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TechnoratiPharmaceutical Payola -- Drug Marketing to Doctors
Last week, a Congressional committee properly raked Big Pharma over the coals for misleading advertising of pharmaceuticals.
A hearing of the House Energy and Commerce Committee's oversight subcommittee focused on advertising campaigns for three drugs, including the remarkable case of Robert Jarvik. Jarvik is featured in endlessly re-run ads for Pfizer's blockbuster cholesterol drug Lipitor. Known as the inventor of the Jarvik artificial heart, he is not a cardiologist, not a licensed medical doctor and not authorized to prescribe pharmaceuticals. He's shown in the ads engaged in vigorous rowing activity, but in fact he doesn't row. Pfizer pulled the ads in February after controversy started brewing.
Among industrialized countries, only the United States and New Zealand permit drug companies to market directly to consumers. It's a bad idea, it drives bad medicine, and it should be banned.
But although it has the highest profile, direct-to-consumer advertising is a small part of Pharma's marketing machine. Researchers Marc-André Gagnon and Joel Lexchin conclude in a recent issue of the journal PLOS Medicine that direct-to-consumer ads make up less than a tenth of industry marketing expenditures ($4 billion of $57.5 billion in 2004). And Gagnon and Lexchin's estimate of $57.5 billion on marketing excludes many industry expenditures that are really driven by marketing, including clinical trials conducted for marketing purposes.
The bulk of the industry marketing effort -- more than 70 percent by Gagnon and Lexchin's calculation -- is directed at doctors.
Why?
Because it works.
The companies spend huge amounts paying firms that carefully track what doctors prescribe, and then they use the information to tailor messages to doctors, distribute samples and develop continuing medical education programs.
Gagnon and Lexchin report that Pharma spends more than $20 billion a year on "detailers" -- the pharma reps that knock on doctor doors, ply the staff with free coffee and lunches, distribute samples ($16 billion worth), and prod docs to prescribe their drugs.
This is complemented by a host of tactics that in other circumstances might be called bribes.
"Virtually all physicians in America take cash or gifts from the drug companies," says Melody Petersen, author of Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, and a former New York Times reporter. "A recent survey said 94 percent of physicians took something of value from the drug companies. Some doctors take hundreds of thousands of dollars a year from these companies, and there's no law that says they can't."
Petersen says she "had no idea this was so extensive until one day I was writing a story about Celebrex and Vioxx -- this was before Vioxx was taken off the market. The story was about the marketing battle between these two pain drugs. I called one of the large societies of rheumatologists and asked for an expert on arthritis. I specifically said I needed an expert who was not being paid as a consultant to one of the manufacturers of these drugs. A staff person said, 'We have lots of people you can talk to, but all of these doctors are consultants to one or both of the drug companies.'"
Drug companies hire doctors to give lectures, and they hire other doctors as "consultants" to go to fancy dinners and listen to the lectures. "There are more than 500,000 of these dinners or events in America every year," Petersen says.
The drug companies weave these diverse strategems into an elaborate tapestry -- not infrequently to push drugs for inappropriate purposes. One eye-opening case that Petersen details in Our Daily Meds concerns Neurontin, a mediocre drug for epilepsy that Warner-Lambert illegally peddled as an unapproved treatment for bipolar disorder, migraines, attention deficit disorder in children and other conditions. The drug does not work for most of these conditions. Many persons were injured by taking excessive doses of Neurontin, and many others wasted money and emotional energy on hopeless Neurontin treatment strategies. Warner-Lambert ultimately paid $430 million to settle criminal and civil charges related to Neurontin marketing, but Petersen says that, even so, the illegal marketing scheme was clearly profitable for Warner-Lambert (and Pfizer, which acquired Warner-Lambert in 2000).
Petersen's account of the Neurontin nightmare draws heavily on a whistleblower, David Franklin. She summarizes the central theme of the story Franklin revealed: "The company got doctors to prescribe the drug for all these experimental uses by paying them. They paid physicians to give speeches to other physicians at restaurants or hotels or resorts. The doctors not only enjoyed a nice meal or a weekend vacation, they often also received a $500 check for attending. The physicians giving lectures at these parties were often trained by the drug company's ad firm to describe how Neurontin could work for conditions like bipolar. ... The company tracked the doctors' prescriptions before and after these dinners or weekend retreats. The executives saw how well it worked."
Which raises an interesting question: How is that industry can so effectively manipulate highly trained doctors?
Answers Adriane Fugh-Berman, a doctor and Georgetown University professor who runs PharmedOut, a project that focuses on how pharmaceutical companies influence prescribing decisions and encourages physicians to educate themselves from non-industry sources: "Physicians are trained in medicine, not psychological manipulation. Every bit of flattery, friendship and information offered by reps is aimed at selling drugs."
There is no simple solution to these problems, though ending patent-based marketing monopolies would transform pharmaceutical marketing practices and likely eliminate most abuses.
In the meantime, a ban on Pharma gifts to doctors would be a modest step forward. In the United States, notes Petersen, "radio disc jockeys can't take cash from music companies. But when it comes to something like medicines -- which mean life or death for people -- doctors can take as much money as they want from the drug companies. We need a law to stop that."
Robert Weissman is editor of the Washington, D.C.-based Multinational Monitor, and managing director of Commercial Alert , which advocates for elimination of direct-to-consumer pharmaceutical advertising.
