Healthy Skepticism Library item: 17394

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Newspaper Article

Vogin GD
PhRMA Code: A Newsmaker Interview with John T. Kelly, MD, PhD
Medscape Medical News 2002 Aug 9

Abstract:

Editor’s note: On July 1, the Pharmaceutical Research and Manufacturers of America (PhRMA) instituted a new code that defines how drug industry representatives should interact with physicians and other healthcare professionals. The voluntary Code on Interactions with Healthcare Professionals, which covers business practices ranging from consulting agreements to entertainment to continuing medical education (CME) activities, comes at a time when the pharmaceutical industry is under intense pressure from policymakers and the public over the rising cost of prescription drugs. Medscape’s Cathy Tokarski recently spoke with John T. Kelly, MD, PhD, senior vice president of scientific and regulatory affairs at PhRMA, about the new code and its potential impact.

Medscape: Why did PhRMA decide it was necessary to issue a new code and set of guidelines?

Kelly: The code was developed by the executive committee of the PhRMA Board of Directors in the context of growing concerns about how pharmaceuticals are marketed to physicians. By taking the lead in addressing this issue, PhRMA has identified ways that individual pharmaceutical companies can conduct their marketing practices and avoid concerns about inappropriate influence on the prescribing practices of physicians.

Medscape: PhRMA notes that these guidelines are being released within a growing context of concern about how pharmaceuticals are marketed to physicians. Much of that discussion — and resulting political pressure — has focused on the cost of prescription drugs. Does PhRMA believe that broad adoption of these guidelines by the industry will relieve some of that pressure?

Kelly: Spending on pharmaceuticals is rising primarily because of increases in the use of pharmaceuticals rather than increases in the prices of medicines. Increased use of pharmaceuticals is the result of improved physician and patient understanding of the benefits of pharmaceuticals. Pharmaceutical marketing has played an important role in encouraging appropriate use of pharmaceuticals. Nevertheless, there is considerable scientific literature that shows that many effective medicines are underused. For example, statins and beta-blockers are underused in the management and prevention of heart disease; vaccines and smoking cessation products are underused; many other medicines are underused.

There is tremendous need to provide reliable and timely information to physicians about the benefits and appropriate use of pharmaceuticals. This is challenging because there is so much information about pharmaceuticals and this information changes frequently. I believe that these principles will guide and influence marketing practices and promote appropriate use of medicines.

Medscape: Some members of Congress and consumer advocates believe that pharmaceutical companies use overly aggressive marketing practices, resulting in certain products being overprescribed, especially some of the newer, more expensive drugs. Does PhRMA believe these new guidelines will address such concerns?

Kelly: Physicians, not pharmaceutical companies, are responsible for deciding which medicines to prescribe to their patients. The code establishes guidelines for how pharmaceutical marketing to physicians should occur. Individual companies are responsible for determining their marketing practices. My impression is that most pharmaceutical marketing practices are consistent with the code and that, when necessary, pharmaceutical companies are working diligently to modify their marketing practices to conform to the code. Providing accurate, reliable information to physicians and consumers in a manner that is consistent with the code meets a critical public health need to promote the appropriate use of medicines.

Medscape: How are physicians reacting when they hear that certain benefits they have become accussstomed to are no longer available?

Kelly: While some physicians may be disappointed at no longer receiving gifts such as pizza and golf balls or not being invited to attend expenses-paid conferences at resorts, the feedback I’ve received from many physicians and physician organizations indicates that most physicians are relieved that PhRMA has raised the standard with regard to the marketing practices. Many pharmaceutical representatives have expressed relief that the code affirms their important role in physician education.

Our challenge is to inform all physicians of the code and encourage them to consider the upside of not continuing to receive benefits to which some physicians and their office staffs may have become accustomed. My belief is that most physicians will embrace the code and few physicians will criticize it.

Medscape: How might the code change the way the industry has traditionally spent some of its marketing dollars?

Kelly: I see resurgence within the pharmaceutical industry of innovative thinking regarding effective strategies to inform physicians about the benefits of pharmaceuticals and redirecting marketing funds previously allocated to food, travel, and entertainment. I anticipate that CME activities could benefit from increased funding and more innovative formats.

Medscape: If certain traditional marketing practices are no longer permitted under the new guidelines, what can CME providers do to encourage commercial supporters to fund educational activities?

Kelly: Pharmaceutical companies have been very strong supporters of effective strategies to educate physicians. A wide variety of CME approaches are available — such as advertising in professional journals, meeting with individual physicians, and sponsorship of organized CME activities. I anticipate that pharmaceutical companies will evaluate these and other mechanisms of informing physicians about pharmaceuticals and attempt to identify the most effective strategies and techniques. There is broad recognition within the pharmaceutical industry of the value of CME. I anticipate that the pharmaceutical industry will continue to be a strong supporter of CME and will do so in a manner that is consistent with the new guidelines.

Medscape: What kinds of educational activities are doctors likely to see more of in the future?

Kelly: It’s somewhat speculative to try to predict how pharmaceutical sponsorship of CME will evolve as a result of the code. I anticipate that pharmaceutical companies will continue to try to identify more effective ways to provide reliable and timely information to physicians and consumers.

Each company makes decisions about the most effective way to market its products. Each company monitors the effectiveness of its marketing strategy. As most physicians now have access to the Internet and use the Internet in their clinical practice, I expect that pharmaceutical companies will evaluate potential ways to use the Internet to provide CME and other information about pharmaceuticals to physicians. As most physicians who use the Internet recognize, the Internet is a very effective and efficient tool to obtain reliable and timely information.

Medscape: As with all voluntary guidelines, compliance works well when everyone feels they have something to gain by adhering to them and something to lose if they don’t. What do member companies have to gain by complying with the new guidelines, or lose if they don’t?

Kelly: There is overwhelming support for the guidelines within the pharmaceutical industry. The PhRMA Board of Directors consists of the chief executive officers of the major pharmaceutical companies in the U.S. These leaders of the pharmaceutical industry have voluntarily adopted these principles. The code has been widely distributed within the pharmaceutical industry, the physician community, the media and elsewhere. PhRMA has made a significant effort to assure there is a broad awareness and understanding of the principles. The PhRMA leadership has established that adherence to these principles is the proper way to conduct pharmaceutical marketing to physicians.

I believe that these principles have had, and will continue to have, a major influence on pharmaceutical marketing practices. Pharmaceutical companies are making a concerted effort to manage their marketing practices according to the code and, where necessary, modify their marketing practices.

This code was adopted in the spring of 2002 and became effective on July 1, 2002. We’re already seeing the results of the code and will continue to see the results of these principles in the future.