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 the 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."
Note: I serve as managing director for Commercial Alert, which advocates for elimination of direct-to-consumer pharmaceutical advertising.
http://www.pbs.org/wgbh/pages/frontline/shows/other/etc/faqs.html
http://www.nybooks.com/articles/17244
http://www.motherjones.com/news/qa/2004/09/09_401.html
http://www.gooznews.com/archives/2005_01.html
http://www.citizen.org/pressroom/release.cfm?ID=954
Consumer advocates estimate that 75% of pharmaceutical companies' R&D expenditures actually go towards marketing concerns rather than the development of new drug compounds.
The first comprehensive study clearly shows that federal (U.S. government) laboratories are by far the leaders in technology transfer in the biomedical, biotechnology and pharmaceutical areas. In these areas, the federal laboratories and the Public Health Service (PHS) and its main component, the National Institutes of Health (NIH), are number one in:
inventions available for licensing;
patents received and patent applications pending;
inventions that have been licensed out; and
therapeutics in active development (even compared to the largest pharmaceutical companies), both in terms of those licensed out and those being developed internally.
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Corporate shills will do their best to convince us that pharmaceutical companies are justified in their pricing due to R&D; the book sited in this article [Our Daily Meds, by Melody Petersen] reveals that much of those supposed R&D expenditures are used to fund rigged clinical trials on drugs of questionable usefulness. The primary scientific research for NEW chemical compounds that may actually provide new useful drugs is most often performed by studies through the NIH, which is funded by we the taxpayers.
Pharmaceutical companies spend far more money in marketing and in efforts to repackage existing drugs [and in the instance of repackaging existing drugs the costs are written off as R&D expenditures].
The bottom line is that we have already paid for most of the innovation seen in truly new and useful drugs.
Everybody loves freebies. Free pen? Sure, grab it, and if it has the name of some drug and drug company on it, that makes it look exclusive - all the better. Post-It notes with drug names? Cool, especially if they're shaped like a brain or something (I have some of those). Clipboards with drug company logos? Fine. We'll take ANYTHING that's free and exclusive looking. The MDs usually get considerably more than pens and note paper - but it's still freebies. And being wined and dined is a nice perk for them, too.
When I was a grad student, I really learned to look for and grab any of those freebies. I think that even to this day, if someone was giving away free used jock straps, I'd take one. No, make that 2 - one for me and one for my spouse. And if they had LOGOs on them - I'd probably wear them on the outside of my clothes.
I am in the pharmaceutical research industry (research, not sales, never sales no matter how much they make) and spend a significant amount of time in medical offices. It never fails to amaze me how much useless, tacky, logo-and-catch-phrase emblazoned crap I see sitting around. I wonder sometimes if the sales reps aren't responsible for halving some offices' supply budget.
How many times I've wished that the pharma companies would the same or larger portion of their revenues on my area (R&D) as they do on marketing and advertising.
You are right about the tacky logo marketing stuf in the doctors offices. I was in a scheduler's office after a recent doctor appointment. She had a bottle of hand sanitizer with a pump top on her desk that was made to advertise Lexapro. It had the Lexapro name and marketing junk on it. I couldn't help to ask if sanitizing my hands with it would make me extra happy.
Thats tax deductible to the pharma ind. That tax money could be put to work for better purposes to be sure.
WE pay for that $57 Billion and get screwed by pharma in thanks.
Nothing like a congress that lets this kind of twisted operation rob their constituents blind...
We need new congressmen and women and NEW LAWS FOR THE PEOPLE NOT AGAINST THE PEOPLE. DUH