[corp-focus] Pharmaceutical Payola -- Drug Marketing to Doctors
robert weissman
http://www.multinationalmonitor.org/editorsblog
Pharmaceutical Payola -- Drug Marketing to Doctors
By Robert Weissman
May 16, 2008
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-Andri
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 theres no law
that says they cant."
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 companys 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 cant
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, <http://www.multinationalmonitor.org> and managing director of
Commercial Alert <http://www.commercialalert.org>, which advocates for
elimination of direct-to-consumer pharmaceutical advertising.
(c) Robert Weissman
This article is posted at:
<http://lists.essential.org/pipermail/corp-focus/2008/000289.html>
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Michael Givel
Why?
Because it works.
there's no law that says they can't."
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, <http://www.multinationalmonitor.org> and managing director
of Commercial Alert <http://www.commercialalert.org>, which advocates
for elimination of direct-to-consumer pharmaceutical advertising.
(c) Robert Weissman
This article is posted at:
<http://lists.essential.org/pipermail/corp-focus/2008/000289.html>
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