An Ethical Analysis of Pharmaceutical Industry Practices

Introduction

In the documentary Food Matters, several health professionals and experts discuss corrupt practices in the medical industry that undermine public health. Among the charges made is that the public is deprived of information on alternative forms of medicine that would be beneficial to their health because of the aggressive marketing tactics of pharmaceutical companies. The film interviewees note that a monetary relationship between drug companies, the government, and academic institutions creates an environment where pharmaceutical companies can promote drug therapy to the public without facing any significant challenges to on the efficacy of such treatments or the benefits of alternative treatments. While Food Matters only takes the side of alternative medicine advocates, research reveals the motivations that inform these practices in the pharmaceutical industry. The pressure for profits, the necessity of expanding their consumer base to develop markets, and the desire to meet the demands of consumers are among the less insidious motivations for engaging in high-stakes methods of promoting pharmaceutical drugs. Through the ethical lenses of utilitarianism, Kantian ethics, and social contract theory, it can be determined that the ethical implications of pharmaceutical industry practices are not as clear-cut as the documentary suggests. Depending on one’s moral perspective, the benefits to larger society of promoting drugs, even by less-than-honest methods, can outweigh the individual health consequences.

Utilitarianism

Utilitarianism provides a beneficial framework for examining the impact of moral decisions on a societal level. The ethical theory of utilitarianism is categorized under consequentialism, a moral philosophy that determines whether actions are wrong or right based upon the results that they yield (Shafer-Landau, 2012, p.124). A key aspect of consequentialism is that it solely focuses on the results of an action and does not take into account whether the intention behind an action is moral (2012, p.124). Utilitarianism is a consequentialist system of ethics that considers the principle of utility in determining the morality of an action. The principle of utility requires the individual to consider whether an action will optimize well-being in order to assess its morality (2012, p.126). Further, utilitarianism holds that individuals are members of a moral community, making it necessary to assess morality at a communal level (2012, p.128). Thus, utilitarianism is a beneficial framework because it enables the activities of the pharmaceutical company to be assessed at both an individual level, considering the harm its practices cause to individuals in society, as well as the societal level, considering the harm its practices cause to society as a whole.

From the perspective of the experts in Food Matters, the partnership between the pharmaceutical industry, the government, and researchers is primarily harmful to individuals and society. In the documentary, Ian Brighthope, a professor of nutritional and environmental medicine, asserts that 6,000 Americans die from the proper use of pharmaceutical drugs every year. Brighthope asserts that because pharmaceutical drugs receive little scrutiny, they are introduced to consumers with little oversight from the government and regulators. Additionally, he argues that the pressure to promote pharmaceutical drugs among doctors results in other forms of treatment, such as vitamin therapy, being overlooked or discounted by medical professionals. Thus, the harm that the cronyism between government and industry causes to individuals has wide societal implications because it compromises the efficacy of our medical system.

The pressure placed on the medical industry by pharmaceutical companies is well documented. Confirming Brighthope’s assertions, research determined that 77 percent of new drugs in 1995 were developed from studies that were funded by the federal government (Fish, 2003, p. 256). Further, research determines that the pharmaceutical industry primarily develops new dosage forms and combinations of existing drugs, questioning the industry’s commitment to developing new drugs that address public medical needs. Additionally, research determines that Fortune 500 drug companies spend 30 percent of its revenue on marketing directly to consumers rather than research and development and $13 billion per year on promotions (2003, p. 256). These findings confirm the contention that the pharmaceutical industry is primarily motivated by profits and holds less value in meeting the health needs of individuals. Further, the force exerted by such wide scale spending in the private industry is detrimental to society as a whole because it forces the medical system to conform to the profit motives of the pharmaceutical industry.

Yet, counterevidence determines that the actions of the pharmaceutical industry possess high utility. First, the pharmaceutical industry plays a significant role in the United States economy, accounting for over 11 percent of total healthcare spending and over 14 percent of total GDP (Chressanthis, 2008, p. 65). It can be noted that marketing is essential for protecting this important segment of the economy and preserving opportunities in the biomedical field. Second, supporters of pharmaceutical products establish that the medications developed by the industry have been demonstrated to improve the quality of life for patients, reduce medical costs of treating patients, and improving social efficiency overall (2008, p. 65). While the documentary claims that close relationships between the pharmaceutical industry and government entities can undermine scrutiny over industry practices, the act of actively promoting medications can be justified from a utilitarian perspective because it provides economic and medical benefits to society as a whole that outweigh the consequences to individual patients who may experience negative drug side effects.

Kantian Ethics

Kantian ethics is included under the category of deontological ethics. In contrast to utilitarianism, Kantian ethics considers the intent behind the actions to determine its morality. In order to assess the intention of an action, Kant considers the principle of universalibility, which holds that an act is only moral if its maxim can be applied universally (Shafer-Landau, 2012, p. 157). Further, the maxim under consideration is the principle of the action, which considers what action is taking place and why the action is taking place (2012, p. 157). Through an assessment of the principles that guide pharmaceutical industry practices, it can be determined that the industry’s marketing practices are unethical by Kantian standards.

The documentary Food Matters poses several allegations on the moral motives of the pharmaceutical industry. As the documentary implied, the industry is motivated to mislead the public on the efficacy and safety of drugs because it is motivated by profit. Researchers Cooper and Shriger (2005) also contend that the primary goal of pharmaceutical industries in advertising their products to medical professionals is to convince clinicians to prescribe the product (2005, p. 487). Further, the researchers confirm that the industry is willing to engage in deception in order to achieve this goal. In their study of 438 sample pharmaceutical ads, the researchers found that 29 percent contained no references to support the medical claims in the ads, and 6 percent of the drug ads contained errors in their citations (2005, p. 488). Additionally, the researchers found that of the 294 pharmaceutical ads that contained references to original research, 58 percent indicated that the research was conducted by an entity affiliated with the pharmaceutical company (2005, p. 488). As this study confirms, the practice of misleading medical professionals is widespread.

Yet, from a Kantian perspective, it can be assessed that this practice is immoral. Utilizing the categorical imperative, the following maxim can be stated: It is right to mislead individuals on the efficacy of a drug when misleading individuals will result in gain for a company or industry. As an examination of this maxim determines, neither the principle nor the justification of the principle are sound. First, it cannot be universally recommended that all people engage in misleading others. Second, the desire for economic gain is not a valid principle upon which one should act. Thus, despite the societal benefits that might come from expanding the availability of drug markets from the utilitarian standpoint, deontological considerations deem the practice of misleading medical professionals through faulty or unsupported advertisement to be unethical.

Social Contract Theory

Finally, social contract theory provides a framework for discussing the moral implications of pharmaceutical industry practices on society as a whole. In Food Matters, the interviewees are strongly critical of the legal relationship between the pharmaceutical industry and the government. As Fish notes, American taxpayers are implicated in pharmaceutical practices through the tax subsidies and credits that are provided for the research, development, and marketing of drugs (Fish, 2003, p. 256). As social contract theory posits, laws are just only if they reflect the terms of a social contract that people would accept under equal conditions and through reason (Shafer-Landau, 2012, p. 188-89). Thus, through the lens of social contract theory, it is necessary to determine whether the relationship between the pharmaceutical industry and society is one that reasonable individuals would agree upon.

As the critics in the documentary note, support of the pharmaceutical industry results in the suppression of non-pharmaceutical treatments and poses the risk of inappropriately prescribing medications to patients. However, from the perspective of the pharmaceutical company, the development and promotion of drugs can be seen as a response to the increased demands for their products. Increasingly, the general public is beginning to view medications as a method of preventing illness and enhancing wellness, rather than merely a method of curing disease (2001, p. 6). Further, aging baby-boomers have increased the demand for a variety of medications that will fix a wide range of medical ailments (2001, p. 6). Additionally, Schoeder asserts that the pharmaceutical industry has a moral obligation from a human rights standpoint to make its medications widely available in order to improve the quality of life for individuals (2011, p. 298). As Witty (2011) highlight, in poorer countries where there is less government stability to support pharmaceutical and business development, diseases are rampant among the population (p. 118). Further, with smaller markets, there is less of an incentive for drug companies to research the diseases that commonly afflict populations in less developed nations (2011, p. 118). Thus, it can be argued from the perspective of social contract theory that citizens of the United States benefit from the partnership between government and pharmaceutical companies. Through reasonable economic assessments, it can be determined that industry partnerships result in the widespread availability of medications that meet the medical needs of the population.

Conclusion

As an analysis of the relationship between the pharmaceutical industry and society reveals, there are no clear moral answers to the industry practices of heavily marketing and promoting drugs to American consumers. While the industry critics in Food Matters note that a conflict of interest arises when the pharmaceutical industry partners with government and other institutions to reduce the oversight over its products, it can also be argued that this practice expands the availability of medicine to the public. From a utilitarian standpoint, the economic and health benefits of making drugs immediately available to ailing individuals surpasses the risks of side effects faced by individuals. Yet, from a Kantian standpoint, the practice of misleading physicians and clinicians in order to increase the sales of new drugs is clearly unethical. However, the overall relationship between the pharmaceutical company and government can be seen as ethical from the perspective of social contract theory because the practice accounts for the higher access to medicine that individuals in developed countries enjoy. Thus, while specific sales and promotional practices of the industry might be seen as unethical, the overall relationship between the public and the pharmaceutical industry enjoys a strong ethical foundation.

References

Chressanthis, G. (2008). Pharmaceutical economics. Business Economics, 43(3), 65-68. Retrieved from http://search.proquest.com

Colquhoun, J. (Director), Ledesma, & C. (Director). (2008). Food matters [Documentary]. Australia: Aspect Films.

Cooper, R. J., & Schriger, D. L. (2005). The availability of references and the sponsorship of original research cited in pharmaceutical advertisements. Canadian Medical Association Journal, 172(4), 487-91. Retrieved from http://search.proquest.com

David, C. (2001). Marketing to the consumer: Perspectives from the pharmaceutical industry. Marketing Health Services, 21(1), 4-11. Retrieved from http://search.proquest.com

Fisher, M. A. (2003). Physicians and the pharmaceutical industry: A dysfunctional relationship. Perspectives in Biology and Medicine, 46(2), 254-72. Retrieved from http://search.proquest.com

Schroeder, D. (2011). Does the pharmaceutical sector have a coresponsibility for the human right to health? Cambridge Quarterly of Healthcare Ethics, 20(2), 298-308. doi:http://dx.doi.org/10.1017/S0963180110000952

Shafer-Landau, Russ. (2012). The fundamentals of ethics (2nd ed.). New York: Oxford University Press.

Witty, A. (2011). New strategies for innovation in global health: A pharmaceutical industry perspective. Health Affairs, 30(1), 118-26. Retrieved from http://search.proquest.com/docview/847269643?accountid=14068