Healthy Skepticism Library item: 7449

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: report

Center for Policy Alternatives
Prescription Drug Marketing
Washington, DC: Center for Policy Alternatives 2006
http://www.stateaction.org/issues/issue.cfm/issue/PrescriptionDrugMarketing.xml

Abstract:

Prescription drug prices are skyrocketing.
Prescription drugs are the fastest growing component of health care spending in the United States.1 From 2000 through 2004, prices for the most frequently prescribed drugs increased by nearly 25 percent.2 Rising drug prices prevent patients from getting the medicines they need, drive up health insurance costs, and make government health programs unaffordable.
Drug manufacturers market directly to doctors-a practice called “detailing”-to encourage them to prescribe the most expensive medicines.
Drug manufacturers spent $22 billion on direct marketing to doctors in the United States during 2003.3 That amounts to about $25,000 per physician per year.4 This money is largely spent on visits to doctors by drug manufacturer sales representatives, called “detailers.” Detailers promote the newest and most expensive brand name drugs. Studies have consistently proven that the practice of detailing causes doctors to prescribe the latest drugs-even when overwhelming medical evidence shows that less expensive, tried and true remedies would be significantly cheaper, equally effective, and in many cases, safer.5
Detailing by drug manufacturers has rapidly escalated.
Spending on marketing to doctors increased by 275 percent between 1996 and 2004, according to the Kaiser Family Foundation.6 The drug industry employed 87,892 detailers in 2001-a 110 percent increase from the 41,855 employed in 1996.7 There is now at least one drug detailer for every five office-based physicians in America.
The influence of detailers puts patients at risk.
The more doctors rely on drug detailers for information about prescription medicines, the less likely they are to prescribe drugs in a manner consistent with patient needs, according to numerous medical studies.8 For example, by the time Merck withdrew the anti-inflammatory drug Vioxx from the market, more than 100 million prescriptions had been dispensed in the United States-the vast majority written after evidence of cardiovascular risks was known. Internal company documents prove that Merck carefully trained its detailers to mislead doctors about the dangers of Vioxx.9
Because of detailers, government programs, private employers, and individual patients often pay too much for prescription drugs.
The job of drug detailers is to promote the newest and most expensive drugs, regardless of what is best for each patient. This drives up the cost of medicine for individuals, businesses, insurance programs, and state governments. For the 50 million Americans who do not have prescription drug insurance coverage, these prescriptions are virtually unaffordable.
Gifts to doctors give detailers undue influence.
Nearly all physicians accept gifts from drug detailers.10 Those gifts, worth billions of dollars, run the gamut from free pens, pads and drug samples to high-priced meals, trips and honoraria. Doctors concede that gifts are one of the main reasons they meet with drug detailers.11 As a result, the average doctor meets with detailers several times every month.12 Many doctors see drug detailers in their offices every day.
Prescriber reports give detailers undue influence.
Unbeknownst to most doctors, drug detailers have access to prescriber reports that let them know-right down to the pill-if their sales pitches are successful. Prescriber reports are weekly lists of every prescription written by every physician, excluding patients’ names.13 Data mining companies like Dendrite International, Verispan and IMS Health buy this information from pharmacies, pharmacy benefits managers, and insurance companies. Dendrite, for example, purchases information on 150 million prescriptions every month and currently has a database of five billion prescriptions.14 This data is sold to pharmaceutical manufacturers, who distribute doctor-by-doctor prescriber reports to their detailers. Prescriber reports allow detailers to target individual doctors and adjust sales pitches until they find the one that works best.15 This invasion of privacy provides absolutely no benefit to doctors or patients-it serves only to enrich drug companies and detailers.
The drug industry’s voluntary code of ethics for marketing isn’t working.
Lavish drug company gifts to doctors led the Pharmaceutical Research and Manufacturers of America (PhRMA) to adopt voluntary ethical guidelines in 1990. Those guidelines prohibited gifts worth over $100. In recent years, PhRMA has recognized the continuing problem of unethical marketing practices and issued a slightly revised voluntary ethical code in 2002, again with a $100 limit. But industry self-regulation has failed.
Vermont and Maine have enacted laws that control drug marketing practices.
In 2002, Vermont enacted legislation that requires drug companies to file annual reports with the state that disclose the value, nature and purpose of any gift, payment or subsidy worth over $25. The law applies to marketing activities to any physician, hospital, nursing home, pharmacist, or health plan administrator. Maine, Minnesota, West Virginia and the District of Columbia have adopted similar measures.
Endnotes
U.S. Government Accountability Office, “Prescription Drugs: Price Trends for Frequently Used Brand and Generic Drugs from 2000 through 2004,” August 2005.
Ibid.
Kaiser Family Foundation, “Trends and Indicators in the Changing Health Care Marketplace,” 2005.
There were 871,535 physicians in the U.S. in 2003 according to the American Medical Association, “Total Physicians By Race/Ethnicity-2003,” January 2005.
Dana Katz, Arthur Caplan, and Jon Merz, “All Gifts Large and Small: Toward an Understanding of the Ethics of Pharmaceutical Industry Gift-Giving,” American Journal of Bioethics, Summer 2003; Ashley Wazana, “Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?” Journal of the American Medical Association, January 19, 2000.
“Trends and Indicators in the Changing Health Care Marketplace.”
Tyler Chin, “Drug firms score by paying doctors for time,” American Medical News, May 6, 2002.
“All Gifts Large and Small” and “Physicians and the Pharmaceutical Industry.”
Rep. Henry Waxman, “The Marketing of Vioxx to Physicians,” based on documents received by the U.S. House of Representatives’ Committee on Government Reform, May 5, 2005.
“All Gifts Large and Small” and “Physicians and the Pharmaceutical Industry.”
Ibid.
Ibid.
Shannon Brownlee and Jeanne Lenzer, “Spin Doctored: How drug companies keep tabs on physicians,” Slate, May 31, 2005; Liz Kowalczyk, “Drug Companies’ Secret Reports Outrage Doctors,” Boston Globe, May 25, 2003.
Dendrite International, Inc., “Solutions: First Source Customer Insight-Longitudinal Prescription Data,” 2005.
For a sample “Physician Targeting Report,” see Paul Kallukaran and Jerry Kagan, “Data Mining at IMS Health: How we turned a mountain of data into a few information-rich molehills,” 1999.