Decisions Made Based on Marketing Budgets Rather than Medical Best Practice

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.

NO SUCH THING AS A FREE LUNCH

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.

WHAT YOU CAN DO

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:

  • Always ask about cheaper and/or generic drugs. As noted above, physicians are influenced by free samples of “new and better” drugs from pharmaceutical companies. But as we’ve said before in Daily Health News, it may be safer in many cases and also far less expensive to stick with older drugs with a long-established track record, unless there is a compelling therapeutic reason to take a new and more expensive drug. And, while it may be convenient when your doctor hands you a freebie, be sure to ask if the free product is really the right product. If a prescription was written, would it be for this product in this dose?
  • Speak up at the doctor’s office. Dr. Angell says she’d raise an objection if she happened to be sitting in a doctor’s office when a drug rep stopped by… and she urges us to do the same. Ask office staff how much time they give to the reps while their waiting room is filled and appointments run late. Share with them your concern that they are often being educated by recent college graduates with large expense accounts and no medical training. Ask what they’re doing to keep themselves apprised of the latest medical breakthroughs not funded or sponsored by drug companies. Other warning signs of drug company influence to look for in medical offices — pens, prescription pads and other trinkets with telltale drug company logos. If you see these, express your concerns to your doctor. If a physician asks if you mind if a drug rep comes into the exam room with you, don’t just object… get a new doctor. And finally, concentrate on staying healthy. That way you will see your doctor less, take fewer drugs, and help make your point in the most substantive way… by impacting cash flow.