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Opioid Epidemic

Recommendation 1a: Curtail pharmaceutical product promotion

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   The simplest way to curtail prescriber-focused marketing is for lawmakers to ban it outright. Some individual states in the USA and health care systems have restrictions of this form, but they are not national in scope. In contrast, in Germany, professional traditions and laws generally forbid the provision of gifts or benefits to physicians that could influence future prescribing decisions or could be considered a reward for past prescribing decisions. In 2018, Canada’s Health Minister finally asked opioid manufacturers to voluntarily cease marketing to physicians, and in 2019 Health Canada announced its intent to put formalized rules in place to legally restrict the content of such promotion.

   The Commission recommends that the USA make comparable national policy moves immediately. Because of its ability to mislead patients, including to the point where they pressure prescribers to make suboptimal care decisions, the Commission also recommends that the USA join the rest of the world in banning direct-to-consumer advertising of pharmaceuticals that makes therapeutic claims.

   Because the current members of the U.S. Supreme Court have ruled that corporations have the same speech rights as individuals, a ban on pharmaceutical advertising is unlikely in the near term. A less potent but still valuable interim alternative is to remove the ability of pharmaceutical companies to deduct the costs of advertising from their income when filing annual tax returns. This policy, which has been proposed both by Republican and Democratic U.S. Senators and by President Joe Biden would raise the cost of advertising relative to other investments the industry might make, for example in research and development.

   Last but not least, the Commission recommends that pharmaceutical industry involvement in the design and implementation of electronic prescribing systems be forbidden. Such systems should be designed solely to improve patient care and should not be exploited as a commercial platform.