Marketing and the pharmaceutical industry

[Aimless]

There you go Illusions scroll down for my input.

In fact, pharma companies typically spend more on advertising than on R&D. How's that for utterly stupid?

That is a mildly one-sided depiction though. Most of those advertising dollars aren't funneled into general advertising, but to advertising directly to doctors, hospitals, and other care facilities, which is somewhat less stupid.

Its only utterly stupid if the amount spent on marketing does not see its cost recouped in sales of whatever is being marketed.

For the company, but for the system it is always stupid.

With the obvious downside that the costs of medicine in general go up since all companies have to spend more on marketing to counter eachother's marketing.

A lot of medicine and medical devices are not directly advertised to patients, and instead is composed mainly of informational material, which is directed at the people which LF mentioned, or is informational material for a patient who is to medicine or a medical device already selected by their doctor to keep them informed about their treatment. This is material that generally has to be put out, otherwise how would a doctor or institution know whether or not to use a certain medication, device, etc.?

If a company makes more money due to their advertising than their advertising costs, how is this stupid? In addition R&D money for the next project has to come from somewhere.

Even if those sales are to people who went and asked their doctor and got on something they don't necessarily need? It's not just a profit/loss thing . . .

Somewhat . . . it depends on how honest the advertising is. Doctors should be choosing medication for patients based on the literature and not on junkets and chachkies they get from pharma sales people.... If pharma wants to get the word out on their products, it should be through professional seminars put on by third parties or some other controled means.

You're making this out to be far bigger than it is. What drugs and medicines are actually advertised to regular people in the media? Now compare that to the actual number of different drugs and medicine in existence/use.

The last part you mentioned is how things actually happen. However not all doctors or medical practitioners have the time to go to all of these events, so I'm not seeing what the problem is if a Sales Rep visits them at their office, institution, or hospital. Again, you're also making this out to be far bigger than it is. This is anecdotal evidence entirely, but the average Sales Rep I've ever seen, or heard about through other people, has mainly brought things like branded pens, sticky-notes, memo-pads, etc. with the most expensive things being lunch/food, or free samples.

I would also like you to consider that perhaps your opinions on these matters is heavily biased by the fact that your main experience with the sales of drugs, medicines, medical devices, etc. may mainly be from the viewpoint of a regular person outside the medical field, so the majority of medical advertising you have experienced is for things like Viagra, Zoloft, Prozac, Allegra, etc.

Main Edit: I'm wondering if instead this current mini-debate should be split off into a Medical Advertising thread so as to not completely derail a discussion about antibiotics and antibiotic resistance.

Stupid for the health care system as a whole. Not for the company.

The goal of the health care system is not to make as much profit as possible, but to increase the health of the population.

Advertisement wont bring more money to the system, but only shift profit from one company to another. Or do you think people will use more prescription drugs because of ads? That would be even dangerous (taking more drugs than needed).

TBH what I know, or more truthfully, my impression of the subject comes from some articles I've heard on NPR programs and some stuff I've read in Public Citizen mailings. I'd have to do some research to bring some actual evidence to the table. I'm not sure I'm interested enough to do that right now.... Do you work in or near the medical industry to have direct experience with pharma sales or is that knowledge via friends?

My first job was as a medical records file clerk, so occasionally we'd have drug reps and sales reps come in, and set their stuff up in the only large, open, available space we had, which was our lunch room. Besides their marketing material, which was either a video of some sort, power point presentation, or pamphlets detailing the purpose of whatever they were trying to sell, and all relevant data, studies, etc. they would at the minimum bring in pens and pads branded with whatever they were selling, and more often than not either bring in a catered breakfast or lunch for the office. By breakfast I mean bagels, with cream cheeses, jellies, and butter, along with orange juice and coffee. Lunch could be anything from Chinese to sandwiches, with coffee and soda. On rare occasions they might bring in a branded coffee mug or small clock or calculator. These aren't really extravagant affairs here. They'd also bring samples of what they were trying to sell sometimes, and this would be more useful to the patients than ourselves, as sometimes we could rack up enough free samples to make sure some patients who couldn't afford to, didn't have to pay for medication for a month or so.

