This was in an email newsletter from
http://www.yourlawyer.com/
Parker and Waichman
(received Sat 27th April). [from] Susan from AVN, Australia
Marketing Drugs in the 21st Century
The Pharmaceutical Companies� Double Barrel
Assault on the Public
For decades, the release of a new prescription drug
onto the market was a rather low-key affair. Publicly,
the event was usually marked by little more than a
news item. Serious media coverage was reserved for
major breakthroughs.
Advertisements, if any, appeared in medical
publications and were directed towards physicians who,
it was presumed, could separate the facts from the
"hype". Patients rarely saw these ads. Samples would
be disseminated to physicians and hospitals with the
hope that they would begin the use and then prescribe
the drug. Small promotional "gifts" to physicians
(pens, paperweights and the like) hardly insured the
commercial success of any drug. Moreover, there was no
direct contact between the pharmaceutical companies
and those who might ultimately use their products. In
fact, drugs were usually forced to succeed or fail
based upon their ability to work as promised while not
exhibiting any disastrous side effects.
Today, however, the rules of the game have changed
dramatically. Stiff global competition, the emergence
of generic drugs, the sky rocketing costs of research
and development, and massive damage awards and
settlements resulting form drugs that have caused
widespread catastrophic injuries, have led
pharmaceutical companies to rely on Madison Avenue and
questionable marketing practices, rather than the
safety and effectiveness of their products, to reap
billions of dollars in profits. Often, these
unconscionably large profits have come from
inadequately tested and hastily marketed drugs that
have caused untold suffering and death before being
pulled off the market by the FDA.
We hope the following will help our readers understand
the magnitude of the campaign that has been launched
against them by the pharmaceutical industry.
I. Direct-to-Consumer Advertising:
One of the most controversial marketing approaches
ever used by any industry is the direct-to-consumer
(DTC) advertising campaign with which pharmaceutical
manufacturers are now bombarding the public.
Advertisements for every conceivable type of
prescription drug are now commonplace on television
and radio as well as in print on billboards, trains,
buses, taxicabs and almost every newspaper and
magazine. Pitchmen (and women) range from famous
politicians (Bob Dole for Viagra) to athletes and
coaches (Dan Reeves for Zocor) to entertainers (Robert
Klein for Combivent) to "everyday people" suffering
from everything from herpes to acid reflux.
Consumers have no way to differentiate between
educational programs promoting their own welfare and
programs designed just to promote the welfare of the
sponsor." In fact, Dr. Shaw even went so far as to
state that the DTC advertising makes drug
manufacturers "health care information providers just
like doctors or hospitals." As a result, "they have
the responsibility to given them [the public] all the
facts". (EthicAd has spent a year developing the
EthicAd DTC standards with the assistance of the
pharmaceutical industry, consumer groups, health care
organizations and the regulatory community, in the
hope that such standards will serve as "a good
starting point".)
In the lead article of Worst Pills, Best Pills News
for March, 2002, (reprinted from the New England
Journal of Medicine 2002; 346: 524-526), its Editor,
Dr. Sidney Wolfe, notes that while "increased access
by patients to accurate, objective information about
tests to diagnose and drugs to treat illnesses is an
important advance, confusion arises when commercially
driven promotional information is represented as
educational." Dr. Wolfe acknowledges other articles
that raise several questions about DTC advertising
such as:
1. Is DTC advertising educational or emotional?
2. How often is it misleading?
3. Is FDA enforcement of advertising regulations
adequate?
4. What can be done to neutralize the effect of DTC
advertising?
5. Can DTC advertising, whose aim is to sell a
product, ever provide the type of information
consumers need?
Pharmaceutical advertising has always been regarded by
many as nothing more than "an attempt to get somebody
to buy something." Clearly, there is nothing scared
about pharmaceutical ads that would make them more
reliable or accurate than any other type of
advertising. In fact, DTC advertising suffers from the
very same shortcomings as advertising. In fact, DTC
advertising suffers from the very same shortcomings as
advertising in general which Canadian economist
Stephen Leacock characterizes as "the science of
arresting the human intelligence long enough to get
money from it".
