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I read Marcia Angell’s argument about the influence of the pharmaceutical industry on American medicine through two lenses: that of a patient and that of a 25-year observer of nursing and health care.
As a patient, I’ve long held deep concerns regarding Big Pharma’s inordinate influence over medical practice, and Angell’s discussion only reinforces them. I am an aging boomer—64 years old—who recently suffered a preventable complication following surgery and needed numerous subsequent visits to medical specialists. I have become profoundly suspicious of what my physicians diagnose, how they prescribe, and what other treatment decisions they make. One need only sit in a physician’s waiting area to recognize that something is very wrong. As patients languish—sometimes for hours—drug company reps waltz in and out of the office and are welcomed with smiles and friendly small talk.
Thanks to Angell and others such as Jerome Kassirer—a former editor of the New England Journal of Medicine and author of On the Take, on the complicity of medicine and big business—I have become so skeptical about the invasiveness, test-intensity, and pharmaceutical-reliance of American medicine, that I routinely check with physicians and nurses I know in other countries to see how they would treat my medical problems. Often their recommendations are very different—lower-tech, fewer pills, more listening and watchful waiting. I worry for all those people who can’t pick up the phone and dial a doc or nurse in the Netherlands, Australia, Iceland, or Canada, like I can.
Which brings me to the second lens.
With rare exceptions, the physician-writers who have exposed drug-company influence on American medicine have not spoken much about what is happening to American nursing. It, too, is being contaminated by the pill pushers.
Although the public is often ignorant of this fact, nurses have a huge influence on patient care and safety. They are an important safety net—one that is now full of holes.
Some docs may not recognize how important nurses can be when it comes to prescribing and treating, but the pharmaceutical industry definitely does. Nurse practitioners (NPs), who also prescribe and treat many patients, are a prime target for the drug and medical-equipment industries.
I first became aware of the alarming relationship between NPs and industry when I was invited to speak to a class at a local university nursing program. The professor had distributed an editorial from the Journal of Pediatric Health Care entitled “Pharmaceutical Company Advertising Practices: Call to Arms.” Nursing PR maintains that nurses are “patient advocates,” and, unlike doctors, holistic practitioners much less likely to resort to the prescription pad. So when I saw the title of this article, I assumed that Bambi Alexander-Banys, the nurse who wrote it, would be critical of the stream of ads spewing out of the pharmaceutical volcano.
Wrong. She had a very different mission. Alexander-Banys understood that Big Pharma tries to influence consumers to “ask their doctor” about the latest expensive drug. But she was not concerned about patients. She worried that NPs were not getting their fair share of the requests. The ask-your-doctor mantra, she complained, ignores the fact that NPs prescribe as well. Her advice is to
take a moment during each visit from pharmaceutical representatives to share with them your concerns about their company’s advertising practices. Be as clear as possible and provide specific recommendations, such as changes in wording from ‘doctor’ to ‘physician or nurse practitioner’ or to ‘primary care provider.’
Concluding her appeal to NPs, she reminds them, “NPs provide a large percentage of primary care and write a great deal of prescriptions. NPs are a huge, and growing, source of revenue for pharmaceutical companies.” If you bargain with the representatives of Big Pharma, “The only sacrifice,” she writes, “is the small amount of time and energy required to speak with pharmaceutical representatives and write a handful of letters, clearly a tiny investment for such a large dividend.” There is of course another sacrifice, which she ignores: professional integrity.
Today nurses no longer have to beg to get noticed. Like medical conferences, nursing conferences are now heavily supported by pharmaceutical and medical-equipment companies, which, like the corporations advertising on public television and radio, demand more and more of the spotlight. Nurses, like physicians, are flown to exotic spots and showered with so-called educational presentations. When I mentioned this phenomenon to a very respected nurse-academic, I expected her to share my concern. Her response: “It’s about time we got ours.”
In my view, this outcome cannot simply be blamed on corporate medicine. It reflects the long-standing struggle between nursing and medicine. Nurses, understandably tired of being overshadowed and under-valued by their physician colleagues, react by taking whatever attention they can get. Big Pharma is ready and waiting to give it.
Some nurses are fighting valiantly to help their colleagues break the growing dependence on Big Pharma. But others jump onboard. What they refuse to acknowledge are the consequences of the bargain they are making. Nurses today are among the most trusted of professionals. In every public survey, respondents rank nurses as more ethical and honest than physicians. How long will that last, if nurses join doctors “on the take”? And what will patients like me do when there is literally no one to trust, no one whose advice is not tainted, no one who, as Nightingale and Hippocrates insisted, is committed to first do no harm?
Relationships between academic institutions and biotechnology companies create conflicts of interest that undermine the goals of academic medicine and harm the public.
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