My girlfriend works in a lab, and although they don't have drug reps come by, they do have sales reps, and mostly its the same spiel, minus the free samples, but with more ordering catalogs, posters, or whatever. This same thing seems to happen with other people I've spoken with in the medical field. Any of the more extravagant drug rep or sales rep things likely happen on much more rare occasions.

My last full time job however was actually to assist with production of animated videos or still imagery targeted at doctors, medical practitioners, patients, etc. to inform them about whatever medicine, drug, device, or procedure we were hired to produce media for. These would mainly be for internal usage, so this wouldn't be anything you'd see on TV, or anything a patient would see unless their doctor was considering it. In addition they weren't exactly like the ads you see on TV, they'd mainly explain how whatever it was operated, why it was better than its competitors, or better for a specific condition, study data to back this up (if available), and how it should be used. The media we created would also be shown at medical conferences if appropriate.

Some background on this business of spending more on marketing than on research:

http://www.sciencedaily.com/releases...0105140107.htm

CAM reported total promotion spending by the U.S. pharmaceutical industry as US$33.5 billion in their 2004 report, while IMS reported US$27.7 billion for the same year. The authors observed, however, important differences in figures according to each promotion category. By selectively using both sets of figures provided by IMS and CAM, in order to determine the most relevant data for each category, and adjusting for methodological differences between the ways IMS and CAM collect data, the authors arrived at US$57.5 billion for the total amount spent on pharmaceutical promotion in 2004. The industry spent approximately US$61,000 in promotion per physician during 2004, according to Gagnon.

(based on: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174966/)

That's a lot of pens

A long article by a physician (anecdotal, may serve to illustrate how things are sometimes done in this field):

http://www.nytimes.com/2007/11/25/ma...5memoir-t.html












Re. the remarks about the folly of spending so much on marketing, certainly they all have to spend a lot on marketing because if a company spends less than its competitors then it will lose out... Illusions mentions that it's only stupid if they can't recoup the costs of marketing through drug sales, and they probably can recoup those costs... but one wonders how they do so. Could those costs perhaps be reflected by the price of a given drug?

Proceed

[EyeKhan]

IMHO perscription pharms don't need to be marketed in the mass media to consumers. A doctor should determine what drug a patient needs based on a diagnosis of whatever's ailing them. There's no room for a patient going to a doctor and saying 'hey, how about that new drug; can I try...?' I have heard, but I don't have any sources, that pharma companies are suspected of spending more on advertising than on R&D. If this is true then there's more going on than what Illusions discussed and the argument for the high cost we American's pay for drugs - that is we subisidize drug development for the rest of the world by paying higher prices than anyone else - is invalid. (I happen to think its invalid regardless of what they spend on advertising, but that's a different argument...)

[Illusions]

A doctor should determine what drug a patient needs based on a diagnosis of whatever's ailing them.

How is a doctor to know what drug that should be though? Think hard on this one.

I'm also genuinely wondering what the forum thinks this marketing consists of, and also the likely costs breakdowns. For instance they say that "The industry spent approximately US$61,000 in promotion per physician during 2004, according to Gagnon." which Aimless then follows up with a comment about that being a lot of pens. Both the article and Aimless seem to equate the expenditures in a manner as if all of it is spent directly on doctors.

[wiggin]

A lot of the job that biomedical companies face today (not necessarily pharma) is educating the doctors and hospitals that will use their system/treatment. There's a lot of inertia in medicine, and unless you have eye-poppingly good improvements on best practice, you're going to need to make a decent sales pitch about why they should switch to your product. It doesn't mean this is leading to a poor patient outcome (though of course it can if doctors don't follow up with their own due diligence) - in fact, it theoretically results in improvements in the system.

I was just reading an interesting article about a robotic surgery startup that was talking to the head of Intuitive Surgical (the guys who make the da Vinci system), and the big takeaway lesson was that when you have a new product whose added utility isn't always obvious for the price, you really need to go to the healthcare administrators and doctors to get their buy-in if you want it to be successful. In this context, I think it's completely reasonable for a new biomedical product to be 'advertised' to healthcare professionals.

Obviously, some of the 'advertising' is less informational and more bribery, and should be strictly regulated (though I'm not in favor of government regulations on this - I think organizations like the AMA and local hospitals/institutions should pull up their own policies to deal with this - I know Hopkins has addressed this fairly aggressively). Furthermore, advertising complex prescription medications directly to patients is a bit iffy - but it might still be reasonable if the medication is a fundamentally new option as opposed to a slightly different formulation of the same drug.

