Alejandro Gonzalez
Dr. Emerson
IDMD-101-004
10/10/23

Physicians Being Paid to Prescribe

The article I chose was from CNN Health about physicians being paid by pharmaceutical
companies and how it affected how often they prescribed that drug. The article talks specifically
about opioids and how an overprescription of them could lead to an addiction to the drug which negatively affects the patients well being. They analyzed databases with the information of doctors being paid by companies and compared it to how often they prescribed the drug, in
which they found a positive correlation. A counterpoint was brought up about the doctors truly
believing the benefits of the drug and that the research only proves correlation and not
necessarily causation. Still, there was a large concern about conflicts of interest for the doctor,
and the financial incentive outweighing the best interest of the patient. There are many ethical
questions raised about this scheme, but the two I want to focus on are brought up in Stegenga’s
Care and Cure are medical paternalism and the patient and physician relationship.

Firstly, medical paternalism, which is defined by the NIH as “The physician makes
decisions based on what he or she discerns to be in the patient’s best interests, even for those
patients who could make the decisions for themselves.” This would come into question when the physician prescribing medication was paid a large sum of money by a pharmaceutical company and is now more often prescribing that drug to more patients. It could be inferred that since they are getting kickbacks from those companies, it provides more incentives for the physician to prescribe that medication, to then receive more money. According to the article, pharmaceuticals pay physicians to do research and also for promotional work, they later go on to claim that the largest amount is paid for the latter. The article also goes into detail about a couple of patient cases where the physician prescribed opioids and the effects they had on the patient. Specifically in the case of Angela Cantone, who was prescribed “an opioid called Subsys for abdominal pain from Crohn’s disease”. The drug Subsys was cited as being “50 to 100 times more potent than morphine”, and it caused her to frequently pass out and caused her great discomfort, and whenever she was off the drug it caused “uncontrollable diarrhea and vomiting.” With these terrible symptoms, she consulted the physician who prescribed her the drug in the first place, and he stated that it couldn’t be Subsys causing it. What she responds with is what I want to focus on, which is the fact that she trusted him, “I trusted my doctor as you trust the police officer that’s directing traffic when the light is out.” This is essential to the root problem of paternalism, which is the fact that patients believe they don’t have autonomy when it comes to their health, and in a hospital setting some patients believe that the physician’s word is law. So, when a physician prescribes them medicine, they believe it is in their best interest and that the physician knows best. In even worse cases, like Cantone, when they ask to be switched to a different medication, they simply refuse. There could be a case where the doctor isn’t affected financially, though for this physician it’s pretty clear why, but even then it is a gross offense to the autonomy of the patient, where they can decide for themselves.

In recent times, due to the expansion of media and access to medical information, I believe patients are becoming more autonomous medically speaking, but I also believe that it has
affected the patient and physician relationship. Also called the doctor-patient relationship, it can be defined as, “a consensual relationship in which the patient knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person as a patient.” This involves trust between parties and there is a relationship built, which allows for cooperation and vulnerability. Articles such as this one allow patients to be aware of their voices, but it can also harm the trust of physicians. It is true that the doctors and companies discussed in this article probably had financial gains as a priority over the health of the patient, for which they were sued and investigated. This is to say that not all physicians are like this, the majority will be on the patient’s side and will look out for their best interest. The article stated that “ In 2015, 48% of physicians received some pharmaceutical payment.”, even for those who were, a portion of them were the ones overprescribing medication, though the severity increased as the number of prescriptions increased. So while these cases are immoral, in most cases it won’t end up this way for patients. Though, after people read this article, and others like it, it creates a negative stereotype for physicians, which are greedy people who are self-centered and only care about their gain. This puts a dent in the patient and physician relationship, where the patient has a pre-established notion that the physician is untrustworthy. This is an unrealistic expectation for patients to have against all physicians and can cause a lack of cooperation and trust that leads to other problems, such as misdiagnosing due to their being lack of information divulged.

Overall, I believe that articles being published like this one are helpful to people, it allows them to be aware of problems in the medical field that they might not have known or considered. Always having access to more information is a good thing, it allows people to make decisions for themselves and be more autonomous, which combats medical paternalism. What I have apprehension about is the over-sensationalized of problems presented by the media. While this article I believe showed both sides and provided studies and information to support their claims, not every publication would go through this length. Articles that sensationalize problems and have hyperbolic headlines are often clicked on and sold. This can create a false perspective for people that has a negative effect on the trust between patients and physicians.

Works Cited
Chipidza, Fallon E, et al. “Impact of the Doctor-Patient Relationship.” The Primary
CareKessler, Aaron, et al. “CNN Exclusive: The More Opioids Doctors Prescribe,
the More Money They Make.” CNN, Cable News Network, 12 Mar. 2018,
www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html.
Kilbride, Madison K, and Steven Joffe. “The New Age of Patient Autonomy: Implications
for the Patient-Physician Relationship.” JAMA, U.S. National Library of Medicine,
20 Nov. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6988779/.
Murgic, Lucija, et al. “Paternalism and Autonomy: Views of Patients and Providers in a
Transitional (Post-Communist) Country.” BMC Medical Ethics, U.S. National
Library of Medicine, 29 Sept. 2015,
www.ncbi.nlm.nih.gov/pmc/articles/PMC4589086/.
Stegenga, Jacob. Care and Cure an Introduction to Philosophy of Medicine. The University
of Chicago Press, 2018.