Big Pharma and…everyone else

The proposed idea of nurses being used to rehabilitate the pharmaceutical industry’s image is a complicated one. Because nurses are being more recognized as key players in health care, they hold a huge responsibility in how they collaborate with and make decisions regarding pharmaceutical advocacy. Additionally, the advancing prescriptive authority in the nursing profession has made Nurse Practitioners (NP’s) a desirable target for drug representatives who see them as expanding opportunities to make more sales. On one hand, this strategy offers a potential plethora of advantages for both the nursing profession and the PhRMA company. Promotional gifts and seminars offered by many drug companies allow nurses to receive benefits such as work tools and continuing education credits that they might not otherwise be offered, thus making nurses a more susceptible target for pharmaceutical marketing schemes (Jutel & Menkes, 2009). Additionally, as nurses strive to enhance their professional role in health care, participating in some of the promotional events can allow them to obtain information about new innovations and updates in pharmacologic treatment options (Crigger, 2005).

 Furthermore, because NP’s have become more widely targeted, the nursing profession as a whole can use its association with drug companies as leverage for support in legislation for policy makers and stakeholders. By initiating a bond with pharmaceutical representatives, they can be enrolled to advocate for nurses in health care decision making, and further

promote growth of the profession. Likewise, the aforementioned bond between NPs and pharmaceutical companies can add many potential benefits to PhRMA: as NPs gain more support and prescriptive authority, there are more sales opportunities through nurses prescribing and recommending the company’s products. Additionally, nurses typically carry out orders and educate patients about their health and options; because nurses often display a caring, trustworthy image, patients may be more likely to accept treatment recommendations from their NP.
Conversely, the positive public perception of NPs may potentially be at stake by collaborating with pharmaceutical companies. Patients may question the integrity of the nurse-patient relationship, as well as the motives of the NP profession. Patients may perceive a nurse’s participation in pharmaceutical promotions as unethical, and conflicting with the patients best interests and the quality of care they receive. A recent study investigating the public’s perceptions of provider participation with pharmaceutical promotions found that a majority of patients believed that health care providers are greatly influenced by outside incentives from drug companies, and that the rising cost of medications were directly related to pharmaceutical provider marketing strategies and gift giving(Crigger, Courter, Hayes, & Shephard, 2009).

Because trustworthiness is a “cornerstone” of the nursing philosophy, any compromise in the trusting nurse-patient relationship may jeopardize the reputation of the nursing profession as a whole. The way a patient views a health care provider significantly impacts the patients perception of health beliefs and willingness to participate and adhere to a recommended plan of care. Therefore, it is crucial that nurses are not influenced by the conflicting obligations and biases often seen with participation in pharmaceutical marketing activities; providers must remain dedicated to keeping the patient’s best interest as their priority in decision making, and ensure they have the ability to recognize ethical dilemmas, and avoid situations that may compromise their moral judgment. Thus, providers must ensure that they fully acknowledge the impact of pharmaceutical marketing on the interest of the general public. The provision of free drug samples is a significant instance where a provider is faced with an ethical conflict of interest. Many providers will offer free samples to patients that are unable to afford the cost of treatment, believing they are serving the best interests of those patients in need. Further, it is often assumed that promotional accessories are afforded through the growing profits of the pharmaceutical companies supplying the products. However, they are often unaware of the financial obligations they are actually passing on to the public, ultimately, the expenses of these activities are obtained from the consumers that purchase their products. Additionally, newer samples that are intensely marketed are typically more expensive than older, similar drugs, and much of the cost is covered through increased federal taxes and higher insurance premiums, thus posing an undue burden of expenses to the general public (Crigger, 2005).

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My personal experiences with promotional gifting and incentive programs from pharmaceutical sales representatives have demonstrated an inevitable influence on patient care. While discussing treatment options and educating patients on specific drug regimens, it is convenient to offer samples to determine the best fit for a patient. For example, a patient seeking contraceptive methods can benefit from having a variety of different brands and methods that they can experiment with to find the right choice. Moreover, providing free samples can reluctance to try a treatment for fear of losing money if they are not satisfied with the outcome. If a patient is satisfied with a particular product, they are more likely to continue using it long term or in the future, thus fueling the pharmaceutical industry. It is without a doubt this practice has a significant influence on which drugs are prescribed, recommended, and sold. While pharmaceutical gifting can serve as a way to improve the quality of health care, the extent of these advantages is circumstantial; the ethical intentions of interest are questionable. This prospect has both positive and negative implications for how health care providers address pharmaceutical marketing strategies and the contribution to their professional practice. Due to the significant impact on the future of the health care system, provider approaches to pharmaceutical promotions must be carefully considered. Nurses especially, should be particularly aware of their increased vulnerability to intense marketing strategies, and should recognize the potential advantages and dangers of pharmaceutical marketing, and how it will affect their patients, their practice, and their contribution to the nursing profession.


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