[EyeKhan]

How is a doctor to know what drug that should be though? Think hard on this one.

Note, I'm talking about marketing to consumers - to patients - not educational seminars for doctors to bring up their awareness of some new drug.

I'm also genuinely wondering what the forum thinks this marketing consists of, and also the likely costs breakdowns. For instance they say that "The industry spent approximately US$61,000 in promotion per physician during 2004, according to Gagnon." which Aimless then follows up with a comment about that being a lot of pens. Both the article and Aimless seem to equate the expenditures in a manner as if all of it is spent directly on doctors.

What do you think its spent on? I'm sure sales people are a big expense. Educational seminars are a big expense (especially if you're flying doctors out to Las Vegas to attend... ). What else?

[Illusions]

Note, I'm talking about marketing to consumers - to patients - not educational seminars for doctors to bring up their awareness of some new drug.

I was quoting you, but the nature of my post was mainly aimed at Aimless, due to his commentary on the articles he posted.

What do you think its spent on? I'm sure sales people are a big expense. Educational seminars are a big expense (especially if you're flying doctors out to Las Vegas to attend... ). What else?

I was mainly trying to get people to think about how such a large amount of money could be spent on marketing, and for people to take this into consideration. Also the link that Aimless posted on the Doctor whom was hired by Wyeth to help sell Effexor may have the opposite intended effect, as they only paid him $30k for one year, where-as if they had used a company Sales Rep or Drug Rep in place of him, it would have been at least twice that amount.

[Aimless]

In this article from the OP direct-to-consumer advertising (DTCA) amounted to ca. 4bn, with ca. 80% of the remainder being spent on marketing that targets physicians. I think it was about 4bn in 2007 as well.

I'm not sure I understand what you mean with your remark about the Effexor-doctor and having the opposite effect

I'm also not sure why you're placing such an emphasis on the educational and informational elements of marketing. If anything, the information presented in drug-ads--as well as the information presented to physicians by sales reps--tend to be presented in such ways as to exaggerate the benefits of the drugs they peddle, and physicians (like everyone else ) frequently overestimate their ability to correctly assess the info they get from reps. Dude, it's advertising--advertising doesn't just serve to inform and to educate, it aims to exploit various biases and other "features" of human cognition in order to increase sales of products. I'm not saying it's all bad and should be banned outright, but I am certainly saying that the heavy advertising comes with problems that should be addressed, whether those problems have to do with high costs of drugs or with affecting prescription behaviour.

Re. education and information, btw, you know as well as I do that pharmaceutical companies aren't above suppressing undesirable data and over-hyping seemingly good results.

[Aimless]

I thought this article was interesting as well:

http://www.ncbi.nlm.nih.gov/pubmed/18708971

OBJECTIVE: To determine whether drug samples are associated with physicians prescribing fewer generic, less costly medications. METHODS: We conducted a retrospective study at a large university-affiliated internal medicine practice containing over 70 physicians. Using a pharmacy database, we identified all prescriptions written to uninsured or Medicaid patients that belonged to one of four classes of chronic medications. For the 9 months before and after the clinic closed its drug sample closet, we calculated the percentage of medications prescribed as generics and the mean cost of a 30-day supply of a prescription. RESULTS: Of 8911 prescriptions, 1973 met inclusion criteria. For uninsured patients, the percentage of medications prescribed as generics rose from 12% to 30% after the clinic closed its drug sample closet (P = 0.004). By consecutive three month periods, the percentage of prescribed generic medications rose steadily to a maximum of 40% (P < 0.001). For Medicaid patients, there was no significant change in generic prescribing (63% generic with samples versus 65% generic without samples, P = 0.42). Two factors were associated with generic prescribing in logistic regression: the absence of drug samples (OR 4.54, 95% CI 1.37-15.0) and the prescriber being an attending physician (OR 5.26, 95% CI 2.24-12.4). There was no statistically significant change in cost for either group. CONCLUSIONS: Physicians were three times more likely to prescribe generic medications to uninsured patients after drug samples were removed from the office. Drug samples may paradoxically lead to higher costs if physicians with access to samples prescribe more brand-name only drugs.

Make of this what you will.

