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The most effective means of marketing a drug is getting doctors to do it for you. “High-writers” – the industry term for physicians who write lots of prescriptions – can be offered to come aboard companies as paid speakers.  Before they know it, they will be jetting off to speaker-training sessions at luxury hotels courtesy of Pfizer, and then paid four figures for lecturing to physicians at educational seminars: “The Great Dr. So-and-So is going to give a presentation on the latest research regarding the effective treatment of post-surgical knee pain!” *cough* sponsored by Celebrex *cough*

Doctors are not stupid, of course. It takes above average intelligence to become a doctor. They trust in their critical thinking skills. They think, “Come on! I’m not stupid! I know this event is put on by drug companies, but why shouldn’t I accept a free weekend at a spa with my wife? I work hard all week in a stressful job, trying to save lives! And besides, I went twice six-figures into debt in med-school to get here! Aren’t I entitled to some enjoyment? Plus, I’m obliged to attend Continuing Medical Education! It’s part of the job!”

Nonetheless, multiple studies prove that the drugs most heavily marketed to physicians are those most likely to be prescribed. “The more time doctors spend with drug reps, and the more free gifts, drug samples, and food they accept, the more likely they are to prescribe the brand-name drugs that the reps are pushing… They give patients expensive, brand-name drugs when there are cheaper and often better, safer alternatives – or when no drug at all would have been the best choice,” quotes Kathleen Slattery-Moschkau, a former drug representative who wrote and directed Side Effects (2005), an independent film about a fictional drug rep. “Us reps upped the gift-giving ante, doctors began feeling entitled to increasingly luxurious favors,” one a music room for their house, another catering for their daughter’s wedding, a third a swimming pool.[1]

It’s easy to monitor the behavior or doctors and clinics to measure the effectiveness of elbow-rubbing. Companies will keep stats on how many doctors meet each rep and how many times, and how many samples each office accepts. How many pens, notepads, coffee cups, calendars, clocks, paperweights, wall posters. They keep a note of who can be enticed for educational dinners, meetings, or weekends away. Then they track the prescribing information of individual doctors, so they know where they’re getting bang for their buck, and who it’s worth bribing. To those who have more will be given, and to those who don’t – well, it’s not personal – it’s just business. Pharmacies are sometimes even allowed to sell prescribing data onto drug companies![2]

Evidence clearly shows that more interactions with pharmaceutical company marketing people leads to doctors prescribing newer, more expensive drugs rather than generics. After all it’s the manufacturers of recent drugs that will have more recently schmoozing them. Even just having free samples on hand is going to create the tendency to favor them, if for no other reason than why waste? The more a doctor sees a sales rep the less likely he will be to identify false claims about the drug. Doctors that have contact with a drug company are then more likely to ask their hospital pharmacy to stock their drugs.[3]

On the face of it, the drug reps seem to be offering a useful service. Doctors have patients to see! They don’t have the time to sift through a near-infinite amount of information to ascertain which of two similar drugs is safer and more effective than the other. Even if they did have the time, most don’t have the specialized expertise to compare a stack of studies on each comparable drug, and they certainly won’t get paid to do it. The drug rep comes along and says that they have studies to show that their drug is safer than its leading competitor, and who is to argue with a study? It’s peer-reviewed, right? Except in comparative studies of two drugs, the company that funded the study’s drug always comes out on top for 90% of the time.[4] The doctor is only likely to retain the memory of one or two options per condition. All the rep needs to do it make sure that one of the two they remember is their own for each class of drug.

Doctor’s should be able to trust studies, and by extension what the drug rep says – in a system that wasn’t broken to the core. There ought to be trustworthy institutions to provide good information to doctors on which drug is best in what instance, having analyzed all the studies and sorted the good science from the bad! Alas, we have not created them yet, and it’s not in the interests of any of the big players to do so.

Abrahamson concludes that, despite being almost universally committed to providing the best care possible for their patients, “professionals on the front lines of medicine have no reliable way to differentiate between care that is necessary and beneficial and care that has been pushed into use by financial interests and will not stand the rest of time.”[5]

 

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[1] Brownlee, S. (2008) “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer” Bloomsbury USA, p219-220

[2] Dr. J. Abramson (2008) “Overdo$ed America: The Broken Promise of American Medicine” Harper Perennial, 3rd Ed p126

[3] Dr. J. Abramson (2008) “Overdo$ed America: The Broken Promise of American Medicine” Harper Perennial, 3rd Ed, p126

[4] Brownlee, S. (2008) “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer” Bloomsbury USA, p230

[5] Dr. J. Abramson (2008) “Overdo$ed America: The Broken Promise of American Medicine” Harper Perennial, 3rd Ed, p190