This document is a 3,499 word essay analyzing the popularity of SSRI prescriptions in the United States. The essay examines how pharmaceutical companies exert power over physicians in the prescribing process through three manifestations: power over the depression narrative, power over information, and power over brand loyalty. It argues that while prescribing practices have various influences, pharmaceutical companies significantly impact the process by marketing a biochemical model of depression and portraying SSRIs as the best treatment, influencing both doctors and patients. The causal relationship observed is that doctors' prescribing trends can be swayed by pharmaceutical marketing strategies.
“Evidenced based” behavioral medicine as bad as bad pharmaJames Coyne
Introduction to symposium held at International Congress of Behavioral Medicine, Groningen, August 2014. Discusses the shortcomings of evidence-based behavioral medicine in light of efforts to reform the shortcomings of the Pharma literature.
This document discusses the influence of pharmaceutical industry funding on clinical research. It provides several examples of how industry funding can affect the direction of medical research, sharing of information, discontinuation of clinical trials, publication of results, and outcomes of clinical research. Industry funding is associated with choosing research topics that are more commercially focused, delays in publishing results, stopping trials early for commercial reasons, control over publication, and statistically significant findings that favor the industry's product. Proper oversight is needed to minimize these influences and ensure research integrity.
Current Status of Hypnotic Prescribing Habits in the United StatesJohn Reites
Psychiatrists represent the second largest prescriber of sleep aids, accounting for 11% of total prescriptions in the US. While primary care physicians prescribe over half of sleep aids, psychiatrists and primary care physicians have similar prescribing patterns for individual sleep aids such as Ambien, Lunesta, and Sonata. Neurologists, who are considered sleep specialists, only account for 2% of sleep aid prescriptions. The study found no significant differences between psychiatrists, primary care physicians, and neurologists in their use of specific sleep medications.
Generic Drugs having low cost. We should know about world drug scenario. In our daily life, we must concern with doctors and take drugs for cure. But we are not aware about drugs.We should know about drugs, not to become a Doctor, but for general awareness or at least to know what we are taking for our helth.
Global Generic Pharmaceutical Market - Qualitative and Quantitative AnalysisAiswariya Chidambaram
This report was presented at the Pharma Tech 2013 Conference - India A Game Changer in the Pharma Industry at Ahmedabad, India in December 2013. The presentation highlights the overview of the global generic pharmaceuticals market, with particular focus on the key market trends and challenges by therapeutic areas and geographies including the U.S, EU and India. List of key blockbuster drugs scheduled to lose patent protection between 2010 and 2020 have been included. Additionally impact of regulation on generic drugs by region and strategic recommendations for the success of market participants are also covered in this report.
The document discusses prescriptions and electronic prescribing. It defines a prescription as an order from a medical practitioner for medicine or treatment for a patient. It explains the parts of a prescription including patient information, medication, and instructions. Electronic prescribing allows doctors to transmit prescriptions directly to pharmacies digitally, improving accuracy and reducing errors compared to handwritten prescriptions. While it provides benefits, electronic prescribing also faces challenges such as accidental errors and security issues.
The document provides an analysis of the Pakistan pharmaceutical market. Some key points:
- The total Pakistan pharma market is US$2.177 billion and is growing at a CAGR of 10.22% in US dollars.
- The top 11 corporations have reached Rs. 5 billion in sales and account for 49.22% of the market share.
- Top 50 corporations control 86% of the market and top 100 corporations control 95.95% of the market.
- 398 new products were launched in the last 12 months, with 20 from multinational corporations and 378 from national companies.
“Evidenced based” behavioral medicine as bad as bad pharmaJames Coyne
Introduction to symposium held at International Congress of Behavioral Medicine, Groningen, August 2014. Discusses the shortcomings of evidence-based behavioral medicine in light of efforts to reform the shortcomings of the Pharma literature.
This document discusses the influence of pharmaceutical industry funding on clinical research. It provides several examples of how industry funding can affect the direction of medical research, sharing of information, discontinuation of clinical trials, publication of results, and outcomes of clinical research. Industry funding is associated with choosing research topics that are more commercially focused, delays in publishing results, stopping trials early for commercial reasons, control over publication, and statistically significant findings that favor the industry's product. Proper oversight is needed to minimize these influences and ensure research integrity.
Current Status of Hypnotic Prescribing Habits in the United StatesJohn Reites
Psychiatrists represent the second largest prescriber of sleep aids, accounting for 11% of total prescriptions in the US. While primary care physicians prescribe over half of sleep aids, psychiatrists and primary care physicians have similar prescribing patterns for individual sleep aids such as Ambien, Lunesta, and Sonata. Neurologists, who are considered sleep specialists, only account for 2% of sleep aid prescriptions. The study found no significant differences between psychiatrists, primary care physicians, and neurologists in their use of specific sleep medications.
Generic Drugs having low cost. We should know about world drug scenario. In our daily life, we must concern with doctors and take drugs for cure. But we are not aware about drugs.We should know about drugs, not to become a Doctor, but for general awareness or at least to know what we are taking for our helth.
Global Generic Pharmaceutical Market - Qualitative and Quantitative AnalysisAiswariya Chidambaram
This report was presented at the Pharma Tech 2013 Conference - India A Game Changer in the Pharma Industry at Ahmedabad, India in December 2013. The presentation highlights the overview of the global generic pharmaceuticals market, with particular focus on the key market trends and challenges by therapeutic areas and geographies including the U.S, EU and India. List of key blockbuster drugs scheduled to lose patent protection between 2010 and 2020 have been included. Additionally impact of regulation on generic drugs by region and strategic recommendations for the success of market participants are also covered in this report.
The document discusses prescriptions and electronic prescribing. It defines a prescription as an order from a medical practitioner for medicine or treatment for a patient. It explains the parts of a prescription including patient information, medication, and instructions. Electronic prescribing allows doctors to transmit prescriptions directly to pharmacies digitally, improving accuracy and reducing errors compared to handwritten prescriptions. While it provides benefits, electronic prescribing also faces challenges such as accidental errors and security issues.
The document provides an analysis of the Pakistan pharmaceutical market. Some key points:
- The total Pakistan pharma market is US$2.177 billion and is growing at a CAGR of 10.22% in US dollars.
- The top 11 corporations have reached Rs. 5 billion in sales and account for 49.22% of the market share.
- Top 50 corporations control 86% of the market and top 100 corporations control 95.95% of the market.
- 398 new products were launched in the last 12 months, with 20 from multinational corporations and 378 from national companies.
The document provides an overview of principles of drug information and the systematic approach used to answer drug-related questions. It discusses key drug information references, both general references like CPS and specialized references covering interactions, adverse reactions, pregnancy/breastfeeding, and natural products. The systematic 10-step approach involves collecting requestor details, determining the question, finding and assessing relevant information from references, formulating a response, and following up.
The document discusses the growing problem of prescription drug abuse and overdose deaths in the United States. Some key points made include:
- In 2010, there were over 38,000 drug overdose deaths in the US, with prescription drugs accounting for over 22,000 of those deaths.
- Prescription drug abuse is the fastest growing drug problem in the country.
- Deaths from drug overdoses now outnumber deaths from motor vehicle accidents.
- The number of forensic drug cases tested has increased over 240% from 2001 to 2011.
- States in the Southwest and Appalachia have the highest rates of drug overdose mortality.
