Biomedical Engineering Reference
In-Depth Information
of a doctor and complying with that doctor's advice (Morgan 1991 ). Parsons' model
predicts a dominant role for the doctor, who uses her biomedical knowledge in a
paternalistic manner to prescribe a treatment that maximizes patient welfare but is
chosen with limited patient input (Charles et al. 1999 ). The white-coat model is
increasingly being challenged.
Recent evidence from the medical and pharmaceutical industries indicates that
therapy choice is increasingly the result of a joint decision-making process in which
both the patient and physician are asked to actively participate (Ding and Eliashberg
2008 ). Despite this evidence, the vast majority of applications of therapy choice,
both in economics and marketing, assume that the prescription choice is made by
the physician, assumed to be a perfect agent for the patient (Manchanda et al. 2005 ).
Even models that explicitly consider the dyadic nature of therapy choice, argue that
patients are not experts in biomedical issues and, therefore, “physicians, by training
and obligation, will not and should not let patients have more power over them”
(Ding and Eliashberg 2008 , p. 831).
However, four macro-trends are contributing to a fundamental change in societal
expectations about the roles played by physicians and patients in therapy choice
contributing to the emergence of patient empowerment , a new paradigm for medical
decision-making that defends the strengthening of the role of the patient in therapy
choice (Camacho et al. 2010 ; Epstein et al. 2004 ). The main trends are (1) the
importance of self-expression in people's lives, (2) demographic and lifestyle
changes, (3) technological developments (e.g., the availability of biomedical infor-
mation on the Internet), and (4) regulatory changes (such as more flexible regulation
of direct-to-consumer-advertising (DTCA) in the USA).
These four macro-trends combine to fundamentally change the medical decision-
making model and the way therapies are chosen. A consequence of this new envi-
ronment and the legitimate aspirations of many patients to participate actively in
their healthcare is that patient empowerment is increasingly seen as the normative
standard in medical decision-making (e.g., Epstein et al. 2004 ; Krahn and Naglie
2008 ). This patient empowerment paradigm also coincides with a more general
trend towards higher customer participation in the marketplace (Prahalad and
Ramaswamy 2000 ; Vargo and Lusch 2004 ).
The pharmaceutical industry, policy-makers, physicians, and patients cannot
afford to ignore the patient empowerment trend as it has the potential to fundamen-
tally change the patient-physician relationship and the way prescription drugs are
chosen during medical encounters. In other words, patient empowerment is driving
a paradigm shift in medical decision-making that will lead to fundamental changes
for pharmaceutical marketing. In particular, the trend towards patient empowerment
suggests the need for pharmaceutical firms to strengthen their focus on the patient
as the key stakeholder.
I will now briefly discuss each of the antecedents of the patient empowerment
paradigm in medical decision-making. In the next section, I will discuss the conse-
quences of patient empowerment on the role of the patient in therapy launch and
therapy promotion.
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