Excessive influence of pharmaceutical manufacturers over doctors

Education and advertising campaigns have raised concerns that pharmaceutical companies, traditionally in the business of finding new drugs for existing disorders, are increasingly in the businesses of promoting their own brands on non-medical grounds and, even more unethically, seeking new disorders for existing drugs. For example, some drug marketing seems to imply that huge proportions of the population need pharmaceutical intervention for relatively common problems, and for which medication is of dubious benefit.

Doctors have become inextricably tied up with the pharmaceutical industry. Their education comes from information supplied by the manufacturers, along with gifts, which some may come to view as a necessary supplement to their salaries. Theoretically, doctors are independent professionals and are trained to assess the value of new drugs when they appear on the market. In practice, most doctors simply prescribe what they are told to by the drug companies, because so many of the medicines now available have appeared since doctors completed their medical training. With an estimated 30,000 drugs being produced, not even the most assiduous expert can hope to keep up to date with what is available. This means that the responsibility for ensuring that new drugs are safe, and that doctors are warned of new side effects when they appear, lies largely with the industry itself. More than 90 percent of the information which doctors receive about drugs comes partly or entirely from the drug manufacturers. Most of the world's 30,000 medical journals are financed by advertisements from the drug industry.

Certain drugs may be treated in in current discussion as if they are obsolete, whereas they can have a great deal of clinical utility, particularly as augmenting medications. The best example of this phenomenon is lithium, an important and proven drug for bipolar disorder. No company is marketing it presently, and there is aggressive marketing of other medications for bipolar disorder. As a result, a lot of clinicians are becoming convinced that lithium is an inferior drug. This kind of marketing has almost relegated a useful medication to the status of historical artifact.

During the period 1990-2000, a comprehensive media campaign was coordinated by a New York public relations agency working for for the pharmaceutical company that manufactures the anti-depressant Paxil. The campaign delivered communications and testimonials from advocates and doctors who claimed that more than 10 million Americans suffered from social anxiety disorder – a debilitating form of bashfulness – making it the most common mental disorder after depression and alcoholism – and that 13 percent of Americans were affected by it. (According to the National Institute of Mental Health says only about 3.7 percent of the US population has social anxiety disorder. Prior to this time, social anxiety disorder had been mentioned only 50 times in the medical literature.) Around 96 per cent of the stories delivered the key message that the drug Paxil was the first and only FDA-approved medication for the treatment of social anxiety disorder. Sales of Paxil, which had been trailing those of Prozac and Zoloft, rose 18 percent in 2000. The campaign mentioned a psychological therapy called cognitive behaviour therapy, but did not stress that the therapy was as effective as medication, had no side effects and did not require patients to stay in treatment indefinitely.