Assignment Ethical and Legal Implications of Prescribing DrugsW.docxfaithxdunce63732
This document provides guidance for an assignment on the ethical and legal implications of prescribing drugs as an advanced practice nurse. It discusses factors to consider when developing a treatment plan, such as the appropriate drug, dosage, administration schedule, and contraindications based on a patient's diagnosis and individual factors. The document emphasizes that nurses have a duty to act ethically and legally when prescribing to avoid harming patients, in accordance with their state's regulations. Students are asked to review scenarios assigned by their instructor and discuss the ethical and legal implications for all stakeholders, as well as strategies for disclosure/nondisclosure of errors and processes for minimizing medication mistakes.
The document discusses issues around the marketing of pharmaceutical drugs. It notes that pharmaceutical marketing can influence doctors' prescribing decisions and priorities. Several studies cited found that doctors view drug sales representatives as an important source of information. The document then outlines a proposed research agenda to further examine the extent and impact of pharmaceutical marketing, including potential costs and benefits to health systems and policies around transparency. It concludes by noting concerns that extensive marketing practices could undermine affordable medical care.
The document analyzes the use of strategic ambiguity in the American Medical Association's Code of Ethics through rhetorical analysis. It identifies examples of strategic ambiguity used to allocate power to physicians and mitigate their culpability. This ambiguity affects the interpretation of the code and the patient-doctor relationship dynamics. The analysis suggests that if patients can identify and address subtle persuasion techniques, they can regain power in the discourse.
Pathway studio reaxys medicinal chemistry schizophrenia presentation 063015Ann-Marie Roche
Drug discovery expert, Jim Rinker, will discuss the process for exploring drug targets for schizophrenia using the tools in Elsevier's R&D portfolio. This approach features a specific workflow between Reaxys Medicinal Chemistry and Pathway Studio. Beginning with mapping known schizophrenia drugs to regulators, Mr. Rinker will walk through the keys steps in finding the proper drug used to improve cognitive function. This step-by-step method of research and data extraction will demonstrate how using these platforms can help identify side effects, build a consensus model, properly profile drugs and effectively map cognition.
This document summarizes and critically analyzes research on prescribing psychotropic medications to children and adolescents. It finds five major flaws that undermine the scientific validity of key antidepressant and stimulant drug trials. These flaws include: 1) compromised blinding due to the use of inactive placebos, 2) reliance on clinician ratings over patient self-ratings, 3) short trial timeframes that do not reflect real-world use, 4) conflicts of interest from pharmaceutical industry funding and ties to researchers, and 5) minimization of risks and side effects in the presentation of results. The analysis aims to help clinicians evaluate scientific claims and inform children, families, and their own practices regarding the risks and benefits of medicating youth.
The Federation of State Medical Boards issued recommendations for physicians recommending marijuana as more states legalize medical and recreational use. The recommendations include: establishing a patient-physician relationship and not recommending marijuana for oneself; conducting an in-person evaluation before recommending marijuana; discussing risks/benefits and obtaining informed consent; creating a written treatment plan not exceeding 12 months; monitoring the patient's response; and referring patients with substance abuse issues. The recommendations aim to provide guidance to physicians as state and federal laws conflict regarding marijuana.
The Impact of Ethnicity on Anti-depressant TherapyThe Case .docxrtodd33
The Impact of Ethnicity on Anti-depressant Therapy
The Case: The man whose antidepressant stopped working.
Gathering information on physical assessment is essential in the management and treatment of the patient’s conditions like depression. The participation of a family is vital in the overall treatment of a person who has a mental disorder.
The three questions necessary to ask the patient with depression are: “How do you feel about being retired?” ; “Can you tell me about your family?”; and “ Are you having thoughts of harming yourself?” The first question will explore the extent of financial demand on the patient and will assess the feeling of guilt regarding financial constraints related to his chronic disease. The importance of financial challenge appeared as the primary stressor on the study on chronic disease and depression (Chan & Corvin, 2016). The second question determines how family relations affect the patient’s condition, whether he has a sound support system. The third question explores the patient's plan for himself.
The patient’s wife in the scenario is his support person. Family and social interactions appeared crucial to coping strategy even without resolution on the problem (Chan & Corvin, 2016). The following questions are necessary to determine how supportive is the patient’s wife: “Do you keep track of your husband’s medication regimen?” ; “ What are the things that you and your husband like to do?”; and “How do you feel about your husband’s illness?”
The first question determines the wife’s involvement in patient care and whether the patient is compliant with his schedules of medication. The second question explore the things that both patient and wife enjoy. The third question assesses how the patient’s wife handles his husband’s illness. The wife can be a husband’s caregiver, and such a job involves managing the patient’s treatment, side effects, and symptoms, which providing such care can be emotionally difficult (Nik Jaafar et al., 2014). Greater caregiver burden is associated with older adults with long-standing depressive manifestations (Marshe et al., 2017).
Physical Examination and Diagnostic Tests
Physical assessment on the patient’s head, thyroid, and nervous system is an appropriate action to rule out other causes of depression. Current studies affirmed a significant correlation between thyroid hormone imbalance in patients with MDD (Shen et al., 2019). The result of a physical examination will enable the provider to treat any condition that might have contributed to the patient’s depression. The patient may also benefit from HAM-D6 or melancholia sub-scale. The HAM-D6 is a focused version of the Hamilton Depression Rating Scale (HAM-D), an outcome measure in MDD (Dunlop et al., 2019). The test result helps identify the effect of an antidepressant (Dunlop et al., 2019). The result is beneficial and helpful in medication decision management.
Three Differential Diagnosis
The three differential diagn.
1) Benzodiazepine use in the US increases with age, from 2.6% of adults aged 18-35 to 8.7% of adults aged 65-80 filling prescriptions in 2008. Use is nearly twice as common among women as men.
2) The proportion of benzodiazepine use that is long-term (120+ days) also increases with age, from 14.7% of young adults to 31.4% of older adults.
3) About one-quarter of benzodiazepine users across all age groups receive prescriptions for long-acting formulations, despite risks of long-term use especially for older adults.
Developing a Shared Vision 1Unsatisfactory 0-710.00.docxhcheryl1
Developing a Shared Vision
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Less Than Satisfactory 72-75%
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Satisfactory 76-79%
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Good 80-89%
89.00%
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Excellent 90-100%
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80.0 %Content
10.0 %Selection of Two Issues or Challenges From Among Those Provided in the Assignment Instructions
Identification /Challenges in health care organizations are not identified.
Issues /Challenges identified are not among those listed in the assignment instructions.
Issues /Challenges are identified but description is unclear or incomplete.
One issue/challenge is identified from among those listed in the assignment instructions.
Two issues/challenges are identified from among those listed in the assignment instructions.
70.0 %Compelling Memo Describing the Issues, Their Impact on the Organization, Opportunities for Improvement, and Recommendations
Memo addressed to ancillary staff is not provided or is incomplete.
Discussion of issues, their impact on the organization, and recommendations is unclear or disorganized.
Discussion of issues includes a brief description of organizational impact and recommendations.
Description of issues includes detailed information regarding organizational impact and opportunities for improvement but recommendations are lacking.
Comprehensive and compelling discussion regarding organizational issues, their impact, opportunities for improvement, and recommendations to foster a shared vision is offered.
15.0 %Organization and Effectiveness
5.0 %Thesis Development and Purpose
Paper lacks any discernible overall purpose or organizing claim.
Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.
Thesis and/or main claim are apparent and appropriate to purpose.
Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.
Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.
5.0 %Paragraph Development and Transitions
Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.
Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.
Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.
A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.
There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.
5.0 %Mechanics of Wr.
