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The prescribing of pharmaceuticals by health care providers is influenced by many factors. The significance of these factors is an important consideration to public health advocates and government agencies, health insurance companies, pharmaceutical firms, physician and provider associations, medical ethics researchers, patient consumers, and other stakeholders in health care. Better understanding the factors that motivate physician prescribing can bring about more efficient use of health care resources through the improved dissemination of information and more informed decision making. This paper attempts to provide a sound and inclusive review of the influences upon physician prescribing patterns in the extant literature. This review identifies several factors as being highly influential upon physician prescribing: peer influence, financial and managed care considerations, pharmaceutical representatives and drug samples, and direct-to-consumer advertising. To date, several key areas have not been well researched; these include the perceived price of a drug, the role of new technology, and the impact of physician experience. Based upon the literature review, a theoretical model of individual physician prescribing in the outpatient setting is proposed. Further research might be directed toward determining the influence of each factor upon physician prescribing and testing the overall model and interactions among its individual components. [ABSTRACT FROM PUBLISHER]

This paper examines the feasibility of achieving U.S. health care reform and prognosis for success. In order to accomplish the task, this paper provides a check list of major problems which emerge continually in the field. In compiling a list of major problems, a tentative list of eight are presented. These problems include the following: unnecessary administrative costs; other major industrial countries can provide adequate health care at a lower rate of the national budget than does the U.S.; increase in malpractice insurance; shortage of primary care physicians in the rural and inner city areas; failure of health insurance; abundance of technology; distribution of care; and increase in health care costs. According to the author, these eight major problems give some indication to the complexity of the issues involved in the health care reform. These problems should be viewed in the context of the five major participant groups in health care: consumers, politicians, physicians and other health care providers, employers, and insurance companies. This paper briefly discusses the affected participants. It also provides a brief review of the proposed solutions to the problem of health care reform.

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians' experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors hold nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging. [Supplementary materials are available for this article. Go to the publisher's online edition of American Journal of Bioethics for the following free supplemental resource(s): An additional table (Table 5) referred to on p. 5] [ABSTRACT FROM AUTHOR]