Was your $100 in drug marketing worth it?
A Decade of Direct-to-Consumer Advertising of Prescription Drugs
By Julie M. Donohue, Ph.D., Marisa Cevasco, B.A., and Meredith B. Rosenthal, Ph.D.
The New England Journal of Medicine
August 16, 2007
Evidence suggests that direct-to-consumer advertising of prescription drugs increases pharmaceutical sales and both helps to avert underuse of medicines and leads to potential overuse. Concern about such advertising has increased recently owing to the withdrawal from the market of heavily advertised drugs found to carry serious risks.
We examined industry-wide trends in spending by pharmaceutical companies on direct-to-consumer advertising and promotion to physicians during the past decade.
Total spending on pharmaceutical promotion grew from $11.4 billion in 1996 to $29.9 billion in 2005. Although during that time spending on direct-to-consumer advertising increased by 330%, it made up only 14% of total promotional expenditures in 2005.
http://content.nejm.org/cgi/content/full/357/7/673
Comment:
By Don McCanne, MD
The $30 billion spent by the pharmaceutical firms in promoting their drugs amounts to an astonishing $100 per each man, woman and child in the United States. That is a lot of money that must be built into the price of drugs. Are we receiving any value for this investment?
Direct-to-consumer marketing does result in patient preferences for drugs that are much more expensive because they are on patent, even though established generic drugs may be therapeutically equivalent or may be an even more appropriate choice. Newer patented drugs actually may turn out to be an inferior choice after post-marketing surveillance demonstrates a greater incidence of untoward events. Direct-to-consumer marketing is a hindrance rather than a help is selecting appropriate treatment.
But drug companies spend far more on promoting their products to physicians. From the perspective of better health care, is that money well spent? Many physicians contend that they always select drugs that are the best choices for their patients, and that they would never be influenced by the marketing of pharmaceutical firms. Sadly, that is not always true. Marketing programs do increase physician prescribing of newly patented products, even when there is a lack of evidence of the superiority of the new product. When a physician uses drug samples to start a patient on a treatment program, he/she has taken the pharmaceutical firm’s bait. And that memo that may stay around for months or years, written on a free scratch pad, will keep the not-so-subliminal name in front of the physician perhaps indefinitely. As with direct-to-consumer marketing, the money spent on promotion to physicians also produces a hindrance rather than a help in the selection of a drug treatment.
The decisions on whether to use drugs and which ones to use should be based strictly on best medical practices rather than on the most effective marketing. Under a national health insurance program, special efforts should be made to keep physicians informed on best practices. Also, negotiations with pharmaceutical firms should result in prices based on legitimate expenses plus fair profits.
One of the first things to go should be that $100 apiece, on average, that we are spending for harmful marketing that is hindering our quest for optimal health care in America.