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DEBRA R. COMER CrossroadsA Case Against Workplace Drug TesLinaCovington707
This document provides arguments against workplace drug testing. It summarizes that drug testing may fail to deter the most harmful drug abuse and there is no conclusive evidence that it enhances productivity or safety. Further, positive drug test results do not necessarily indicate poor work performance and may be more common for some ethnic groups, risking discrimination. The technology of drug testing also has limitations as it can produce false positives and only detects prior drug exposure rather than impairment. Additionally, drug testing violates individuals' right to privacy. The document proposes that performance testing may be a less intrusive alternative to ensure workplace fitness.
This document provides guidelines from the CDC for prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. It summarizes that while opioids can provide short-term pain relief, there is little evidence for their long-term effectiveness and they present serious risks including overdose and opioid use disorder. It then outlines recommendations for clinicians on when to initiate or continue opioids, opioid selection and dosing, assessing risks, and addressing harms to improve safety and reduce risks of long-term opioid therapy.
1. The document discusses concerns about mental health medication use in Washington State Medicaid programs, including issues like inaccurate diagnoses, overprescribing of medications, high-risk patients, and regional variations in prescribing practices.
2. Data shows that antipsychotic drugs are a top expenditure and that some patients are prescribed multiple antipsychotics by multiple doctors, putting them at higher risk. Regional variations in excessive dosing were also found.
3. When data is shared across agencies and programs, it can help identify risks and reduce things like narcotic prescriptions, emergency room visits, and costs of care for high-risk patients.
Annotated Bibliography (sample)Bozarth, M.A. (1983). Opiate rewa.docxdurantheseldine
Annotated Bibliography (sample)
Bozarth, M.A. (1983). Opiate reward mechanisms mapped by intracranial self-administration. In J.E. Smith and J.D. Lane (eds.), Neurobiology of Opiate Reward Processes (pp. 331-339). Amsterdam: Elsevier/North Holland Biomedical Press. [This is an example of an article published in a book.]
This book chapter reviews data suggesting that the ventral tegmental area is critically involved in opiate reward. In addition it presents the first of several theoretical reviews by the author suggesting that opiate and psychomotor stimulant reinforcement involves activation of the same dopaminergic substrate. (By the mid-1980s the notion that different addictive drugs might share a common reward substrate would become paradigmatic for the study of drug reinforcement and addiction.) Control procedures and other methodological issues for conducting intracranial self-administration studies are also discussed.
Bozarth, M.A. (1987). (ed.) Methods of Assessing the Reinforcing Properties of Abused Drugs. New York: Springer-Verlag. [This is an example of a book citation.]
This book provides the definitive compendium of the experimental methods used to study drug reinforcement. Thirty chapters written by leading experts in each technique provide synopses of the experimental procedures. Both preclinical and clinical methods are presented, grouped by general approach (e.g., preclinical reinforcement studies, preclinical conditioning methods, clinical subjective-effects measures, clinical self-administration procedures). Most chapters present an overview and review of an experimental method, while some chapters provide original experimental data illustrating specific applications of a technique.
Interestingly, none of the researchers presented physical dependence tests as a method of assessing potential drug reinforcement; this is probably because of the editor’s assertion that physical dependence is not a primary motivation for drug-taking behavior and because of the obvious consensus shared by his contributing authors. The book sold-out shortly after its publication and has not been reprinted. It is, however, available in its entirety on the Internet at www.AddictionScience.net and can be downloaded chapter-by-chapter without charge.
Bozarth, M.A. (1987). Conditioned place preference: A parametric analysis using systemic heroin injections. In M.A. Bozarth (Ed.), Methods of assessing the reinforcing properties of abused drugs (pp. 241-273). New York: Springer-Verlag. [This is an example of an article published in a book.]
This chapter provides both a brief review and original data from the author’s extensive work using this experimental method. Although conditioned place preference appears to be a reliable and valid measure of potential drug reward, several experimental manipulations that usually have strong effects on conditioned responses had only modest effects on conditioned place preference. The author’s conclusion is that t.
The document discusses open data about medicines and drugs. It notes that there are over 4,600 known active pharmaceutical ingredients, including about 1,800 that are currently FDA-approved and marketed in the US. DrugCentral is an online resource that contains information on these drugs and their targets, with data on over 667 human proteins and 226 pathogen proteins that FDA-approved drugs act on. The document advocates for making more drug data openly available to further scientific understanding of medicines and discovery efforts.
Sexual dysfunction due to SSRI antidepressants: How to manage?Apollo Hospitals
Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of commonly prescribed antidepressants in clinical practice. Sexual dysfunction is a common side effect of SSRIs, which often goes unrecognized but adversely affects the quality of life of the patient. This review takes a look at the occurrence of sexual dysfunction among patients receiving SSRIs from a clinical viewpoint. The review explores into the possible reasons of such a dysfunction and the differential diagnoses to be entertained while dealing patients receiving SSRIs and experiencing sexual dysfunction. The review discusses the management strategies for addressing such dysfunction due to SSRIs, including cessation or reduction of dose, changing to another antidepressant, augmentation with another antidepressant, additional use of medications for erectile dysfunction and use of other add-on strategies. The choice of a specific strategy should be customized to individual needs of the patient.
Byock, I. (2016). The case against physician-assisted suicide and .docxjasoninnes20
Byock, I. (2016). The case against physician-assisted suicide and euthanasia. The Oxford
handbook of ethics at the end of life, 366.
The article is by Byock (2016) and it presents the case against physician-assisted suicide and euthanansia. It seems the source is arguing against allowing euthanasia and the physician assisted suicide. It presents the case that the euthanasia and suicide weakens the moral grounding as well as the structural integrity of the medical profession when it is allowed. This source is using evidence such as articles and peer reviewed sources to support the argument against euthanasia and physician assisted suicide. A counterargument for one of the provided sources could be that the euthanasia and physician assisted suicide has been used to alleviate suffering of various people who face pain in their lives. Personally, I believe the source is doing a good job of supporting its arguments because it has cited sources which are peer reviewed. At the same time, the authors have also cited each section with the source that has supported the argument. I think this source will be very helpful in supporting my argument because it has good points on why euthanasia and physician assisted suicide should not be allowed.
Brueck, M. A., & Sulmasy, D. P. (2019). The genealogy of death: A chronology of US
organizations promoting euthanasia and assisted suicide. Palliative &
supportive care, 17(5), 604-608.
The source is by Brueck (2019) and it looks at the organizations in the United States which promote assisted suicide and euthanasia. It seems the source is arguing that there are several organizations which continue to come up and exist over the years in the United States supporting euthanasia. The source is using evidence from peer reviewed sources such as journals and government registration documents. Official government websites and those of organizations are used as part of the material. A counterargument for one of the provided sources could be that these organizations have struggled to get euthanasia and assisted suicide legalized in the United States. Personally I believe the source the doing a good job in supporting its arguments because it has exhaustively looked at the genealogy of the organizations which have pushed for legalization of the two items over the years in the United States. I think this source will be very helpful in supporting my argument because it shows the organizations which have fought for the legalization but have failed over the years because of the approach and what they have stood for.
Elmore, J., Wright, D. K., & Paradis, M. (2018). Nurses’ moral experiences of assisted
death: A meta-synthesis of qualitative research. Nursing Ethics, 25(8), 955-972.
The authors of this article look at the moral experiences of nurses when it comes to assisted death. It seems this source is arguing that the experiences and perspectives of nurses are underrepresented in the ethical discourses about ass ...
More Related Content
Similar to Pharmaceutical Company Power Over the SSRI Prescription Habits of Physicians in the United States
The document provides an overview of principles of drug information and the systematic approach used to answer drug-related questions. It discusses key drug information references, both general references like CPS and specialized references covering interactions, adverse reactions, pregnancy/breastfeeding, and natural products. The systematic 10-step approach involves collecting requestor details, determining the question, finding and assessing relevant information from references, formulating a response, and following up.
The document discusses the growing problem of prescription drug abuse and overdose deaths in the United States. Some key points made include:
- In 2010, there were over 38,000 drug overdose deaths in the US, with prescription drugs accounting for over 22,000 of those deaths.
- Prescription drug abuse is the fastest growing drug problem in the country.
- Deaths from drug overdoses now outnumber deaths from motor vehicle accidents.
- The number of forensic drug cases tested has increased over 240% from 2001 to 2011.
- States in the Southwest and Appalachia have the highest rates of drug overdose mortality.
Assignment Ethical and Legal Implications of Prescribing DrugsW.docxfaithxdunce63732
This document provides guidance for an assignment on the ethical and legal implications of prescribing drugs as an advanced practice nurse. It discusses factors to consider when developing a treatment plan, such as the appropriate drug, dosage, administration schedule, and contraindications based on a patient's diagnosis and individual factors. The document emphasizes that nurses have a duty to act ethically and legally when prescribing to avoid harming patients, in accordance with their state's regulations. Students are asked to review scenarios assigned by their instructor and discuss the ethical and legal implications for all stakeholders, as well as strategies for disclosure/nondisclosure of errors and processes for minimizing medication mistakes.
The document discusses issues around the marketing of pharmaceutical drugs. It notes that pharmaceutical marketing can influence doctors' prescribing decisions and priorities. Several studies cited found that doctors view drug sales representatives as an important source of information. The document then outlines a proposed research agenda to further examine the extent and impact of pharmaceutical marketing, including potential costs and benefits to health systems and policies around transparency. It concludes by noting concerns that extensive marketing practices could undermine affordable medical care.
The document analyzes the use of strategic ambiguity in the American Medical Association's Code of Ethics through rhetorical analysis. It identifies examples of strategic ambiguity used to allocate power to physicians and mitigate their culpability. This ambiguity affects the interpretation of the code and the patient-doctor relationship dynamics. The analysis suggests that if patients can identify and address subtle persuasion techniques, they can regain power in the discourse.
Pathway studio reaxys medicinal chemistry schizophrenia presentation 063015Ann-Marie Roche
Drug discovery expert, Jim Rinker, will discuss the process for exploring drug targets for schizophrenia using the tools in Elsevier's R&D portfolio. This approach features a specific workflow between Reaxys Medicinal Chemistry and Pathway Studio. Beginning with mapping known schizophrenia drugs to regulators, Mr. Rinker will walk through the keys steps in finding the proper drug used to improve cognitive function. This step-by-step method of research and data extraction will demonstrate how using these platforms can help identify side effects, build a consensus model, properly profile drugs and effectively map cognition.
This document summarizes and critically analyzes research on prescribing psychotropic medications to children and adolescents. It finds five major flaws that undermine the scientific validity of key antidepressant and stimulant drug trials. These flaws include: 1) compromised blinding due to the use of inactive placebos, 2) reliance on clinician ratings over patient self-ratings, 3) short trial timeframes that do not reflect real-world use, 4) conflicts of interest from pharmaceutical industry funding and ties to researchers, and 5) minimization of risks and side effects in the presentation of results. The analysis aims to help clinicians evaluate scientific claims and inform children, families, and their own practices regarding the risks and benefits of medicating youth.
The Federation of State Medical Boards issued recommendations for physicians recommending marijuana as more states legalize medical and recreational use. The recommendations include: establishing a patient-physician relationship and not recommending marijuana for oneself; conducting an in-person evaluation before recommending marijuana; discussing risks/benefits and obtaining informed consent; creating a written treatment plan not exceeding 12 months; monitoring the patient's response; and referring patients with substance abuse issues. The recommendations aim to provide guidance to physicians as state and federal laws conflict regarding marijuana.
The Impact of Ethnicity on Anti-depressant TherapyThe Case .docxrtodd33
The Impact of Ethnicity on Anti-depressant Therapy
The Case: The man whose antidepressant stopped working.
Gathering information on physical assessment is essential in the management and treatment of the patient’s conditions like depression. The participation of a family is vital in the overall treatment of a person who has a mental disorder.
The three questions necessary to ask the patient with depression are: “How do you feel about being retired?” ; “Can you tell me about your family?”; and “ Are you having thoughts of harming yourself?” The first question will explore the extent of financial demand on the patient and will assess the feeling of guilt regarding financial constraints related to his chronic disease. The importance of financial challenge appeared as the primary stressor on the study on chronic disease and depression (Chan & Corvin, 2016). The second question determines how family relations affect the patient’s condition, whether he has a sound support system. The third question explores the patient's plan for himself.
The patient’s wife in the scenario is his support person. Family and social interactions appeared crucial to coping strategy even without resolution on the problem (Chan & Corvin, 2016). The following questions are necessary to determine how supportive is the patient’s wife: “Do you keep track of your husband’s medication regimen?” ; “ What are the things that you and your husband like to do?”; and “How do you feel about your husband’s illness?”
The first question determines the wife’s involvement in patient care and whether the patient is compliant with his schedules of medication. The second question explore the things that both patient and wife enjoy. The third question assesses how the patient’s wife handles his husband’s illness. The wife can be a husband’s caregiver, and such a job involves managing the patient’s treatment, side effects, and symptoms, which providing such care can be emotionally difficult (Nik Jaafar et al., 2014). Greater caregiver burden is associated with older adults with long-standing depressive manifestations (Marshe et al., 2017).
Physical Examination and Diagnostic Tests
Physical assessment on the patient’s head, thyroid, and nervous system is an appropriate action to rule out other causes of depression. Current studies affirmed a significant correlation between thyroid hormone imbalance in patients with MDD (Shen et al., 2019). The result of a physical examination will enable the provider to treat any condition that might have contributed to the patient’s depression. The patient may also benefit from HAM-D6 or melancholia sub-scale. The HAM-D6 is a focused version of the Hamilton Depression Rating Scale (HAM-D), an outcome measure in MDD (Dunlop et al., 2019). The test result helps identify the effect of an antidepressant (Dunlop et al., 2019). The result is beneficial and helpful in medication decision management.
Three Differential Diagnosis
The three differential diagn.
1) Benzodiazepine use in the US increases with age, from 2.6% of adults aged 18-35 to 8.7% of adults aged 65-80 filling prescriptions in 2008. Use is nearly twice as common among women as men.
2) The proportion of benzodiazepine use that is long-term (120+ days) also increases with age, from 14.7% of young adults to 31.4% of older adults.
3) About one-quarter of benzodiazepine users across all age groups receive prescriptions for long-acting formulations, despite risks of long-term use especially for older adults.
Developing a Shared Vision 1Unsatisfactory 0-710.00.docxhcheryl1
Developing a Shared Vision
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Unsatisfactory 0-71%
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Less Than Satisfactory 72-75%
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Satisfactory 76-79%
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Good 80-89%
89.00%
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Excellent 90-100%
100.00%
80.0 %Content
10.0 %Selection of Two Issues or Challenges From Among Those Provided in the Assignment Instructions
Identification /Challenges in health care organizations are not identified.
Issues /Challenges identified are not among those listed in the assignment instructions.
Issues /Challenges are identified but description is unclear or incomplete.
One issue/challenge is identified from among those listed in the assignment instructions.
Two issues/challenges are identified from among those listed in the assignment instructions.
70.0 %Compelling Memo Describing the Issues, Their Impact on the Organization, Opportunities for Improvement, and Recommendations
Memo addressed to ancillary staff is not provided or is incomplete.
Discussion of issues, their impact on the organization, and recommendations is unclear or disorganized.
Discussion of issues includes a brief description of organizational impact and recommendations.
Description of issues includes detailed information regarding organizational impact and opportunities for improvement but recommendations are lacking.
Comprehensive and compelling discussion regarding organizational issues, their impact, opportunities for improvement, and recommendations to foster a shared vision is offered.
15.0 %Organization and Effectiveness
5.0 %Thesis Development and Purpose
Paper lacks any discernible overall purpose or organizing claim.
Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.
Thesis and/or main claim are apparent and appropriate to purpose.
Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.
Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.
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Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.
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Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.
A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.
There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.
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DEBRA R. COMER CrossroadsA Case Against Workplace Drug TesLinaCovington707
This document provides arguments against workplace drug testing. It summarizes that drug testing may fail to deter the most harmful drug abuse and there is no conclusive evidence that it enhances productivity or safety. Further, positive drug test results do not necessarily indicate poor work performance and may be more common for some ethnic groups, risking discrimination. The technology of drug testing also has limitations as it can produce false positives and only detects prior drug exposure rather than impairment. Additionally, drug testing violates individuals' right to privacy. The document proposes that performance testing may be a less intrusive alternative to ensure workplace fitness.
This document provides guidelines from the CDC for prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. It summarizes that while opioids can provide short-term pain relief, there is little evidence for their long-term effectiveness and they present serious risks including overdose and opioid use disorder. It then outlines recommendations for clinicians on when to initiate or continue opioids, opioid selection and dosing, assessing risks, and addressing harms to improve safety and reduce risks of long-term opioid therapy.
1. The document discusses concerns about mental health medication use in Washington State Medicaid programs, including issues like inaccurate diagnoses, overprescribing of medications, high-risk patients, and regional variations in prescribing practices.
2. Data shows that antipsychotic drugs are a top expenditure and that some patients are prescribed multiple antipsychotics by multiple doctors, putting them at higher risk. Regional variations in excessive dosing were also found.
3. When data is shared across agencies and programs, it can help identify risks and reduce things like narcotic prescriptions, emergency room visits, and costs of care for high-risk patients.
Annotated Bibliography (sample)Bozarth, M.A. (1983). Opiate rewa.docxdurantheseldine
Annotated Bibliography (sample)
Bozarth, M.A. (1983). Opiate reward mechanisms mapped by intracranial self-administration. In J.E. Smith and J.D. Lane (eds.), Neurobiology of Opiate Reward Processes (pp. 331-339). Amsterdam: Elsevier/North Holland Biomedical Press. [This is an example of an article published in a book.]
This book chapter reviews data suggesting that the ventral tegmental area is critically involved in opiate reward. In addition it presents the first of several theoretical reviews by the author suggesting that opiate and psychomotor stimulant reinforcement involves activation of the same dopaminergic substrate. (By the mid-1980s the notion that different addictive drugs might share a common reward substrate would become paradigmatic for the study of drug reinforcement and addiction.) Control procedures and other methodological issues for conducting intracranial self-administration studies are also discussed.
Bozarth, M.A. (1987). (ed.) Methods of Assessing the Reinforcing Properties of Abused Drugs. New York: Springer-Verlag. [This is an example of a book citation.]
This book provides the definitive compendium of the experimental methods used to study drug reinforcement. Thirty chapters written by leading experts in each technique provide synopses of the experimental procedures. Both preclinical and clinical methods are presented, grouped by general approach (e.g., preclinical reinforcement studies, preclinical conditioning methods, clinical subjective-effects measures, clinical self-administration procedures). Most chapters present an overview and review of an experimental method, while some chapters provide original experimental data illustrating specific applications of a technique.
Interestingly, none of the researchers presented physical dependence tests as a method of assessing potential drug reinforcement; this is probably because of the editor’s assertion that physical dependence is not a primary motivation for drug-taking behavior and because of the obvious consensus shared by his contributing authors. The book sold-out shortly after its publication and has not been reprinted. It is, however, available in its entirety on the Internet at www.AddictionScience.net and can be downloaded chapter-by-chapter without charge.
Bozarth, M.A. (1987). Conditioned place preference: A parametric analysis using systemic heroin injections. In M.A. Bozarth (Ed.), Methods of assessing the reinforcing properties of abused drugs (pp. 241-273). New York: Springer-Verlag. [This is an example of an article published in a book.]
This chapter provides both a brief review and original data from the author’s extensive work using this experimental method. Although conditioned place preference appears to be a reliable and valid measure of potential drug reward, several experimental manipulations that usually have strong effects on conditioned responses had only modest effects on conditioned place preference. The author’s conclusion is that t.
The document discusses open data about medicines and drugs. It notes that there are over 4,600 known active pharmaceutical ingredients, including about 1,800 that are currently FDA-approved and marketed in the US. DrugCentral is an online resource that contains information on these drugs and their targets, with data on over 667 human proteins and 226 pathogen proteins that FDA-approved drugs act on. The document advocates for making more drug data openly available to further scientific understanding of medicines and discovery efforts.
Sexual dysfunction due to SSRI antidepressants: How to manage?Apollo Hospitals
Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of commonly prescribed antidepressants in clinical practice. Sexual dysfunction is a common side effect of SSRIs, which often goes unrecognized but adversely affects the quality of life of the patient. This review takes a look at the occurrence of sexual dysfunction among patients receiving SSRIs from a clinical viewpoint. The review explores into the possible reasons of such a dysfunction and the differential diagnoses to be entertained while dealing patients receiving SSRIs and experiencing sexual dysfunction. The review discusses the management strategies for addressing such dysfunction due to SSRIs, including cessation or reduction of dose, changing to another antidepressant, augmentation with another antidepressant, additional use of medications for erectile dysfunction and use of other add-on strategies. The choice of a specific strategy should be customized to individual needs of the patient.
Byock, I. (2016). The case against physician-assisted suicide and .docxjasoninnes20
Byock, I. (2016). The case against physician-assisted suicide and euthanasia. The Oxford
handbook of ethics at the end of life, 366.
The article is by Byock (2016) and it presents the case against physician-assisted suicide and euthanansia. It seems the source is arguing against allowing euthanasia and the physician assisted suicide. It presents the case that the euthanasia and suicide weakens the moral grounding as well as the structural integrity of the medical profession when it is allowed. This source is using evidence such as articles and peer reviewed sources to support the argument against euthanasia and physician assisted suicide. A counterargument for one of the provided sources could be that the euthanasia and physician assisted suicide has been used to alleviate suffering of various people who face pain in their lives. Personally, I believe the source is doing a good job of supporting its arguments because it has cited sources which are peer reviewed. At the same time, the authors have also cited each section with the source that has supported the argument. I think this source will be very helpful in supporting my argument because it has good points on why euthanasia and physician assisted suicide should not be allowed.
Brueck, M. A., & Sulmasy, D. P. (2019). The genealogy of death: A chronology of US
organizations promoting euthanasia and assisted suicide. Palliative &
supportive care, 17(5), 604-608.
The source is by Brueck (2019) and it looks at the organizations in the United States which promote assisted suicide and euthanasia. It seems the source is arguing that there are several organizations which continue to come up and exist over the years in the United States supporting euthanasia. The source is using evidence from peer reviewed sources such as journals and government registration documents. Official government websites and those of organizations are used as part of the material. A counterargument for one of the provided sources could be that these organizations have struggled to get euthanasia and assisted suicide legalized in the United States. Personally I believe the source the doing a good job in supporting its arguments because it has exhaustively looked at the genealogy of the organizations which have pushed for legalization of the two items over the years in the United States. I think this source will be very helpful in supporting my argument because it shows the organizations which have fought for the legalization but have failed over the years because of the approach and what they have stood for.
Elmore, J., Wright, D. K., & Paradis, M. (2018). Nurses’ moral experiences of assisted
death: A meta-synthesis of qualitative research. Nursing Ethics, 25(8), 955-972.
The authors of this article look at the moral experiences of nurses when it comes to assisted death. It seems this source is arguing that the experiences and perspectives of nurses are underrepresented in the ethical discourses about ass ...
Similar to Pharmaceutical Company Power Over the SSRI Prescription Habits of Physicians in the United States (20)
Byock, I. (2016). The case against physician-assisted suicide and .docx
Pharmaceutical Company Power Over the SSRI Prescription Habits of Physicians in the United States
1. Candidate Number: W09855
7SSHM612 Pharmaceuticals and Society
Pharmaceutical Company Power Over the SSRI Prescription
Habits of Physicians in the United States
Final Essay
MA Bioethics & Society
May 04, 2016
Word Count: 3,499
2. Introduc)on
Selec%ve Serotonin Reuptake Inhibitors (SSRIs) are a class of pharmaceu%cal drugs used for
the treatment of depression and have existed on the American market since the 1980s (Gorman,
1997, p. 90). The popularity of SSRI prescrip%ons in the United States has steadily increased since
their introduc%on, and they remain the most popularly prescribed class of an%depressant today
(Harris et al., 2009, p. 37; Kantor et al., 2015, p. 1829). Despite their popularity, many medical
professionals and academics have argued that there is liPle to no scien%fic evidence that SSRIs are
an effec%ve treatment for most forms of depression. If the evidence indeed demonstrates that
SSRIs are not effec%ve, how is it that SSRI prescrip%ons remain so popular in the United States?
In this essay, I will analyze the popularity of SSRI prescrip%ons in the United States using
“power as causa%on” theory, which explains social events or trends in terms of a cause-and-effect
rela%onship between actors exer%ng power over each other (McFarland, 2015). I will examine the
actors involved in the SSRI prescribing process, analyze how power is exerted by one actor over
another, and examine observable instances of how exer%ons of power can influence the SSRI
prescribing trends. I will narrow my focus to two actors— doctors and pharmaceu%cal companies
— and examine how pharmaceu%cal companies exert power over doctors in the prescribing
process. I will also sort my research of these power dynamics into three manifesta%ons of power
over the SSRI prescribing process: power over the depression narra%ve, power over informa%on,
and power over brand loyalty. I will conclude with arguing that while prescribing prac%ces have a
variety of influences, pharmaceu%cal companies have a significant amount of power over the
prescribing process. Understanding the power of pharmaceu%cal companies may help physicians
and policymakers overcome these influences to ensure pa%ents receive the best recommended
treatment for their depression.
Depression and SSRIs
Candidate Number: W09855; 7SSHM612 Pharmaceuticals and Society; Final Essay
2
3. The World Health Organiza%on (c2016) defines depression as a common mental disorder
than can have a range of emo%onal symptoms and be mild, moderate or severe in form.
Depression is commonly thought to be caused by low levels of the neurotransmiPer serotonin in
the brain (Goldacre, 2012, p. 256). An informa%onal leaflet (Eli Lilly and Company Limited, 2016)
for the SSRI Prozac (fluoxe%ne) explains that SSRIs are believed to relieve depression by increasing
the levels of serotonin. While this biochemical model remains the commonly understood cause of
depression, many health resources assert that the actual cause of depression is s%ll unknown
(Chwas%ak, 2003, p. 1304; Centers for Disease Control, 2016). It is also argued that the
biochemical model of depression and the significance of serotonin levels is fundamentally flawed
(Goldacre, 2012, p. 256; Healy, 2003 cited in Moynihan and Cassels [2005, p. 23]). Research also
suggests that clinical trials have failed to prove that SSRIs are effec%ve in relieving mild to
moderate depression because the SSRIs barely outperform placebos (Chwas%ak, 2003; FDA 2008
study cited in Healy [2009, p. 56]). Because SSRIs can also cause a variety of unpleasant symptoms,
the research that argues that SSRIs are no more effec%ve than a placebo in trea%ng mild and
moderate depression suggests that these drugs may not be a benefit to most pa%ents.
SSRI Prescrip)ons and Power
Despite the evidence cas%ng doubts on SSRI efficacy, the number of SSRI prescrip%ons in
the United States has con%nued to grow since SSRIs were first introduced. SSRI use in the United
States grew 147.5% during the 1990s (Skaer et al. 2000 study cited in Clarke and Gawley [2009, p.
91]). Between 1999 and 2012, SSRI use doubled and became the most popular prescrip%on for
trea%ng depression (Kantor et al., 2015). If a doctor’s duty is to prescribe the best possible
medica%on for a pa%ent, and the effec%veness of SSRIs are so seemingly ques%onable, what could
cause the con%nual popularity of SSRI prescrip%ons in the United States?
I will examine this phenomenon through “power-as-causa%on” theory, which seeks to
explain social trends or events in terms of a cause-and-effect rela%onship of actors exer%ng power
Candidate Number: W09855; 7SSHM612 Pharmaceuticals and Society; Final Essay
3
4. over each other. Ben Goldacre, in his book Bad Pharma (2012, p. 240) acknowledged the role of
power in the prescribing process when he described how the actors involved “exert pressure” on
one other. The poli%cal scien%st Robert A. Dahl (1957, pp. 202-203) defined power as: “A has
power over B to the extent that he can get B to do something that B would not otherwise do.” If
prescribing SSRIs can be construed as something a doctor “would not otherwise do” in light of the
evidence against SSRIs, the consistently high SSRI prescribing trends could be explained in terms of
actors exercising power over the prescribing process if a cause-and-effect rela%onship can be
established.
In my analysis of influences of power on the prescribing process, I will focus on the power
rela%onship between doctors and pharmaceu%cal companies, as they are the actors that form two
essen%al components of a prescrip%on; pharmaceu%cal companies manufacture the medica%on
for the prescrip%on, and doctors write the prescrip%on. I will examine the extent to which
pharmaceu%cal companies may have power to cause doctors to do something they “would not
otherwise do” (prescribe an ineffec%ve treatment). To analyze any kind of power rela%on, poli%cal
scien%st Andrew MacFarland (2015, p. 760) writes: “A statement of power then implies
observa%ons of instances of A changing B’s behavior. . . One first has to observe the causal
rela%onship; then one analyzes how power was wielded.” I have categorized my findings into three
expressions of power over doctors and the prescribing process: (1) pharmaceu%cal company
power over the depression narra%ve, (2) pharmaceu%cal company power over informa%on, and (3)
pharmaceu%cal company power over brand loyalty.
