Pharmaceutical industry research and marketing methods and relationships with prescribing providers pose numerous ethical challenges. The authors review the impact pharmaceutical treatments and their costs play in the overall health care system. Several problematic prescribing practices are described along with a discussion of how the pharmaceutical industry has contributed to these practices. The Food and Drug Administration and the legislation that guides it bear much responsibility for how the pharmaceutical industry performs, but is significantly impaired in its ability to sufficiently monitor and regulate some pharmaceutical industry practices. Although the pharmaceutical industry has made major contributions to the improvement of health through the introduction of newer and better therapeutic agents and through its support of physician education and patient access to some medications, it is nonetheless driven in part by its profit motivation, which may undermine some of its more noble goals. In particular the marketing methods utilized by the industry, including the use of pharmaceutical sales representatives, direct-to-consumer advertising, biased or misleading professional journal advertisements, and biased professional educational events, make it very difficult for prescribing providers to make rational and effective treatment decisions. The authors review how conflicts of interest can be avoided and how evidence-based decision-making may be accomplished. Many useful and less biased resources on drugs and evidence-based prescribing are provided. Key Words: drug industry, marketing, ethics, evidence-based medicin
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