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how do doctors determine which drugs to give you?


Prescription Habits

Gerd Altmann – Freiburg/Deutschland – Pixabay

“The authors go on to say that for every dollar pharmaceutical companies spend on “basic research,” $19 goes toward promotion and marketing.”   From the August 9, 2012 issue of the Huffington Post (Pharmaceutical Companies Spent 19 Times More On Self-Promotion Than Basic Research: Report) The article was about a study from that month’s issue of the British Medical Journal (Pharmaceutical Research and Development: What do we get for all that Money?)

“Similarly, Dr. Charles Nemeroff resigned as chair of the psychiatry department at Emory University after failing to report a third of the $2.8 million in consulting fees he received from GlaxoSmithKline. At the time he received these fees, Dr. Nemeroff had been principal investigator of a $3.9 million NIH grant evaluating five medications for depression manufactured by GlaxoSmithKline.  From the October 4, 2008 issue of the Los Angeles Times (Doctor Accused in Congress’ Probe).

“In 2012, the pharmaceutical industry spent more than $27 billion on drug promotion — more than $24 billion on marketing to physicians and over $3 billion on advertising to consumers (mainly through television commercials). This approach is designed to promote drug companies’ products by influencing doctors’ prescribing practices.”  Statistics from the November 11, 2013 issue of the Pew Charitable Trust (Persuading the Prescribers: Pharmaceutical Industry Marketing and its Influence on Physicians and Patients)

“Among the 30% of Americans who say they talked to their doctor about a medicine they say they saw advertised in the past, 44% (representing 13% of the public overall) say that the doctor gave them the prescription medication they asked about.”  From the Kaiser Family Foundation’s 2001 study called Understanding the Effects of Direct-to-Consumer Prescription Drug Advertising.  As you’ll soon see, this problem is not improving.

One of the main premises of the late Dr. Fred Barge’s book (Are You the Doctor, Doctor?) is simple:  If you’re going to be a doctor, you’ll sometimes have to make difficult decisions.  I recently had a long-time patient — an older gentleman, who had always done great after getting an adjustment or two.  Recently, he struggled with a low back problem / Sciatica that was not responding after four or five adjustments.  This patient wanted to keep treating, but I told him I would not treat him anymore without him visiting his doctor first, which frankly, ticked him off a bit.  His wife called the other day thanking us, as her husband had been diagnosed with a “mass” in his lumbar spine — a “pus pocket” of infection that could have done some serious damage if left unchecked. 

Medical Doctors are faced with a myriad of decisions each and every day.  One of the most common decisions in our DRUG-BASED CULTURE involves determining which medication to give a patient — particularly when said patient is wanting PREGENTATORIVOX (actually, you could insert any drug here) because they “saw it on TV“.   Do patient’s requests for certain drugs affect doctor’s prescription habits, and if so, how much?  Enter a study that was published in April’s issue of Medical Care (Effects of Patient Medication Requests on Physician Prescribing Behavior: Results of a Factorial Experiment).   The study’s conclusions answer at least part of this question by stating that, “Patient requests for a medication substantially affected physician-prescribing decisions, despite the drawbacks of the requested medications.”  But this does not even begin to tell the whole story.

We intuitively know that doctors prescription habits are affected by patient requests; otherwise ‘Big Phama’ would not be spending the sort of money on advertising they do.  How much money do they spend on advertising?  While there are no hard and fast statistics on this, some estimates put the amount at upwards of sixty billion dollars per year.  What does this tell you?  It makes us realize that advertising works (HERE).  Of course, this begs the question of how well such advertising works.  The question is at least partially answered in the research mentioned in the previous paragraph.  In this study, a group of almost 200 physicians underwent two video experiments. 

  • In the first experiment, physicians were shown videos of patients with SCIATICA, who had not yet received an official diagnosis (as a side note, Sciatica is a symptom — not a diagnosis).  Half of the sciatica patients specifically asked for Oxycodone, while the other half simply wanted, “something to help with the pain“.  Of the “something for the pain” group, only 1% were prescribed Oxycodone — a powerful and extremely addictive NARCOTIC.  But in the other group, 1 in 5 doctors gave in to the patient’s request for Oxycodone (the generic form of Oxycontin — which around here is known as “Hillbilly Heroin”).  To put this in perspective for you, the asking-for-Oxycontin group was 2,000% higher than the “something for the pain” group.


  • In the second experiment, the same physicians were shown videos of patients who had already received a diagnosis of DJD of the knee.   Half of this group specifically asked for Celebrex, while the rest again wanted, “something to help with the pain“.   53% of those specifically requesting Celebrex got it, while only 24% of the patients only asking for ‘pain relief‘ got Celebrex.  This was a difference of well over 100%.

This is why I have repeatedly said that when it comes to the Pharmaceutical Industry, true “EVIDENCE-BASED MEDICINE” is a myth — a pipe-dream — a pie-in-the-sky fantasy along the same lines as the hobo’s Big Rock Candy Mountain.  Until doctors are willing to take Barge’s advice and be the doctor, things aren’t going to change.  And while I am talking about this subject, what class of drug would I argue is requested and prescribed more than almost any other?  How about ANTIBIOTICS.  I promise that if I were to go into ten doctor’s offices with zero symptoms, but complain about a terrible SORE THROAT and EARACHES, I’ll come away with a prescription for Antibiotics almost 100% of the time (HERE), even with no objective symptoms.  This is particularly true if I were to push the issue a bit — something I hear patients bragging about regularly.


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