Big Pharm Bribes
Segment # 613
What a system - see below. The Big Pharm bribes are 1. Authorized through legislation 2. Made through media adverising and direct payments to doctors 3. Reported in a public database in the interest of transparency. Only in America. Yes only the USA and New Zealand permit this insanity.
The pharmaceutical industry wields significant influence over media advertising and utilizes extensive incentive programs to encourage doctors to use and prescribe their products.1 This control and these incentives are central to the industry's marketing strategies, particularly in countries like the United States where direct-to-consumer (DTC) advertising is permitted.
1. Control Over Media Advertising
The pharmaceutical industry’s control over media advertising primarily stems from its massive advertising budget, the regulatory environment that permits direct advertising to consumers, and the subtle ways it can shape the public narrative around health and disease.
Direct-to-Consumer (DTC) Advertising
Unique Permission: The United States and New Zealand are the only two countries that allow pharmaceutical companies to advertise prescription drugs directly to the general public on TV, radio, print, and digital media.3 In most other countries, prescription drug advertising is restricted to scientific or medical journals for healthcare professionals.
Advertising Spend: Pharmaceutical companies spend billions of dollars annually on DTC advertising, making them major advertisers and giving them considerable leverage with media outlets. This substantial spending can create a financial dependence for media companies, potentially leading to a reluctance to publish critical content about the pharmaceutical industry or its products.
Content and Regulation: The U.S. Food and Drug Administration (FDA) regulates DTC drug advertising, requiring a "fair balance" between a drug's benefits and its risks (including side effects and contraindications).4 However, critics argue that the sheer volume and emotional appeal of the advertising often overshadow the mandatory risk disclosures, which are frequently delivered quickly or in a subdued manner.
Shaping Public Perception
"Disease Mongering": Critics argue that advertising campaigns sometimes engage in "disease mongering," which involves broadening the definition of a medical condition or emphasizing the severity of a mild one to increase the number of potential patients who will seek treatment—and thus, the sale of the drug.5
Driving Patient Requests: DTC advertising is highly effective in prompting patients to ask their doctors for a specific, often expensive, brand-name drug.6 Studies show that when patients request an advertised drug, physicians are more likely to prescribe it, even when a cheaper, generic alternative may be medically appropriate.7
Content Marketing: The industry also influences public health discourse through unbranded content—materials that raise awareness about a disease state without naming a specific drug. This content often appears to be objective, educational material but primes the audience to accept a pharmacological solution, for which the company likely has a product.
2. Incentive Programs to Pay Doctors
Pharmaceutical companies invest heavily in marketing to healthcare professionals (HCPs), as doctors are the gatekeepers for prescribing medications. These incentive programs, often referred to as "payments" or "transfers of value," are regulated but are a common and effective industry practice.
Types of Payments and Incentives
Incentives range from small gestures to substantial financial compensation, and typically fall into the following categories:
CategoryDescriptionEthical/Legal Context
Consulting and Speaking Fees - Paying doctors to serve on advisory boards, present on the company's behalf (Speaker Bureaus), or consult on marketing strategies. This often involves high-value payments.Must be for bona fide services and paid at fair market value. Regulated by the Physician Payments Sunshine Act (U.S.) for transparency.
Food and Meals - Providing free, often modest, meals (e.g., lunch for a whole office) during a sales representative's visit or informational presentation.This is the most common and often smallest payment type. Even small payments have been shown to influence prescribing habits.
Travel and Lodging - Reimbursing doctors for travel, lodging, and other expenses to attend industry-sponsored meetings, conferences, or promotional events.The industry's voluntary code (PhRMA Code) restricts payment for non-faculty doctor's personal expenses for educational events to avoid it being seen as a gift.
Gifts and Educational Items - Historically included branded small gifts (pens, notepads), though these are now often restricted or prohibited by self-regulation (like the PhRMA Code) and institutional policies.Must be for the benefit of the patient or practice, not the doctor's personal benefit.
