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Government policy
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By poorly remunerating doctors and expecting hospitals to support themselves largely through the sale of drugs, government policy encouraged over-prescribing of expensive drugs and discouraged quality assessment and improvement exercises.
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Pharmaceutical industry
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By spending a large amount of money on drug advertising, gifts and financial "kick-backs" to doctors who prescribed their drugs drug companies encouraged excessive prescribing ("kick-backs" were particularly attractive given the low salary of hospital doctors).
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Hospital Drug and Therapeutics Committees
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Generally regarded as ineffective; in particular they provided no monitoring of prescriptions and little independent education to medical staff.
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Surgeons attitude and knowledge
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By being less interested in drugs than physicians ("operations were more important") misunderstandings were perpetuated such as, "new antibiotics are stronger"; "new drugs kill most germs"; "the bigger the operation, the greater the need for newer and stronger antibiotics".
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Deteriorating relationship between doctors and patients
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This led to doctors protecting themselves from being sued by prescribing unnecessary &/or expensive drugs; this practice was often acerbated by media reports of patients physically assaulting the medical staff &/or extorting money from hospitals when treatment failed.
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