There's a bevy of opinion pieces and articles about drug marketing in the news today, mostly in the wake of the "Jarvik-row-gate," the scandal concerning Dr. Robert Jarvik, Lipitor pitchman, being neither a licensed physician nor a practicing rower. We blogged on this story here and here.
Here's a roundup, saving you the time of actually having to go read these pieces yourself. We aim to please here at the PAL blog.
In the Chicago Tribune today, Katie Watson, acting associate director of the medical humanities and bioethics program at Northwestern University's Feinberg School of Medicine, opines about "a terrible disease -- physician addiction to drug money." She cautions against overfocusing on Dr. Jarvik and his lack of prescribing and rowing credentials, and recommends instead that "Congress should use his Lipitor endorsement as a catalyst for reviewing the larger issues it raises."
She raises a point that we here at PAL and others have made in the past: That pharmaceutical advertising, nay, medical advertising in general, improperly turns "patients" into "consumers:"
Pharmaceutical advertising is a good place to start. This is typically called "direct-to-consumer" advertising, and the committee's letter to Pfizer says it's concerned that "consumers" may misinterpret Jarvik's health claims. But consumers can't buy prescription drugs, only patients can. Patients are people who make decisions with expert partners; consumers roam grocery stores picking cereal alone. Once patients were recast as consumers, prescription drugs could be advertised as if they were tennis shoes. It was just a matter of time before a celebrity pitchman turned a drug like Lipitor into Air Jarvik.The pharmaceutical industry uses advertising to pull patients away from physicians -- come in with your mind made up, and your physician is reduced to prescription writer. The industry undermines the other side of the patient-physician partnership by throwing money at physicians. This half of the divide-and-conquer strategy usually happens behind the scenes, but Pfizer's partnership with Jarvik for mutual profit makes a widespread practice visible.
Business Week hosts a "debate" on the topic of "Halt the Pharma Freebies." On the "Pro" side to ending pharma trips, meals and gifts is Dr. Philip A. Pizzo, from Stanford University Medical Center. He recounts Stanford's adoption of policies in 2006 seriously restricting pharma access to doctors in the hospital:
In October, 2006, we enacted a policy across the Stanford University Medical Center campus, prohibiting our faculty members from accepting gifts of any kind, however small, anywhere on the medical campus or at off-site facilities where they may practice.It also bars industry sales and marketing representatives from wandering the hallways of our two hospitals and our laboratories, and prevents companies from directly paying for meals in connection with educational programs—once a fairly common practice. It requires that those involved in the decision to buy formulary drugs or clinical equipment disclose any related financial interests....
Since our policy went into effect, many other academic medical centers have followed suit. As we train the next generation of physicians under these new standards, we will sow the seed for what could be a wholesale cultural change in the U.S. medical profession.
Our colleagues at The Prescription Project are working with numerous other academic medical centers to adopt policies similar to Stanford's. They author the very fine blog, PostScript.
On the "Con" side is Ken Johnson, from PhRMA, who has the unenviable task of defending his industry's positions. Unfortunately, his arguments fail to stray from the now-very-tired PhRMA playbook, and fly in the face of quite a bit of documented evidence.
So, despite what critics say, it’s insulting to suggest that doctors would prescribe treatments based on who gave them a slice of pizza, a pen, or a medical dictionary.
It might be insulting, but it doesn't make it not true. Numerous studies document that even small gifts affect prescribing. (See, e.g. Physicians and the Pharmaceutical Industry- Is a Gift Ever Just a Gift? in JAMA from 2000. See also here for many more studies documenting this.) This is not a conscious quid pro quo ("Gee, that pizza the drug rep brought sure was good. I think I'll prescribe her drug to the next patient I see.") but rather a subconscious engendering of good feeling and goodwill. We are all prone to it, whether we went to medical school or not.
What’s more, there are regulations and a comprehensive industry ethics code to help make sure information about new treatments provided by America’s pharmaceutical research companies is accurate and well-substantiated.
