As I grabbed the Dispatch off my front porch yesterday, I was greeted by an interesting headline. Pfizer, the world’s largest pharmaceutical company, was fined $2.3 billion because of “unlawful prescription-drug promotions.” Apparently, the corporate giant encouraged its employees to shower doctors with financial perks and other incentives to get them to prescribe their medications for “off-label” indications. Many medicines are used to treat conditions for which they were not specifically approved by the FDA, but it is illegal for drug companies to market them as such.
The idea that what medicine we’re prescribed can be determined by something other than pure medical science – especially when that other something looks an awful lot like corporate greed – is infuriating and scary. But what really struck me about this story is what was behind it… literally. The entire back page of the front section of the paper was covered with a color advertisement taken out by a local grocery chain who – for a limited time! – is offering FREE 14-day supplies of antibiotics because they “Care About Your Health.”
Free prescriptions!? How does a store make money by giving away antibiotics? I’m no marketing guru, but I believe the term is “loss leader”: if you come in for the free antibiotics, the theory goes, you’ll also pick up some laundry detergent or beer or kitty litter and they’ll make a tidy profit. So why aren’t they giving away free milk, or Oreos (besides the obvious safety concerns over the stampede that would surely ensue)?
Maybe it’s because you can’t buy antibiotics without a prescription so they don’t have to worry about losing too much money. Or maybe it’s because the psychological associations we make with medicines are more powerful than the ones we make with Oreos (albeit not by much): on some level we’re all worried that we won’t be able to afford health care when we need it nowadays so the idea of getting vital medication for free really strikes a nerve.
You could argue that getting people to choose one pharmacy over another isn’t quite the same as promoting the use of a medication in a way it wasn’t intended, but you could also argue that it isn’t all that different either. Maybe you’re going on vacation next week and you’re already in your doctor’s office for a check-up and hey, it’s free, so you ask for a script “just in case.” Or you’re prone to urinary tract infections and money is tight this month so you want to get some antibiotics now while they’re free. Or your doctor tells you that you have a cold and you don’t really need an antibiotic but gives you a script for one to fill now in case it doesn’t get better by next week. In a real sense, these are all “off label” uses of antibiotics that occur all the time and that can have a negative impact on your health and the health of the community.
My point is this: the grocery store is doing exactly what Pfizer got in trouble for – using financial incentives to influence the behavior of health care consumers in a way that is more about profit than good medicine. The only difference (besides a few billion bucks, give or take) is that the people getting the perks are the prescribe-ees (i.e. us) as opposed to the prescribers. Whether that’s a good thing or not is up to you to decide, but either way, a big part of being an educated health care consumer is recognizing that when it comes to your health, there are often forces at work that you may not even be aware of.
John A. Vaughn, MD (OSU SHS)