No matter what condition you have, there is a pill for it. If there’s more than one pill for it, then the expensive one is the one to take. That seems to be the mentality of many doctors these days.

 

A recent study found that, when a doctor receives benefits from a drug company, they’re more likely to prescribe medications in general. The more money a doctor gets from the drug companies, the more expensive the drugs they prescribe. Another study found that pharmaceutical companies can influence doctors’ prescriptons just by buying them a meal. It’s a disturbing state of affairs.

 

Many of these problems are the result of myths that we have about the medical profession. One big myth is that doctors are more like scientists than artists, and that every decision they make is a calm, calculated judgment based on the scientific research and the patient’s particular clinical situation.

 

The reality is very different: most pharmaceutical products are approved on the basis of “non-inferiority,” which just means proving that the drug isn’t worse than the existing treatments. The “proof” for most drugs is little more than a clinical trial that showed one drug is equal to another drug. The drug companies almost never test drugs against lifestyle changes, like improved diets or more exercise, and they typically limit the studies to very narrow criteria that they can control. Many drugs are approved even when there is no showing of any benefit in patients’ health, but instead there’s a “statistically significant” improvement in some “surrogate marker.” The scientific community that has a name for one of the ways the drug companies make their drugs look useful: “p-value hacking.”

 

Which brings us back to the doctors. When a doctor is seeing a patient, how do they decide what to do next? Should they prescribe a drug, or should they encourage lifestyle changes? If they should prescribe a drug, which drug should they choose?

 

In most cases involving preventative medicine (instead of an acute problem that needs treatment immediately), neither of those questions has an obvious answer. So how do doctors decide? I might have a lot of questions about how the medical profession works, but I’m not so cynical to think that doctors are regularly prescribing a particular drug solely because that drug company has sent them samples, bought them lunch, or offered them a speaking opportunity or retreat. Instead, I think that many doctors don’t really have a strong view one way or the other, and so they go with what they know, and what they have a positive feeling about. Unfortunately, that means they often go with the most expensive drug, the drug so expensive that the drug company thought it was worth sending out a sales representative, buying the doctor lunch, or paying for the doctor to go on a trip.

 

Until these sorts of payments and benefits are tightly regulated, or until doctors learn to control themselves from this sort of influence, the pill-popping culture of medicine will persist.