Physicians routinely make prescribing decisions for all kinds of sensible, considered, rational reasons. However, the Nobel prize winner Richard Thaler suggested that all humans, to some degree or other, also incorporate psychologically driven “supposedly irrelevant factors” into their decision making (1).

Below are three reasons, specific to the pharmaceutical industry, why practitioners in - and commissioners of - physician prescribing research need to be especially aware of the existence of such factors. If acknowledged and understood, psychology can play a critical role in not only helping us to understand the “full picture” of prescribing behaviour, but also to understand why physicians sometimes appear - at least on the face of it - to be making “sub-optimal” decisions.

1. HIGH COMPETITION: First, the B2B pharmaceutical marketplace is “overwhelmingly crowded”, with differentiation a “challenge for all pharmaceutical organizations” (2). Given this busy environment, it is likely not all physicians will be aware of, inclined to, or able to become highly knowledgeable about every possible product available. As a result, psychological factors may play an enhanced role in decision making, such as for example the familiarity principle (3) – which can lead to an over-reliance on brands with which physicians are already familiar.

2. HIGH USAGE: Second, in the UK, the annual number of prescriptions dispensed increased by 65% from approximately 653 million in 1999 to 1,074 million in 2009 (4,5). Even at 1999 levels of busyness (and certainly now), many physicians are likely to have relied to some extent on psychological processes such as habits or heuristics – designed to conserve mental headspace in a highly challenging environment. Psychological factors such as habit can also be especially valuable in helping to explain why physicians may not (often understandably) always appear to choose what observers judge to be the “optimum” product.

3. HIGH INNOVATION: Finally, even before COVID-19, it is fair to say innovation levels were high in the pharmaceutical industry: a PwC report (6) found that pharmaceutical companies spend a significantly higher proportion of revenues on innovation than the average company. However, even if new products do produce vastly superior patient outcomes, will this automatically translate into increased usage? In an environment with high innovation, it becomes especially important to understand psychological factors that drive or inhibit take-up - such as for example level of risk aversion among physicians.

In summary, the above is not intended to suggest that psychological factors will always dominate for every physician – or that the specific factors referred to above will always be influential. However, given the three characteristics of the industry described above, an awareness of the importance of psychology is essential in any study seeking to understand physician prescribing.

Chris Harvey
Founder, Activate Research

References

1. Thaler, R. (2015). Misbehaving: The Making of Behavioral Economics. London: Allen Lane.
2. https://www.orientation.agency/insights/pharmaceutical-marketing-challenges
3. Zajonc, R.B. (1968). Attitudinal effects of mere exposure. Journal of Personality and Social Psychology, 9, 1-27.
4. Pearce D., & Goldblatt, P. (2000). United Kingdom Health Statistics. http://www.ons.gov.uk/ons/rel/ukhs/united-kingdom-health-statistics/2000/index.html.
5. Smith M., Sweet, D., & Holley, R. (2010). United Kingdom Health Statistics. http://www.ons.gov.uk/ons/rel/ukhs/united-kingdom-health-statistics/2010/index.html.
6. https://www.pwc.com/gx/en/pharma-life-sciences/assets/pwc-managing-innovation-pharma.pdf