many doctors don’t even realize that the information that they use to determine which medications are best for you often originates from the marketing branch of the drug company. As a result of all of the influence that drug companies attempt to leverage on doctors and hospitals, there’s a chance that you could be unnecessarily prescribed medications that in some cases might be dangerous and have life-threatening side effects.

It’s promising that medical schools, medical journals, state and federal governments, and even the pharmaceutical industry itself have taken steps to limit or eliminate gifts and payments to prescribers—doctors, physician assistants and nurses. But make no mistake: Pharmaceutical-industry dollars continue to flow to doctors, to the medical organizations to which the doctors belong and to the authors of the medical-journal articles that most doctors read. You must be savvy and circumspect at all times to make sure that doctors don’t dispense prescriptions if they’re being swayed by pharmaceutical manufacturers.

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“There have been some policy changes, and there is some evidence that doctors are modifying their behavior, like by not accepting free meals” from prescription-drug companies, says Allan Coukell, who is the director of Pew Prescription Project, which works to limit the effect that drugmakers have on consumers. “But the fundamental prescription-drug marketing model still hasn’t changed.”

SAMPLE SIZE. It’s no secret that drugmakers send salespeople door to door (or office to office) to get doctors and hospitals to prescribe their medications. Drug companies spent $28 billion on marketing in 2010 (the latest year for which figures are available), half of which was spent on promoting medications to the health-care professionals who write prescriptions. A survey by SK&A, which conducts research about the health-care market, revealed that in 2009, 77 percent of doctors allowed pharmaceutical representatives to visit them. Nearly 99 percent of those doctors reported that they were visited by as many as 20 drug-company representatives in a given week.

It’s legal for drug companies to market office to office, and the pharmaceutical industry defends such marketing as educational and informative for doctors. But don’t be fooled into thinking that such visits are just typical door-to-door sales calls. Drug-company representatives purchase doctors’ prescribing data from pharmacies and can monitor whether sales visits increase a doctor’s prescription-writing of the promoted medication, which provides clear evidence how the information that’s dispensed is aimed at increasing sales, not merely informing doctors, as pharmaceutical companies insist.   

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