Although Dr. Wolfe strongly recommends that the FDA
"crack down harder on misleading ads", he notes that
as DTC advertising has sky rocketed, there has been a
"significant decrease in the number of actions taken
by the FDA to enforce advertising regulations." Dr.
Wolfe sees this as the direct result of a "grossly
understaffed" Division of Drug Marketing, Advertising,
and Communications within the FDA and the fact that
the FDA lacks the authority "to impose civil monetary
penalties on companies even when the repeatedly
violate the law."
Although the pharmaceutical industry claims that DTC
advertising is an excellent way to educate consumers,
many physicians argue that their patients receive
unbalanced information that misleads them "into
believing that drugs are better than they actually
are.
Finally, what may be the best indication that DTC
advertising is paying big dividends to the
pharmaceutical industry is the fact that sales of the
50 most heavily advertised drugs accounted for 48% of
the $20.8 Billion increase in retail prescription drug
spending between 1999 and 2000. Those same 50 drugs
also accounted for about $41.3 Billion or 31% of the
entire amount Americans spent on all prescription
drugs in 2000. Thus, the $2.5 Billion spent on DTC
advertising in 200 amounted to a brilliant investment
by the drug industry. (Consider that Merck spent
$160.8 Million promoting Vioxx in 2000. In return,
Merck made $1.5 Billion from the sale of Vioxx alone
in 2000. In 1999, Vioxx sales were only $417 million.
The 360% rise in sales was primarily attributable to
the DTC ad blitz. Pfizer and Pharmacia which co-market
Celebrex spent $78.3 Million on DTC ads for that drug
which enjoyed sales of $2.6 Billion in 2000, an
increase of 78% over 1999.
Nancy Chockley, President of the National Institute
for Health Care Management Research and Education
Foundation (NIHCM) stated that DTC advertising is
"clearly becoming an important influence." Steven
Findlay, NIHCM's Director of Research Studies states
"DTC advertising does have a more than subtle effect
of steering millions of patients to ask for drug X
rather than another one." Significantly, however, the
drug industry's leading trade organization has denied
that there is any direct relationship between DTC
advertising and the dramatic sales increases for
prescription drugs. We leave it to our readers to draw
their own conclusion.
II. The Not-So-Subtle Seduction of the Medical
Establishment
No prescription drug can be even modestly successful
without the cooperation of tens of thousands of
physicians. In the end, pharmaceutical companies must
rely on individual physicians to write and re-write
the hundreds of thousands or millions of prescriptions
required to make a drug profitable. How is it that one
of the world's largest industries can base its very
survival on unpredictable acts of individuals over
whom it has no apparent control. The answer is quite
simples. The pharmaceutical companies do, in fact,
control much of the medical profession in the very
same way Pavlov controlled his dogs.
Promotional gifts have always been associated with
American business. Every type of industry has always
given away log-laden trinkets such as pens, key
chains, calendars, paperweights, letter openings,
coffee mugs, flash lights and, of course, free
samples. The goal of such "generosity" is no secret.
It is designed to remind potential customers of a
particular product t or company name as often as
possible. While this practice can sometimes be
"tacky", it is harmless enough when associated with
most products and services. Unfortunately, when it
comes to the pharmaceutical industry, the gifts
involved can be quite lavish and the goal can be much
more subliminal.
Traditionally, pharmaceutical companies would promote
goodwill and name recognition by the widespread
distribution of trivial gifts to physicians and
hospitals. Along with promotional information and free
samples of its products, a drug company would hand out
pens, pads, paperweights and the like through it sales
representatives.
Although these marketing techniques were
unquestionably designed to aid in the sale of
pharmaceutical products in some tangible, if not
measurable, way, there never seemed to be any
manipulative or coercive aspect to the practice.
In the early 1980's, however, changes in the
pharmaceutical industry apparently convinced drug
manufacturers that they needed to have more control
over the physicians who determined which drugs were
prescribed to the public. Higher research and
development costs, greater financial risks from
litigation and unsuccessful products, increased
competition, and the enormous profit potential for
"breakthrough" type drugs for HIV/ AIDS, cancer,
diabetes, obesity and other contemporary medical
problems seem to have made drug companies less willing
to leave the most critical aspect of the
pharmaceutical marketing cycle to chance. Thus, the
industry as a whole began to bombard the medical
profession with an array of lavish gifts and funding.