(c) Robert Weissman
16 Comments so far
Show AllThe pharmaceutical companies are only after one thing and that is money. They do not care if the drugs that they are making will cause someone to die or need treatment from Narconon VistaBay. They are not worried about these things, they just want to get paid and they will do whatever it takes to get the money. I remember seeing the commercial for Lipitor and I never knew that he wasn't even able to give medical advice. Even though they say that direct-to consumer marketing doesn't show a high percent the fact is that it does reach them. It is hard enough to trust a doctors work ethics these days let alone believe what the TV is telling you is good for you.
Prescrire, published in France, and the Therapeutics Initiative, working in British Columbia, have been steadily chipping away at the pharmaceutical industry's pedestal. They do this by reminding physicians of their responsibility to review evidence of benefit (or none) versus harm in peer reviewed, randomized, controlled trials. Both have websites.
It's easy to keep drug sellers out of the office.
It's satisfying to teach people about the relative lack of a drug's effect, and the need to monitor for organ damage. The financial burden personally and to health care generally
from a drug such as lipitor is incredible. This is a drug which has been marketed for primary prevention of heart disease, and there is no evidence to sustain that claim. Diet and exercise are proven, but do not sell.
To all of the above.....
AMEN!
I find it interesting that most major "end days religions", have references to "pharma" in their respective "Bibles", an always on the wrong side of the scales.
Yet this little "Gem" rarely, if ever reaches the pulpits of the said priest crafts.
Logan G
Have you looked at the medication charts for people in longterm care?
It is very easy to rip Big Pharma. But the American public never takes any self-responsibility. Wonder why we need so many drugs? We lead sedintary lifestyle. The majority of the population eat too much, don't get enough excercise and are stressed out in our personal and professional lives. We put garbage in our bodies in the way of food (whether its processed or fruits and vegatables sprayed with pesitsides), and many still smoke. Perhaps if the general public took better care of themselves, perhaps we wouldn't necessarily need/want so many perscription drugs. If people would manage their personal health better the incidence of Type-2 diabetes and other vascular related diseases would drop. Blamming Pharma is the easy way out.
And PS - many physicians see the drug reps from multiple companies to get samples which they can give to their patients who have high drug co-pay's or no perscription coverage at all. Any good physician worth their degree (now I know a lot who are NOT worth their degree) would never let a two bit drug rep influence their prescribing habbits. But then again, it's easy to lay blame.
They are drug dealers, what do you expect?
Last Friday, Bill Moyers did an interview with Melody Peterson, former NYT reporter and author of the recently released "Our Daily Meds." They discussed all of the tactics that Big Pharm uses, including "renting" researchers to put their names on "studies" that run in medical journals.
Here is the interview:
www.pbs.org/moyers/journal/05162008/transcript2.html
One question. Are the pharmaceutical companies also
schmoozing your local pharmacist?
yogajan: If one of the surgeons or the nurse anesthetist need any information about a medication, it is easy to find it on the internet or a quick phone call to a local pharmacist.
There you have it. Tthe capitalists have totally ignored (or suppressed) the huge potential of the internet to streamline healthcare, in the managing of health records, doctor patient communication, and so on. Damn the efficiencies. They have to create demands out of thin air, and expand the economy at all cost. The "invisible hand" of the market has been handcuffed - by the fanatical "free market" capitalists. The people bear the burden.
This is disgusting. Why are drugs like Cannabis and Asprin vilified while artificial CRAP is given the Nobel Prize? I smell a rat- and it is not a living one. The Drug War has put 2 million in prison- thank the non existent god that it is not me yet. I hear getting on the net in prison is not that easy.
I have a BS in Genetic Biology so I know a thing or two about the human physiology. Where is Science? Where is Truth? These people are so disgusting. ARRRRGHHHH!! I am so frustrated.
The problem is not with Big Pharma, the problem is with doctors who allow themselves, for whatever reasons, to be used and manipulated.
Here's a solution, for example: when some drug sales-asshole shows up to push the latest repackaged shit, the doctor says, "Get the f**k out of my office."
Too difficult, Doc?
Big Pharma wanting to influence consumers and doctors (payola perhaps :)) in addition to the politicals in Washington? - Imagine my surprise. :)
Marketing is driving medicine, and I would imagine it would be safe to guess that all the marketing (to consumers and to providers) likely exceeds the costs of all the drug manufacturing and research, maybe by several multiples.
Who knows? Our government should, and probably doesn't.
America has millions of computers and little honest public AGGREGATED ACCOUNTING information on the combined activities of corporations (the shadow "paper citizens") that is useful to us actual people.
I wrote another post on this today on the article appearing also today about "Tier 4" drugs. It's not nice to copy long posts all over the place, so I won't. But that new related trend by insurance companies is something to think about. See: "Drugs, the Patient, and the Insurance Company".
Direct advertising to consumers is nonsense. You can't go to the market and purchase any of these drugs without a prescription. It is your doctor's job to prescribe the best medication for your condition. It is his job to understand the new drugs, their interaction with other drugs and all of the side effects. The drug companies can educate the doctors but it is still the doctor's job to learn as much as he can to be giving the right meds and doses to his patients. If the drug companies used the advertising monies to lower the cost of the drugs so more patients could have access to life saving meds it would be a boon for the pharmacies, not to mention the consumers.
I am the administrator of a surgery center for a group of plastic surgeons. We have a policy of not seeing any pharm reps. If one of the surgeons or the nurse anesthetist need any information about a medication, it is easy to find it on the internet or a quick phone call to a local pharmacist.
It is my opinion that we would not have a health care crises in this country, if the government would regulate the pharmaceutical/supplies companies and health insurers. I will not see that happen in my lifetime, because of the excessive lobbying by these industries.