[GGT]

"States Begin Targeting Drug Company Marketing Practices"

http://www.medpagetoday.com/Practice...icolegal/13235

J & J is revamping their marketing of samples-for-physicians, product-specific educational seminar junkets, free pens, the whole nine yards. Too many law suits.

[Khendraja'aro]

However, direct to consumer marketing should be banned. Doesn't serve any purpose as normal people simply don't have the knowledge needed to analyze an advert for a prescription drug.

[Dreadnaught]

I don't see why information and knowledge about new drugs should be restricted to an elite class of institutionalized professionals.

It's sorta like saying that personal computer advertising should be banned, as normal people simply don't have the knowledge needed to analyze an advertisement for a high-end PC.

[Khendraja'aro]

I don't see why information and knowledge about new drugs should be restricted to an elite class of institutionalized professionals.

It's sorta like saying that personal computer advertising should be banned, as normal people simply don't have the knowledge needed to analyze an advertisement for a high-end PC.

A high-end PC does not kill you. Side / cross effects which are not mentioned in the adverts do. Honestly, we're taking too much medicine as it is, and adverts don't exactly help on that front.

[GGT]

The US would rather litigate than legislate. Keeps the lawyers fat and happy, and the politicians can spout on about freee markets.

[Khendraja'aro]

What I'm wondering is: Why doesn't there exist a site which lists all drugs, their effects, side and cross effects, links to their respective studies and allows one to search by, say, effect or illness? You could easily throw in a comparison feature - if you've got several drugs yielding the same effect, you could easily compare their effectiveness and the potential problems.

I understand that this is not needed actually for the established drugs - but it would make life easier for non-established drugs to be judged by their merits (or lack of them).

[GGT]

I don't see why information and knowledge about new drugs should be restricted to an elite class of institutionalized professionals.

It's not restricted. But marketing ads aren't really intended to "spread the knowledge".

What I'm wondering is: Why doesn't there exist a site which lists all drugs, their effects, side and cross effects, links to their respective studies and allows one to search by, say, effect or illness? You could easily throw in a comparison feature - if you've got several drugs yielding the same effect, you could easily compare their effectiveness and the potential problems.

I understand that this is not needed actually for the established drugs - but it would make life easier for non-established drugs to be judged by their merits (or lack of them).

Besides the PDR we have all sorts of books and web sites available to lay people, plus pharmacists who can print out information sheets.

[Khendraja'aro]

Yes, I know that this information already exists. But it isn't linked - which means that you have to search and cross-reference stuff for yourself, potentially missing information.

That's what I mean - a web site which accumulates the information out there.

[GGT]

But that's more about how to do internet searches than having trouble finding info on meds. Can search by classification or by disease, there's always a 'see also' link.

Pharmacists have a more advanced data base and can be very helpful that way. Plus, they know the consumer price for all the brand names and generics (and how much an insurance company pays).

[Khendraja'aro]

I'm still not sure that you understand what I'm aiming at. And I'm also pretty sure that a pharmacist's data base does not include rates of effectiveness in order to compare drugs.

And you'll have a blast comparing, for example, the various kinds of antibiotics with your web search.

[Flixy]

I was mainly trying to get people to think about how such a large amount of money could be spent on marketing, and for people to take this into consideration. Also the link that Aimless posted on the Doctor whom was hired by Wyeth to help sell Effexor may have the opposite intended effect, as they only paid him $30k for one year, where-as if they had used a company Sales Rep or Drug Rep in place of him, it would have been at least twice that amount.

Not su sure, since a sales rep would be working fulltime and this guy did it as an extra job on the side.

I'm not against marketing to doctors, as long as they are honest of course. It's hard to keep up with other drugs otherwise.

And dread: the problem is that medicine is pretty subtle. There is a reason it takes a long education to become a doctor and to know what drugs to prescribe. You can hardly expect just anyone to judge what drugs are best for his personal situation.

[GGT]

I'm still not sure that you understand what I'm aiming at. And I'm also pretty sure that a pharmacist's data base does not include rates of effectiveness in order to compare drugs.

What are you aiming at? You said direct marketing to consumers should be banned. I wouldn't go that far, but do agree there's too much aimed at consumers who then run to the doctor for the latest new pill.

You suggested linked sites for cross-comparing meds should exist. For whom? The consumer?