To which I can only say, Ha. One need only browse the boards at CafePharma to read numerous tales of the thwarting, skirting and even outright ignoring of said regulations and codes of ethics.
Existing federal law is very clear: Pharmaceutical research companies and their technically trained representatives, including some health-care professionals, must not give physicians anything of value in exchange for the doctors writing prescriptions for their medicines. The companies must also ensure that information they convey to physicians is consistent with pharmaceutical product labeling approved by the Food & Drug Administration. The fact is, federal and state authorities, including the FDA, the Justice Dept., and state Attorneys General are closely monitoring for improper activities.
And guess what? That monitoring, and the work of brave qui tam whistleblowers, has brought to light countless examples of widespread improper activities in the past few years. Which suggests that perhaps, methinks, compliance is not fully robust.
For its part, the Pharmaceutical Research & Manufacturers of America (PhRMA) sponsors ethical guidelines to keep communications between its member companies and physicians focused on proper use of medicines and the needs of patients. The PhRMA ethics code says all forms of entertainment are inappropriate and only modest meals—such as sandwiches—should be provided when doctors meet with pharmaceutical research companies. Additionally, our code says items given to physicians should not exceed $100 in value and should be things, including stethoscopes and medical dictionaries, that benefit patients or support a medical practice.
Ah, voluntary guidelines, the pharmaceutical industry's favored method to forestall true regulation and enforcement. These guidelines are not binding (except in California, which by legislation adopted them as state law), and there's no enforcement for violations. PhRMA and their members liked these unenforceable physician gift guidelines so much that they used the same approach for drug advertising in their ""Guiding Principles on Direct to Consumer Advertisements About Prescription Medicines." These guidelines earned PhRMA one of PAL's coveted "Bitter Pill Awards" in 2006: The Fox Guarding the Henhouse Award: For Pushing Toothless "Guiding Principles" on Drug Advertising.
In the end, it’s clear pharmaceutical research companies have the most extensive information about new medicines. After all, they devote 10 to 15 years and spend nearly $1 billion to develop just one new medicine in a process that generates thousands of pages of scientific data.
They also have the greatest incentive to "spin" their drugs, by withholding negative information and clinical trial results (ahem, Zetia/Vytorin anyone?), by pushing on doctors medical journal articles that show their drug only in the most favorable light, etc. And PhRMA, please stop trotting out the tired $1 billion figure for new drug development. Merrill Goozner handily refuted that myth in his book The $800 Million Pill (back when PhRMA was only claiming it cost $800M for a new drug) and continues to do so on his excellent blog GoozNews.
Over at HOI-19 News (an ABC affiliate), there's a story called "Drug Pitch Police." It begins by reciting, mostly unquestioningly, PHrMA's claims about drug marketing and the costs of drug development, but then gives a description of the Independent Drug Information Service (IDIS), a program that is providing "counter-detailing" or "academic detailing" to physicians in Pennsylvania. These "academic detailers," mostly nurses and pharmacists, provide a vital counterbalance to the self-serving and slanted messages of the drug company sales reps. They provide doctors in PA with information about the true effectiveness and cost-effectiveness of various drugs, in order to both reduce costs to Pennsylvania's Medicaid program and improve treatment.
The Roanoke Times has an editorial today calling on Congress to "Pull the Plug on Drug Ads." It talks about the House Committee on Energy and Commerce looking into Dr. Jarvik's bona fides and says, among other things:
The committee is compiling information and will most likely head on down the rabbit hole of "celebrity endorsements." Instead, it ought to be looking at the bigger picture: It is unwise to allow pharmaceutical companies to continue direct marketing to consumers whether they feature Jarvik or a next-door neighbor...The House committee should be persuaded to go much further than looking at deceptive marketing and, instead, renew the ban on marketing to consumers."
That's it, folks, a busy day for those holding forth on drug marketing. What do you think? Good points? Bad points? Beside the point? Let us know in the comments.