Pharmaceu)cal Company Power Over the Depression Narra)ve
Researchers Juanne Clarke and Adele Gawley (2009, pp. 94-99), in a review of ar%cles from popular
magazines between 1980 and 2005, found that the percep%on of depression in the United States
was not consistent within that 25 year period; in the 1980s, depression was viewed as “many
things” and its cause was “linked to normal events and social life” but in the 1990s, they found that
Candidate Number: W09855; 7SSHM612 Pharmaceuticals and Society; Final Essay
4
5. “depression becomes defined as biomedical” and “the vast majority of explana%ons were
scien%fic, technical, or physical explana%ons.” This rise in the cultural percep%on that depression is
biologically caused may be linked to the growth of an%depressants and how they were marketed
for the biochemical model of depression (Clarke and Gawley, 2009, p. 100; Moynihan and Cassels,
2005, p. 22-23). Ben Goldacre argues in favor of this theory:
The story of the serotonin hypothesis for depression, and its enthusias%c promo%on by
drug companies, is part of a wider process that has been called ‘disease mongering’ or
‘medicalisa%on,’ where diagnos%c categories are widened, whole new diagnoses are
invented, and normal variants of human experience are pathologised, so they can be
treated with pills (2012, p. 258).
Pharmaceu%cal companies that manufacture SSRIs have a vested interest in medicalizing and
propaga%ng a biochemical narra%ve of depression, because any alterna%ve explana%ons of the
cause of depression (such as nega%ve circumstances) that challenge SSRI sales will challenge
profits.
Pharmaceu%cal companies can influence the depression narra%ve through marke%ng. Large
pharmaceu%cal companies invest heavily in marke%ng and typically spend more money on
marke%ng than on research and development (GlobalData 2013 study cited in Anderson [2014]).
Pharmaceu%cal companies invest heavily in marke%ng because it is proven to work (Chew et al.
2000 study cited in Schweitzer, [2007, p. 85]; Spurling et al. 2010 systema%c review cited in
Goldacre [2012, p. 271]). Marke%ng can target the populace through direct to consumer
adver%sements (which is permiPed in the United States), and pharmaceu%cal marke%ng can also
target doctors through visits from pharmaceu%cal representa%ves, direct-mail promo%ons, medical
journal adver%sing, or con%nuing medical educa%on programs (Schweitzer, 2007, pp. 87-92).
How does influencing the dominant depression narra%ve influence the prescribing process?
If the widespread understanding of depression is biochemical causes, and SSRIs are marketed to be
the best treatment for these causes, pa%ents will be more likely to seek SSRIs as treatment for
Candidate Number: W09855; 7SSHM612 Pharmaceuticals and Society; Final Essay
5
6. their depression and doctors will be more likely to prescribe them. In addi%on, the very act of
seeing a doctor to request a specific drug has been shown to influence the prescribing process.
Anthropologist Joseph Dumit describes this effect through a 2005 study (Kravitz et al. 2005 study
cited in Dumit [2012, p. 56]):
Actors posing as pa%ents visited doctors, presented symptoms of depression, and in
some cases men%oned seeing a direct to consumer commercial and asked for a drug by
name. The troubling result by these “standardized” pa%ents was a profound increase in
prescrip%on rates for an%depressants.
The causal rela%onship observed is the research that shows that doctors’ prescribing trends
can be influenced by the marke%ng strategies of pharmaceu%cal companies. The way that power is
wielded in this instance is through marke%ng a biochemical model of depression alongside SSRIs as
a treatment. By changing the narra%ve of depression from social or circumstan%al causes to
biochemical ones, SSRIs become viewed as first-line treatments by both doctors and pa%ents.
Pa%ents become more likely to ask for SSRIs, and doctors are more likely to prescribe them.
Pharmaceu)cal Company Power Over Informa)on
The data gathered on drugs during clinical trials to test safety and efficacy is an incredibly
important component of understanding the effects that a drug may have on a pa%ent, making that
informa%on very important to doctors. In the US, pharmaceu%cal companies are ac%vely involved
at almost every stage of a drug’s development, which places them in a posi%on of influence over
the informa%on that makes it to doctors.
One significant issue is that of missing informa%on. Clinical trials that produce nega%ve
results are not open published, which can misrepresent the safety or efficacy of a drug. A single
favorable study may make a drug appear effec%ve, but six addi%onal studies that produced
nega%ve results would make the drug appear ques%onable. Research shows that pharmaceu%cal-
funded trials are more vulnerable to this kind of manipula%on. In a 2010 study of five hundred
Candidate Number: W09855; 7SSHM612 Pharmaceuticals and Society; Final Essay
6
7. clinical trials, 85% of the pharmaceu%cal-funded trials were posi%ve, compared to only 50% of
government-funded trials (Bourgeois et al. 2010 study cited in Goldacre [2012, p. 1]). Ethicist
Leonard J. Weber references a specific example from the history of SSRIs:
In the FDA review in 2004 of the safety/risks of suicide related to the use of [SSRIs] by
teenagers and younger children, one of the most significant points that came to light
was that companies had not made public the results of some clinical trials showing a
link between the drugs and suicidal behavior. . . It is not enough to publish only the
posi%ve results of studies” (Harris, [2004] cited in Weber [2006, p. 102-103]).
The structure of a clinical trial can also be manipulated to produce a favorable result. The
size of the study, the types of par%cipants recruited, and the type of control group are all variables
that can be adjusted to produce a favorable result. In a 2009 study (Kendrick et al.) of SSRI efficacy
when used in conjunc%on with suppor%ve care, the results indicated that prescribing SSRIs in
addi%on to suppor%ve care was more effec%ve than suppor%ve care alone. On the surface, this
conclusion appears to demonstrate that SSRIs are effec%ve, but the structure of the study was not
able to rule out the placebo effect, as the control group was not administered a placebo. Other
prac%ces that can misrepresent or hide clinical trial data include inten%onally stopping an
unfavorable study early before it can be published, and failing to give researchers who are wri%ng
the study access to all of the data (Weber, 2006, p. 125).
It is important to note that it is impossible for any doctor to review all of the data available
for a par%cular drug (Goldacre, 2012, p. 242). Research by Coleman et al. (1966 study cited in Lilja
et al. [2008, pp. 259-260]) demonstrates that physicians are more likely to be informed by a
network of colleagues, with medical “opinion leaders” (expert physicians of influence) in the
center of the network. Researchers Lilja et al. (2008, pp. 260-262) argue that these opinion-leading
physicians can affect the prescribing habits of other doctors, which makes them a target for
pharmaceu%cal company influence. Opinion leaders can be used by a pharmaceu%cal company to
increase the adop%on of a drug by other doctors in different ways. Physicians could be paid to give
Candidate Number: W09855; 7SSHM612 Pharmaceuticals and Society; Final Essay
7
8. talks or meet with other doctors to discuss the merits of a drug (Moynihan and Cassels, 2005, p.
39). Physicians could also be hired to be an “author” of a clinical trial that they were not involved
in or to sign their name to a favorable report wriPen by a pharmaceu%cal company writer (Weber,
2006, p. 125). Easch of these examples are instances of marke%ng that are presented to physicians
as expert opinion or knowledge. This prac%ce extends into the psychiatric world, and Moynihan
and Cassels argue that the endorsements of opinion leaders has demonstrably influenced SSRI
prescribing prac%ces:
By any objec%ve analysis, one of the reasons the SSRI an%-depressants were embraced
by prescribing doctors so fulsomely all over the world for so long was because the hard
work of detailers [pharmaceu%cal representa%ves] was backed with the credibility of
psychiatrist thought-leaders in the pay of the drug makers (2005, p. 40).