And you'll have a blast comparing, for example, the various kinds of antibiotics with your web search.

At some point the consumer needs to trust that physicians and pharmacists are the professionals that know what the hell is best.

[earthJoker]

I don't see why information and knowledge about new drugs should be restricted to an elite class of institutionalized professionals.

It's sorta like saying that personal computer advertising should be banned, as normal people simply don't have the knowledge needed to analyze an advertisement for a high-end PC.

Do we talk about advertisement or information? Two different things IMO.

[Khendraja'aro]

Such a site would be aimed at everyone who's interested. My primary target, however, would be the physician - as Dread has pointed out, getting information about new drugs out to the doctors who actually prescribe them is somewhat problematic.

And marketing aimed at doctors is somewhat biased. So this site would aspire to be an unbiased information point about (new) drugs, their effects and problems.

[GGT]

Might help if several neutral scientific groups did the research studies on new meds, published in peer review journals and added to a comprehensive site. Not just the pharmaceutical company who wants FDA approval, paying physicians to run trials and write articles. There's a conflict of interest and disclosure issue there. Is that what you mean?

[Khendraja'aro]

Yeah, a comprehensive site with aggregates the information out there.

[Dreadnaught]

Do we talk about advertisement or information? Two different things IMO.

I think they are very related —*advertisements funnel you towards information and let you make choices. When it comes to pharma advertising, you actually have less choice because you ultimately have to see if your doctor agrees with you.

But I'm not comfortable with the idea of banning something from paid media because people are "too dumb" to understand the product. No one gains from restricting information. In fact, I think many lose out.

For example, consider erectile dysfunction (inability to have an erection). Before the 1990s this was something that men just didn't talk about. If they were having problems as they got older, they often just accepted it. A big breakthrough was when Bob Dole (a US politician, ran against Bill Clinton in 1996) appeared in a series of TV ads talking about erectile dysfunction and mentioning Viagra. Besides helping sell Viagra, the ads made it a lot more comfortable for men to talk about these issues with their doctors.

In the US we have a series of very strict rules for pharma advertising dictating the terms of the ads -- in general, they work well. I don't think anyone loses by learning that a particular medication exists for a specific condition, and they should ask their doctors for more information to see if it's right for them.

[Nessus]

For example, consider erectile dysfunction (inability to have an erection). Before the 1990s this was something that men just didn't talk about. If they were having problems as they got older, they often just accepted it. A big breakthrough was when Bob Dole (a US politician, ran against Bill Clinton in 1996) appeared in a series of TV ads talking about erectile dysfunction and mentioning Viagra. Besides helping sell Viagra, the ads made it a lot more comfortable for men to talk about these issues with their doctors.

I debated internally for awhile whether to start a new thread about this, and decided against it; nonetheless, I think this is a horrendously offensive example.

In a discussion, fundamentally, about who deserves which treatment (deserve in the right wing sense, natch), you chose as your poster child the old man who can't get it up? I'm sure it's nice for him and his peers that they too can now enjoy sex as they never did, but that they're being advertized to is endemic to the situation. Their money fuels a drug market which serves...What, exactly? Human greed and desire to get laid? I'm sure advertising helps a bunch with that. Does it help with what medicine ostensibly should do, i.e. help young and smart people to breed and maintain a household for their children? I'm not convinced.

In the US we have a series of very strict rules for pharma advertising dictating the terms of the ads -- in general, they work well. I don't think anyone loses by learning that a particular medication exists for a specific condition, and they should ask their doctors for more information to see if it's right for them.

That's a laugh. In Godless Finn-land, we have very strict rules too; you don't advertize prescription drugs. In general, that works well. I don't think anyone loses by not being spoon-fed some view-point this and that medical corporation wants to espouse (bearing in mind that Finn-land makes some money off of drug sales). You don't exactly need a talking head on tee-vee to ask your doctor about this and that unless you're a spoiled brat.

[Dreadnaught]

Making people aware that other people share their medical issues and there are treatments available is offensive? Please explain this.

[Nessus]

I should have started a new thread. Sorry

[Dreadnaught]

[Khendraja'aro]

Making people aware that other people share their medical issues and there are treatments available is offensive? Please explain this.

And this can only be done via advertisement for a specific product. Right.