Marcia Angell, MD
Marcia Angell, MD, is senior lecturer in the department of social medicine at Harvard Medical School. She has held various editorial positions at the New England Journal of Medicine from 1979 to 2000, including editor-in-chief.
In 2004, the book The Truth About the Drug Companies: How They Deceive Us and What to Do About It by Marcia Angell, MD, a senior lecturer at Harvard Medical School, caused a stir when she unmasked the level of influence pharmaceutical companies have over decisions and recommendations made by all of our doctors. Sadly, the ruckus has calmed but nothing has changed. Medical consumers continue to be treated based on marketing messages rather than best medical practice. According to recent reports, pharmaceutical companies spent anywhere from $28 to $58 billion on promotional activities in 2004 and a report in the Journal of the American Medical Association recently disclosed that 90% of the money companies spend on marketing is directed toward physicians. In addition, researchers at a scientific meeting of the American Academy of Family Physicians reported that doctors who hand out sample medications are also more likely to write prescriptions for them. A survey of physicians last year found that nearly all doctors say they accept free drug samples, free meals and free travel from pharmaceutical and medical device companies or other industry representatives. It’s an issue getting more attention — and one we consumers can impact by speaking up when we notice these things going on, as they very definitely affect the care we receive.
Drug company representatives routinely bring meals and gifts to the staff at physicians’ offices and also wine and dine the doctors themselves. The indoctrination begins as early as medical school, where drug reps connect with hungry, sleep-deprived residents by bringing them pizzas and colas — not to mention free medical equipment, like stethoscopes that cost as much as $250 and are emblazoned with the name of the sponsoring drug company.
I spoke again to Dr. Angell about these latest reports. She told me that drug companies call these outreach efforts “education” — sponsoring educational dinners at fine restaurants and educational conferences in exotic locales such as Hawaii or Puerto Rico. Physicians go along with this and even receive CME (Continuing Medical Education, often required for licensure and admitting privileges at hospitals) credits at these junkets, but Dr. Angell points out that drug company activities are not education. What they are is marketing. There is no such thing as unbiased education from drug companies.
The bottom line is that the system should be changed, and laws should be enacted to bring a halt to these sorts of actions of pharmaceutical companies. Activists are working toward this goal, but let’s not sit around waiting for it. According to Dr. Angell, the important drugs don’t need big marketing budgets — they sell. Most marketing, she says, is for “me-too” drugs (trivial variations to expand the market of a major drug — for instance, there are six statin drugs similar to Lipitor). She believes, therefore, that the economic impact of cutting out inappropriate marketing would be huge — roughly 30% of their revenues. Strategies you can undertake on your own include: