Medicine for profit: The pharmaceutical industry’s stronghold and impact on patient wellness

From developing lifesaving drugs to therapies, the pharmaceutical industry has been at the forefront of medical innovation.

However, there have been concerns regarding the industry’s growing influence and the potential conflicts of interest that arise when profit takes precedence over patient well-being. At the heart of this issue lies a fundamental tension between pharmaceutical companies’ fiduciary responsibility for financial gain and the ethical obligation to prioritize public health.

While these companies invest billions of dollars in research and development, their ultimate goal is to generate profits for their shareholders. As primary care physicians, we have a duty to understand the nuances of these tactics used by the pharmaceutical industry to better serve and care for our patients.

The pervasive influence of Big Pharma

The pharmaceutical industry’s lobbying efforts and political contributions have significantly shaped health care policies and regulations. According to Statista, the industry spent a staggering $378.5 million on lobbying in 2023 alone, making it one of the most influential lobbying forces in the United States.

This financial clout has enabled pharmaceutical companies to influence legislation that directly impacts their bottom line. For instance, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which prohibited Medicare from negotiating drug prices with manufacturers, was heavily lobbied for by the industry, potentially contributing to the rising costs of medications for millions of Americans.

Moreover, Big Pharma’s marketing strategies have been scrutinized for their potential to influence prescribing practices and patient demand. Direct-to-consumer advertising (DTCA) is a prime example, with the United States and New Zealand being the only two countries that allow this practice.

According to Statista, pharmaceutical companies spent a staggering $6.88 billion on DTCA in the United States in 2021. Yet these advertisements often downplay potential side effects and risks, leading to a skewed perception of the benefits and driving patient demand for specific medications, even when alternative or nonpharmacological treatments may be more appropriate.

Pharmaceutical companies have historically been known to employ aggressive marketing tactics targeting health care professionals — including providing incentives such as gifts, meals or speaking fees — which raise ethical concerns about potential conflicts of interest and the undue influence on prescribing practices. The pervasive influence of Big Pharma’s lobbying efforts and marketing strategies highlights the need for greater transparency, ethical oversight and a realignment of priorities to ensure that patient well-being takes precedence over financial gains, such as we have seen from regulations like the Physician Payments Sunshine Act.

The cost of medication and accessibility

One of the most pressing issues in the pharmaceutical industry is the skyrocketing cost of medications, which has made essential drugs inaccessible to many. According to a report by AARP, prices of “1,216 medications rose an average [of] 31.6% over 12 months” in 2022.

This trend has serious implications for patient affordability and adherence. For instance, a poll by KFF found that nearly one in five Americans struggled to pay for their prescribed medications, with many choosing to skip doses or forgo treatment altogether due to financial constraints. The high costs of medications are particularly burdensome for patients with chronic conditions requiring multiple prescriptions, as well as those without adequate insurance coverage or those on fixed incomes, such as older adults.

Beyond affordability, barriers to accessing medications can stem from various factors, including limitations in health care coverage, geographical disparities, systemic inequities in the health care system and insurance companies simply refusing to cover medications for no apparent reason. These barriers often disproportionately affect marginalized communities and exacerbate existing health disparities.

Addressing the rising costs of medications and improving accessibility is crucial for individual patient well-being and the long-term sustainability of the health care system. As physicians, part of our job is to fight for our patients and help them get the care they need and deserve, and are paying for.

The conflict of interest in research and education

A significant portion of medical research is funded by the pharmaceutical industry, raising concerns about potential biases and conflicts of interest. Reports from 2023 estimate that the industry invested over $122 billion in research and development.

While industry funding is crucial for advancing medical knowledge and developing new treatments, it also creates an inherent conflict of interest. It’s not a secret that industry-sponsored research is more likely to yield favorable results for the sponsor’s products than independently funded studies. In fact, it’s not even new, as an extensive report of more than 600 studies since 2018 showed these very results.

The pharmaceutical industry’s influence extends beyond research and into the realm of medical education. Companies often sponsor continuing medical education (CME) programs designed to keep health care professionals up to date with the latest advancements and treatment strategies. However, there are concerns that industry-sponsored CMEs may be biased toward promoting the sponsor’s products, potentially influencing prescribing practices and treatment decisions.

For instance, the American Board of Medical Specialties (ABMS) is currently being reevaluated by physicians due to seemingly endless fees and unnecessary exams. The National Board of Physicians and Surgeons is trying to change the CME and testing requirements to better align with what we actively practice, as the ABMS changes rules and increases fees without warning, highlighting how it doesn’t have physicians’ best interests at heart. Its practices have also resulted in multiple class-action lawsuits from medical boards against the ABMS.

Addressing these conflicts of interest is crucial to maintaining the integrity of medical research and education. Greater transparency, stricter regulations, and a shift toward independent, unbiased sources of funding and education are essential to ensure that patient well-being remains the primary focus rather than the financial interests of the pharmaceutical industry.

Potential solutions and alternatives

As primary care physicians, we stand at the front lines of patient care, witnessing firsthand the consequences of the pharmaceutical industry’s profit-driven practices. While the challenges we face are multifaceted and deeply ingrained within the health care system, we nevertheless have the power to drive meaningful change by taking proactive steps and advocating for ethical, patient-centered practices.

One of the most significant actions we can take is prioritizing evidence-based medicine and resisting the influence of pharmaceutical marketing and promotion. By critically evaluating research findings, scrutinizing industry claims and relying on independent, unbiased sources of information, we can make more informed decisions that prioritize patient well-being over financial incentives.

As respected voices in the medical community, we have the opportunity to advocate for greater transparency and ethical oversight within the pharmaceutical industry. This may involve supporting initiatives that mandate the disclosure of industry funding and potential conflicts of interest in research and education and pushing for stricter regulations on marketing practices and drug pricing.

While the pharmaceutical industry plays a vital role in medical innovation, we must explore alternative models that prioritize patient access and affordability. This could include supporting nonprofit drug development initiatives, advocating for value-based pricing strategies, or exploring partnerships with organizations that provide low-cost or free medications to underserved populations.

Ultimately, addressing the pharmaceutical industry’s stronghold requires a collaborative effort among health care professionals, policy makers, patient advocacy groups and the public. Eliminating the prior authorization process is a start, but this must also be accompanied by insurance companies abiding by physicians’ medical decision-making, especially by organizations with no medical director or physicians employed to follow peer-to-peer review processes.

By leveraging our collective voices and expertise, we can advocate for systemic changes that prioritize patient well-being, promote ethical practices and restore trust in the health care system.

Sulagna Misra, MD, is the founding physician at Misra Wellness, a direct primary care medical practice in Los Angeles, California, specializing in weight loss, men’s health, integrative medicine and primary care. She holds certifications in integrated medicine, internal medicine and aesthetic medicine, and is passionate about patient advocacy, bringing the doctor and patient back together, and promoting health and care in health care.