Conflict of Interest

In an interesting discussion by Andrew Lakoff entitled “The Anxieties of Globalization: Antidepressant Sales and Economic Crisis in Argentina”, several themes arise in which the author questions the cause of a marked increase in antidepressant sales in Argentina at the end of the 1990’s. Although the tremendous increase in profit is interesting, what is worrisome is an unaddressed conflict of interest between Argentinean physicians, some of the major pharmaceutical corporations, and ‘audit firms’ (companies that collect and analyze data on pharmaceutical sales and physicians’ prescription behaviour which is sold to pharmaceutical companies).

Between physicians and pharmaceutical companies in Argentina, it was not uncommon for sales representatives to have structured an “informal gift economy in which doctors’ prescriptions were rewarded with foreign travel and other perks.” (Lakoff, 253) The relationship formed between these parties worked as a successful marketing tool to conform the prescription habits of physicians. The relationships of physicians with pharmaceutical companies in such scenarios are intertwined in a dangerous conflict of interest that ought not to occur. Though we would hope that their professional integrity not be compromised, one must still worry that the physician’s prescribing behaviours be unduly influenced by the trips and technology, (Or worse: access to the latest expertise and knowledge of drugs that is withheld when they do not chose to be bought) that they would receive should they meet their quota in sales of new SSRIs.

Physicians are further controlled by ‘audit firms’ which sell data to pharmaceutical companies, letting them know which physicians really are prescribing the most of a specific drug. These essentially tell the pharmaceutical sales reps who to befriend and provide the latest in empirical data or gifts. Conversely, it also lets them know which markets need their attention, who to push if prescriptions are low, and what data to follow to see trends about which drugs have potential to become more popular. Audit firms, like pharmaceutical companies, are therefore guilty of coercing the practices of Argentinean physicians; if not for expensive trips and technology, then at very least for access to information that has the potential to help physicians practice better medicine.

-JL

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