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Summary: decision analysis encourages one to consider all outcomes (and their probabilities), including those that involve side effects.

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I previously described decision analysis, a well-known framework for making an “optimal” healthcare decision. As a follow up, I described the patient and provider’s roles in a decision analysis (specifying utilities and probabilities, respectively). I will now discuss how decision analysis interacts with the pharmaceutical industry.

The pharmaceutical industry is essential to the healthcare system. Their medications help us—among other things—fight infections, prevent strokes, and treat cancer. The pharmaceutical companies make risky investments, and they stand to profit. However, it is important that the pursuit of profit not influence medical decision-making directly.

For example, a company might want providers to prescribe more medications, but this can be harmful to patients if the medications have adverse effects (e.g., consider the opioid epidemic). A decision analysis can protect the patient from this. In particular, in a decision analysis, the side effects appear in the utility function. One cannot ignore their importance.

Decision analysis also protects the patient from advertising. For example, advertisements often focus on favorable outcomes: we see patients in TV commercials that initially have incapacitating diseases but take medications and are shown to be laughing, dancing, swimming, flying a kite, etc. Although seeing patients participating in these high-utility activities might make the product more appealing to the viewer, decision analysis reminds us that it is not just the utility of these outcomes but their probabilities that matter. Even more, under a decision analysis, these probabilities are the provider’s territory, and they are tied to the medical literature.

Decision analysis also protects the patient from a company that tries to influence the provider. In a decision analysis, the provider’s role is confined to supplying the probabilities of outcomes, which are, as mentioned, tied to the literature. So, a company has less to work with in terms of influencing the provider—to do so, the company would have to influence the literature. They can try to do this. However, the literature—unlike a one-off medical decision—is generally scrutinized by multiple parties (competitor companies, researchers, regulators, the public).

In the end, although pharmaceutical companies take risks and have a right to pursue profit, decision analysis allows them to do so without influencing medical decision-making directly. In a sense, this allows them to achieve profit through good products rather than good tactics. This leads to better medications, better decisions, and healthier patients.