Opinion leaders can influence the prescribing habits of other doctors because their knowledge or
exper%se is valued or respected. When pharmaceu%cal marke%ng is disguised as expert
knowledge, “informa%on” of the merits of a par%cular drug is misrepresented.
The type of power wielded by pharmaceu%cal companies in these instances is an ability to
misrepresent, hide, or manipulate the scien%fic data about drugs that the medical community
relies on for prescribing knowledge. The cause and effect rela%onship between the concealment or
manipula%on of data and prescribing trends is apparent; if the best available informa%on is
withheld or misrepresented to any individual, they will be unable to knowingly act according to the
best informa%on available. The cause and effect rela%onship between “opinion leader”
endorsements and prescribing prac%ces can be seen through the research showing that leading
physicians have a strong influence on the prescribing habits of doctors (Coleman et al., 1966 study
cited in Lilja et al. [2008, pp. 259-260]). The extent to which pharmaceu%cal companies can buy
endorsements from opinion leaders that are disguised as expert knowledge to influence other
physicians is an instance of pharmaceu%cal power over the prescribing process.
Candidate Number: W09855; 7SSHM612 Pharmaceuticals and Society; Final Essay
8
9. Pharmaceu)cal Company Power Over Brand Loyalty
The American Marke%ng Associa%on Dic%onary (c2016) defines brand loyalty as, “The
situa%on in which a consumer generally buys the same manufacturer-originated product or service
repeatedly over %me rather than buying from mul%ple suppliers within the category.” To translate
this defini%on to the prescribing process, the doctor would be the consumer, and brand loyalty
would be wri%ng prescrip%ons for the same product rather than prescribing with more variety.
True loyalty between two actors is something that can never be elicited through force, but the
ability to win an individual’s loyalty s%ll usually involves possessing a level of power or influence.
As an example, a farmer from a small US town who decides to run for president may have the
charisma to gain a following, but may never aPract millions of supporters the way that a senator
with resources and poli%cal influence might. Pharmaceu%cal companies cannot force brand loyalty
on doctors, but they do have resources that could increase the likelihood that doctors consistently
prescribe their product.
It is important to note that there are many reasons a doctor could choose to consistently
prescribe one type of drug that are not connected to pharmaceu%cal exer%ons of power or
influence. Doctors could favor a drug that is most cost-effec%ve or the drug that is proven to be the
best on the market for trea%ng a certain condi%on, which are all mo%va%ons in the best interest of
pa%ents. Power would only be linked to influencing the prescribing process if it could be shown
that a doctor consistently prescribed a brand for reasons that offered no direct benefit to pa%ents.
One pharmaceu%cal marke%ng strategy that can elicit brand loyalty is the provision of free
drug samples to clinics. In 2004, $15.9 billion worth of pharmaceu%cal samples were distributed to
physicians in the United States (Kaiser Family Founda%on, 2005 cited in Schweitzer [2007, p. 89]).
Free samples are supplied to give doctors and pa%ents the opportunity to “try out” a new drug,
and doctors are shown to distribute these free samples among themselves and their pa%ents
(Weber, 2006, pp. 82-83). Free samples can be understood to benefit doctors and pa%ents, but as a
marke%ng strategy, the sole purpose of free samples is to encourage pa%ents and doctors to
Candidate Number: W09855; 7SSHM612 Pharmaceuticals and Society; Final Essay
9
10. exclusively use and prescribe these products. And providing free samples can influence the
prescribing process. One study (Chew et al,. 2000 study cited in Schweitzer [2007, p. 89]) found
that doctors will distribute samples even if it is not the drug they would have otherwise prescribed.
Physicians are also more likely to simply con%nue prescribing drugs that ini%ally began as a free
sample (Coyle, 2002 cited in Weber [2006, p. 84]). If pa%ents no%ce a favorable response using a
free sample, they are also more likely to request this drug from their physician in future
prescrip%ons (Schweitzer, 2007, p. 89).
Physicians can also be swayed when free samples create a gip rela%onship with
pharmaceu%cal companies. According to ethicist Leonard J. Weber (2006, p. 89):
Personally benefi%ng from sample medica%ons, like personally benefi%ng from other
gips, can compromise the physician’s independence and objec%vity. Gips of greater
value [drugs of higher costs] open have higher poten%al for giving rise to a sense of
indebtedness to the giver, and consequently, influencing and/or compromising behavior.
Moynihan and Cassels (2005, p. 24) agree: “Human beings have a natural tendency to want to
repay kindness, and the best way doctors can do that is by prescribing the products that the
detailers are pushing.” These are paPerns that exist throughout the clinical world, and are equally
true of SSRI samples on prescribing habits (Moynihan and Cassels, 2005, pp. 22-23).
Pharmaceu%cal companies spend billions of dollars on marke%ng strategies to elicit brand
loyalty prescribing from doctors. Providing free samples is one example of how pharmaceu%cal
power is wielded in this instance, as such tac%cs has been shown to influence prescribing habits.
This demonstrates a causal rela%onship between pharmaceu%cal exer%ons of power and the
prescribing process through marke%ng strategies to win brand loyalty.
Conclusion
Marke%ng and data misrepresenta%on are ways in which pharmaceu%cal companies can
wield power over the prescribing process. In the case of SSRIs and how doctors in the United
Candidate Number: W09855; 7SSHM612 Pharmaceuticals and Society; Final Essay
10
11. States con%nue to prescribe these an%depressants despite the academic and medical research that
asserts that these drugs are ineffec%ve at trea%ng depression, these prescrip%on trends can be
linked to these pharmaceu%cal company exer%ons of power. Pharmaceu%cal company marke%ng
has been argued to have had a profound impact on changing the narra%ve of depression into a
biochemical interpreta%on of depression that is best treated with SSRIs (Goldacre, 2012; Moynihan
and Cassels, 2005). This can impact the SSRI prescribing process by causing SSRIs to be viewed as a
first-line treatment, when in reality, other treatments may be more effec%ve. Pharmaceu%cal
company power over providing drug informa%on can also have a large impact on the prescribing
process, because incomplete informa%on prevents doctors from knowing what the best possible
treatment for their pa%ents may be (Goldacre, 2012; Weber, 2006). Efforts to market SSRIs under
the guise of “expert knowledge” through the hiring of “opinion leaders” further demonstrates a
level of pharmaceu%cal control over the kind of informa%on that is presented to doctors to inform
their prescribing habits. Lastly, pharmaceu%cal company power over brand loyalty can influence
the SSRI prescribing prac%ce by encouraging doctors to con%nually write prescrip%ons for the SSRI
drugs manufactured by the company. Through gip-giving or the provision of free drug samples,
these strategies have an effect on encouraging doctors to con%nue wri%ng prescrip%ons for the
medica%ons pushed by companies. This can cause prescrip%ons to be wriPen out of habit or upon
a pa%ent’s request rather than through serious evalua%on.
The power of pharmaceu%cal companies is not the only power that can exert influence over
the SSRI prescribing process, as pa%ents, government, and funders can also demonstrate a level of
influence (Goldacre, 2012, p. 240). However, the above cause-and-effect rela%onships indicate that
pharmaceu%cal companies have a fairly significant influence over the SSRI prescribing process, and
because pharmaceu%cal companies are mo%vated primarily by profits, the level of influence may
not always work in the best interest of pa%ents. Acknowledging the power that pharmaceu%cal
companies have over the SSRI prescribing process may help physicians and policymakers iden%fy
Candidate Number: W09855; 7SSHM612 Pharmaceuticals and Society; Final Essay
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