This has raised serious questions as to conflicts of
interest, medical ethics, manipulation and other
potential abuses which strongly suggest prescriptions
are now very often written as a direct result of the
quality of the gifts associated with the drug, rather
than the quality of the drug associated with the
gifts.
The following is only a partial list of the kind of
gifts and funding given out to members of the medical
profession:
1. Paid vacations.
2. Airlines travel miles awarded on the basis of
prescriptions written.
3. Complimentary meals and entertainment at Continuing
Medical Education (CME) courses.
4. Consultation fees.
5. Financial support of CME-accredited activities.
6. Sponsorship of psuedo-CME courses. (These are not
accredited and usually little more than thinly veiled
advertising campaigns)
7. Meals of all types ranging from buffets offered to
hospital residents, to lunches and dinners at the
finest restaurants for physicians and their families.
8. Funding for travel or lodging
9. Honoraria
10. Sponsorship of events for physicians and their
families at theme parks including meals, entertainment
and the use of the facilities.
In January of 2000, the Journal of the American
Medical Association presented an excellent Commentary
by Dr. Robert M. Tenery and Review by Dr. Ashley
Wazana on this subject. (JAMA, Vol. 283 No. 3). We
highly recommend both pieces, which are extensively
annotated, to our readers who wish to read more about
these controversial issues.
We also highly recommend David D. Kirkpatrick's
article entitled "Selling Happiness" in the May 15,
2000 issue of New York Magazine. Mr. Kirkpatrick has
certainly done his homework and everyone taking a
relatively new prescription drug of any kind would be
well served by reading this captivating expose of an
industry practice that uses "free gifts, dinners,
propaganda and research funds" to "capture the minds
of doctors". There can bee little doubt, if any, that
an industry that commands an army of 68,000 sales
representatives and spends $9 Billion dollars on
marketing to its target audience ($12,000 for each
doctor in the U.S.), wants (and gets) much more than
just name recognition. In fact, many suspect that the
degree to which many doctors now fund themselves
influenced by this highly questionable practice
borders on the unethical.
Dr. Robert Goodman, a New York internist, fed up with
this entire matter, has launched the "No Free Lunch"
campaign. His t-shirts, coffee mugs and pens read "NO
FREE LUNCH : JUST SAY NO TO DRUG REPS". He even has a
website, www.nofreelunch.org which includes "facts and
research about the influence of drug companies of
medicine." Dr. Goodman openly admits, "What really
annoyed me was physicians' willingness to be bribed."
Finally, we note that for the past 10 years, the
pharmaceutical manufacturers have been compiling
information on the prescribing patterns of the
nation's health care professionals. As a result of
buying all of the available information from
pharmacies, the AMA, and the federal government, the
drug industry has succeeded in compiling "prescriber
profiles" for just about every health care
professional who write prescriptions. These profiles
allow drug companies to target specific doctors or
geographical areas with promotional campaigns for
specific drugs or categories of drugs.
Although the pharmaceutical industry "has the best
market research system of any industry in the world"
according to Mickey C. Smith, a professor of
pharmaceutical marketing at the University of
Mississippi, many health privacy experts like Lawrence
O. Gostin of the Georgetown University Law Center,
regard such practices as "a fundamental violation" of
a physician's right to privacy.
Recently, an article by Dr. Ashley Wazana, in the
Journal of the American Medical Association, analyzed
29 studies on the effects of gifts to doctors. Dr.
Wazana's analysis concluded that doctors are
"influence able".
Thus, the one-two punch of DTC advertising and gifts
to health care professionals has succeeded in
generating ever-increasing revenues for the drug
industry. With such results, it is highly unlikely
that the drug companies will choose to police
themselves in either area. Clearly, the FDA, AMA and
the federal government must formulate, promulgate and
enforce standards and rules regarding both. In the
end, however, it is up to each health care
professional to guard against being unduly influenced
and each consumer to resist being flimflammed by an
industry that has demonstrated it is capable of doing
both when the price is right.