[corp-focus] Pharmaceutical Payola -- Drug Marketing to Doctors

[robert weissman]

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Pharmaceutical Payola -- Drug Marketing to Doctors
By Robert Weissman
May 16, 2008

Last week, a Congressional committee properly raked Big Pharma over the 
coals for misleading advertising of pharmaceuticals.

A hearing of the House Energy and Commerce Committee's oversight 
subcommittee focused on advertising campaigns for three drugs, including 
the remarkable case of Robert Jarvik. Jarvik is featured in endlessly 
re-run ads for Pfizer's blockbuster cholesterol drug Lipitor. Known as 
the inventor of the Jarvik artificial heart, he is not a cardiologist, 
not a licensed medical doctor and not authorized to prescribe 
pharmaceuticals. He's shown in the ads engaged in vigorous rowing 
activity, but in fact he doesn't row. Pfizer pulled the ads in February 
after controversy started brewing.

Among industrialized countries, only the United States and New Zealand 
permit drug companies to market directly to consumers. It's a bad idea, 
it drives bad medicine, and it should be banned.

But although it has the highest profile, direct-to-consumer advertising 
is a small part of Pharma's marketing machine. Researchers Marc-André 
Gagnon and Joel Lexchin conclude in a recent issue of the journal PLOS 
Medicine that direct-to-consumer ads make up less than a tenth of 
industry marketing expenditures ($4 billion of $57.5 billion in 2004). 
And Gagnon and Lexchin's estimate of $57.5 billion on marketing excludes 
many industry expenditures that are really driven by marketing, 
including clinical trials conducted for marketing purposes.

The bulk of the industry marketing effort -- more than 70 percent by 
Gagnon and Lexchin's calculation -- is directed at doctors.

Why?

Because it works.

The companies spend huge amounts paying firms that carefully track what 
doctors prescribe, and then they use the information to tailor messages 
to doctors, distribute samples and develop continuing medical education 
programs.

Gagnon and Lexchin report that Pharma spends more than $20 billion a 
year on "detailers" -- the pharma reps that knock on doctor doors, ply 
the staff with free coffee and lunches, distribute samples ($16 billion 
worth), and prod docs to prescribe their drugs.

This is complemented by a host of tactics that in other circumstances 
might be called bribes.

"Virtually all physicians in America take cash or gifts from the drug 
companies," says Melody Petersen, author of Our Daily Meds: How the 
Pharmaceutical Companies Transformed Themselves into Slick Marketing 
Machines and Hooked the Nation on Prescription Drugs, and a former New 
York Times reporter. "A recent survey said 94 percent of physicians took 
something of value from the drug companies. Some doctors take hundreds 
of thousands of dollars a year from these companies, and there’s no law 
that says they can’t."

Petersen says she "had no idea this was so extensive until one day I was 
writing a story about Celebrex and Vioxx -- this was before Vioxx was 
taken off the market. The story was about the marketing battle between 
these two pain drugs. I called one of the large societies of 
rheumatologists and asked for an expert on arthritis. I specifically 
said I needed an expert who was not being paid as a consultant to one of 
the manufacturers of these drugs. A staff person said, 'We have lots of 
people you can talk to, but all of these doctors are consultants to one 
or both of the drug companies.'"

Drug companies hire doctors to give lectures, and they hire other 
doctors as "consultants" to go to fancy dinners and listen to the 
lectures. "There are more than 500,000 of these dinners or events in 
America every year," Petersen says.

The drug companies weave these diverse strategems into an elaborate 
tapestry -- not infrequently to push drugs for inappropriate purposes. 
One eye-opening case that Petersen details in Our Daily Meds concerns 
Neurontin, a mediocre drug for epilepsy that Warner-Lambert illegally 
peddled as an unapproved treatment for bipolar disorder, migraines, 
attention deficit disorder in children and other conditions. The drug 
does not work for most of these conditions. Many persons were injured by 
taking excessive doses of Neurontin, and many others wasted money and 
emotional energy on hopeless Neurontin treatment strategies. 
Warner-Lambert ultimately paid $430 million to settle criminal and civil 
charges related to Neurontin marketing, but Petersen says that, even so, 
the illegal marketing scheme was clearly profitable for Warner-Lambert 
(and Pfizer, which acquired Warner-Lambert in 2000).

Petersen's account of the Neurontin nightmare draws heavily on a 
whistleblower, David Franklin. She summarizes the central theme of the 
story Franklin revealed: "The company got doctors to prescribe the drug 
for all these experimental uses by paying them. They paid physicians to 
give speeches to other physicians at restaurants or hotels or resorts. 
The doctors not only enjoyed a nice meal or a weekend vacation, they 
often also received a $500 check for attending. The physicians giving 
lectures at these parties were often trained by the drug company’s ad 
firm to describe how Neurontin could work for conditions like bipolar. … 
The company tracked the doctors’ prescriptions before and after these 
dinners or weekend retreats. The executives saw how well it worked."

Which raises an interesting question: How is that industry can so 
effectively manipulate highly trained doctors?

Answers Adriane Fugh-Berman, a doctor and Georgetown University 
professor who runs PharmedOut, a project that focuses on how 
pharmaceutical companies influence prescribing decisions and encourages 
physicians to educate themselves from non-industry sources: "Physicians 
are trained in medicine, not psychological manipulation. Every bit of 
flattery, friendship and information offered by reps is aimed at selling 
drugs."

There is no simple solution to these problems, though ending 
patent-based marketing monopolies would transform pharmaceutical 
marketing practices and likely eliminate most abuses.

In the meantime, a ban on Pharma gifts to doctors would be a modest step 
forward. In the United States, notes Petersen, "radio disc jockeys can’t 
take cash from music companies. But when it comes to something like 
medicines -- which mean life or death for people -- doctors can take as 
much money as they want from the drug companies. We need a law to stop 
that."


Robert Weissman is editor of the Washington, D.C.-based Multinational 
Monitor, <http://www.multinationalmonitor.org> and managing director of 
Commercial Alert <http://www.commercialalert.org>, which advocates for 
elimination of direct-to-consumer pharmaceutical advertising.

(c) Robert Weissman

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