By Marika Sboros

Is Big Pharma really as sinister as research suggests? Certainly, its products have been life-saving but also life-taking. And the world’s biggest pharmaceutical companies have long had unhealthy effects on economies in many countries. Consequently, people’s health in those countries has become secondary to Big Pharma’s profits.

It is especially the case in the US, which spends the most per capita on prescription drugs than any other country. Research by The Law Firm shows that Americans filled 4.3 billion prescriptions for $374 billion dollars in 2014.

Rebecca Hill has developed an innovative infographic for the personal injury law firm on how Big Pharma spends its money. (Scroll down  to view it below).  It highlights the effect of the spend on the health and finances of Americans, says Hill. It also reveals who spent the most money – Genentech, which spent $388 million in payments to 1,888 doctors. And it points the way forward to reducing the burden of Big Pharma on people’s health and pockets, she says.

That way requires re-educating doctors to overcome their reliance on drugs as first resort. Hill is a blogger and outreach co-ordinator, a graduate of  York University, in Ontario, Canada, who loves all thing tech and science. In the graphic, she refers to a  groundbreaking 2011 study in the JAMA (Journal of the American Medical Association) . Lead author of the study, titled Principles of Conservation, is Harvard Medical School internal medicine specialist Dr Gordon Schiff. Schiff is also associate professor of medicine at Harvard.

Rebecca Hill

The study authors say that drugs are the therapy physicians most frequently deploy. They need to learn to “think beyond drugs”.

“It is often impossible for patients and physicians alike to imagine ending a clinical encounter without a medication prescription,” they say. Likewise,  for most doctors, “it is equally unimaginable not to turn to the most up-to-date drugs” to help patients.

They prescribe “conservative prescribing”. They say that it’s an approach that goes beyond the oft-repeated physician’s mantra of “first, do no harm.” It sums up lessons from past experience and research demonstrating that doctors commonly use medications inappropriately and excessively.

Conservative prescribing also embodies a new construct, which they call the precautionary principle. It’s an ecologic paradigm that stresses forecaring. In other words, doctors learn to anticipate potential adverse effects even when science hasn’t fully established cause-effect relationships.

Rather than mainly prescribing drugs, doctors should broaden their repertoire to include effective counseling, the authors say. Doctors should also learn to prescribe exercise, physical therapy, diet changes, smoking cessation, orthotics, or surgery when appropriate. Substantial literature supports non-drug measures as initial or preferred therapy for a range of conditions that doctors commonly treat with drugs. Among these conditions are hypertension, diabetes, insomnia, back pain, arthritis, and headache.

The study authors say that mastering conservative prescribing is “especially important for young physicians and trainees”. That’s because they “lack historical knowledge of past drug harms and withdrawals from the market”.




Learning to prescribe is a skill, the authors say, just like learning to perform a procedure or becoming facile in physical examination. Medical schools relegate this important skill to a few pharmacology lectures on pharmacokinetics or dosing.

Other tips for doctors include to:

  • Start treatment with only one drug at a time, whenever possible;
  • Have a “high index of suspicion” for adverse drug effects (ADEs);
  • Educate patients about ADEs so they recognise these as early as possible; and
  • Learn about new drugs and indications from trustworthy, unbiased sources

Patients also have a responsibility. Hill says that staying informed helps people to make the best decision for their health. It also helps to prevent Big Pharma from “using their money and influence over trusted healthcare professionals”.