Kristina Fiore, Staff Writer, MedPage Today

    August 24, 2010
    Many patients taking prescription drugs believe that pharmaceutical companies have too much influence over their physicians' prescribing practices, according to a new survey.
    A telephone survey of more than 2,000 U.S. adults by Consumer Reports found that the majority of those currently taking medications -- 69% -- had such concerns.
    About half of the medication-users believed that their doctors were too eager to write a prescription when other nonpharmacological options are available.
    "On the one-to-one level, many patients trust their physicians," Lee Green, MD, MPH, of the University of Michigan, told MedPage Today. "But I see a lot of skepticism out there and it's well-founded."
    Jerome Kassirer, MD, professor of medicine at Tufts University in Boston and former editor of the New England Journal of Medicine, said trust between a doctor and a patient "is absolutely essential in getting patients to believe what their doctors are telling them. ... Any kind of loss of trust between doctor and patient is deleterious."
    That could mean patients don't heed instructions about taking their medications, according to physicians interviewed by MedPage Today.
    The findings come from a telephone survey of 2,022 patients in the U.S., with the final analysis based on 1,154 responses from those adults currently taking prescription drugs.
    On average, those patients reported routinely taking four different medications.
    Almost half of the patients taking medications who were surveyed (47%) thought that gifts from pharmaceutical companies influenced their doctor's choice of drugs.
    Most of them (81%) were concerned that physicians engaged in practices that resulted in being rewarded by pharmaceutical companies for writing lots of prescriptions for the company's drugs -- a practice that is illegal, according to Randy Wexler, MD, MPH, of the Ohio State University.
    "Unfortunately, I have found this fear expressed in my own research," he told MedPage Today.
    But Green said this practice is more likely to occur among specialists because their smaller numbers make it easier to keep track of the drugs and devices they prescribe.
    Surveyed patients were also worried about their physicians acting as paid spokespersons for drug companies (72%), speaking at industry conferences (61%), and getting free meals (58%).
    Their fears may not be unfounded -- given that pharmaceutical companies are increasingly targeting primary care doctors rather than high-profile academicians to spread the word about their drugs. (See On the Stump: When Academics Are Out of the Picture).
    Green said pharmaceutical companies are increasingly turning to eloquent community physicians, partly because academic doctors "are asking too many questions." Many academic institutions have also set new rules against such conflicts of interest.
    Kassirer said the physician "who works in the community may not be as informed about the drugs and might be more willing to follow the line of the pharmaceutical company in telling others how to use those drugs."
    Indeed, 66% of patients reported receiving free samples of prescription medications, and 41% felt their doctors prescribed newer and more expensive drugs over proven generics.
    Eroding trust, especially combined with rising costs of medications, could spur compliance issues, researchers say.
    The survey found that monthly out-of-pocket patient spending is around $68 -- and 14% of patients spend more than $100 of their own money every month on prescription drugs.
    In the past year, 27% of patients said they failed to fully comply with their medication regimens, most commonly skipping a prescription fill (16%), taking expired medication (12%), skipping a dose (12%), cutting pills in half (8%), or sharing pills (4%).
    This combination of circumstances "provides some with the ability to rationalize why a specific medication does not have to be taken," said Wexler. "That can be very dangerous in the setting of many chronic diseases such as diabetes, high blood pressure, hypertension, and high cholesterol."
    More than half of patients feel that their doctors don't consider their ability to pay when they prescribe. In fact, 64% of survey respondents didn't learn how much the prescription would cost them until they picked it up at the pharmacy.
    Only 6% were informed of the costs of prescription drugs while in their doctor's office.
    Physicians are hardly the lone party at fault.
    About 20% of patients reported asking their doctor for a drug they saw advertised on television. And physicians complied with those requests 59% of the time.
    Still, physicians should take steps to make it clear to patients that they're free of conflicts of interest, Green said.
    Kassirer said physicians can avoid being on speakers' bureaus, and discourage pharmaceutical representatives from coming into offices bearing free lunches and free samples. They should also "eliminate all evidence of pharma largess from their offices -- no pens, no pads, none of that."
    He also cautioned that it's up to patients "to be alert to these things."
    Wexler added that it's "reasonable for patients to ask their physicians what, if any, arrangements they have with outside vendors, and what that relationship is."
    "If the physician will not discuss it," Wexler said, "then it is time to find another physician."