Grants and Research Funding - Providing financial support for research or Continuing Medical Education (CME) programs.Must be directed to the institution or program provider, not the individual doctor, to maintain educational independence.
The Incentive and the Impact
The primary incentive for the pharmaceutical industry is a return on investment in the form of increased sales. Numerous studies have found a correlation between payments to doctors and their prescribing behavior:9
Increased Prescribing: Physicians who receive payments from a specific pharmaceutical company are more likely to prescribe that company's brand-name drugs, even when equivalent, cheaper generic options are available.10
Prescription Volume: The association is often seen in the volume and cost of prescriptions, with paid doctors prescribing more of the promoted drug compared to their unpaid peers.11
Transparency and Regulation
In the U.S., the Physician Payments Sunshine Act (part of the Affordable Care Act) requires drug and device manufacturers to track and publicly report all payments and transfers of value greater than a certain threshold to physicians and teaching hospitals.
This information is available in the public Open Payments database, intended to increase transparency and mitigate potential conflicts of interest by allowing patients to see if their doctor has financial ties to a drug company.13
The Open Payments database is a crucial element of the U.S. government's effort to bring transparency to the financial relationships between the pharmaceutical and medical device industries and healthcare providers. It is a national disclosure program established under the Physician Payments Sunshine Act (part of the Affordable Care Act).
Here is a detailed breakdown of the Open Payments database:
What is the Open Payments Database?
The Open Payments database is a publicly accessible, searchable database managed by the Centers for Medicare & Medicaid Services (CMS). Its core function is to collect and publish data on payments and other "transfers of value" made by drug and device manufacturers to covered recipients.
Who is Required to Report (Reporting Entities)?
The entities required to report data are:
Applicable Manufacturers: Pharmaceutical companies, medical device companies, and manufacturers of biologics or medical supplies that are covered by Medicare, Medicaid, or the Children's Health Insurance Program (CHIP).
Applicable Group Purchasing Organizations (GPOs).
Who Receives the Reported Payments (Covered Recipients)?
The financial data is reported about specific healthcare providers:
Physicians (including doctors of medicine, dentistry, optometry, podiatry, and chiropractic).
Teaching Hospitals.
Non-Physician Practitioners (NPPs): This category was expanded in 2021 to include Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, Anesthesiologist Assistants, and Certified Nurse Midwives.
What Information is Included (Transfers of Value)?
The law requires reporting all payments and transfers of value of $10 or more, or aggregated payments that total over a certain annual threshold. The reported items fall into three main categories:
CategoryDescriptionExamples
General PaymentsPayments not related to a formal research agreement.Consulting fees, speaking fees, honoraria, meals, travel/lodging, gifts, educational materials, and charitable contributions.
Research PaymentsPayments made in connection with a formal research agreement or clinical trial protocol.Grants, funding for clinical trial expenses, or payments to investigators.
Ownership or Investment InterestAny ownership or investment interest (like stock options or partnerships) held by a physician or their immediate family members in a reporting entity.Value of ownership interest, payment for an investment interest.
Why the Database Matters
The Open Payments database serves several critical purposes:
Transparency: It allows the public, patients, and researchers to see which healthcare providers have financial relationships with drug and device companies.
Conflict of Interest: It helps identify potential Conflicts of Interest (COI). While a payment does not necessarily imply an improper relationship, studies have shown a strong correlation between receiving payments and increased prescribing of the paying company's brand-name products.
Informed Decisions: Patients can use the data to have a more informed conversation with their doctor about prescription decisions, especially concerning expensive, brand-name drugs.
Compliance: It encourages manufacturers and providers to be more mindful of ethical guidelines and anti-kickback statutes.
How to Access the Data
The data is available through the CMS Open Payments website (openpaymentsdata.cms.gov). Users can search by:
Individual Provider (name, state, specialty).
Teaching Hospital.
Reporting Entity (drug or device company).
The data is typically collected for the previous calendar year and is released to the public annually, typically in June, after a period where providers can review and dispute the information attributed to them.