The Pharmaceutical Industry and You

1
The Pharmaceutical Industry and You

• Stacie Beck Pete Karlin
• (Jake Donaldson Alana Benjamin)

January 22, 2007
2
Why should pre-medical students, medical students
and residents even care about the pharmaceutical
industry?
3
1
We

• have young, impressionable minds

• love free food

• always need pens

• are the future generation of prescribers

Therefore, we are HUGE targets for
pharmaceutical marketing!
4
2
Its in the news our patients might ask us about
it
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• It presents a challenge to our professionalism.

3
6

• I havent accepted THAT much free stuff from
  drug reps.
• -- Fill in your name here?

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Pharmaceutical Branding of Resident Physicians

• Survey of 181 primary care residents 164 (91)
  responded.
• First asked to complete survey, then asked to
  empty pockets of white coats.
• 98 had eaten drug company-sponsored meal within
  the past year.
• 97 of residents were carrying at least one item
  with pharmaceutical insignia.

JAMA 20012861024
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Pharmaceutical Branding of Resident Physicians

JAMA 20012861024
9

• That stuff doesnt influence me at all. I dont
  even know what drug is on my pen. I just go for
  the food.

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Perceived influence of pharmaceutical reps on
prescribing practices
You
Other Physicians
P
Am J Med 2001110551
11
Influence of pharmaceutical reps on prescribing
practices
JAMA 2000 283378
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Physician Influence, concluded

• The evidence available today, therefore, seems
  conclusive on 2 pointsfirst, that we are indeed
  heavily influenced by reps and second, that we
  ourselves are very poor judges of the extent of
  that influence.
• -- Howard Brody, Ann Fam Med, Jan-Feb
  2005

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Well, at least the free samples are good for
my patients.
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A Physician Survey of the Effect of Drug Sample
Availability on Physicians Behavior

• HTN scenario When samples were made available,
  32 of the 35 physicians who said they would give
  a drug sample selected a drug that differed from
  their preferred choice.
• LATER Patient now has health insurance, blood
  pressure controlled on drug sample
• 69 said they would write a prescription for the
  sampled medication rather than switch therapy.
• 88 of sample users would have written a
  prescription for a drug that differed from their
  preferred choice.

J Gen Int Med 200015478
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• The reason that drug prices are so high is
  because drug companies spend a lot of money on
  researching new drugs, right?

16
Comparison of median revenue dedicated to RD,
profits, and marketing/administration, Fortune
500 drug companies, 2000 (n11)

Source Public Citizen, 2001
17
Research and Development?
Percentage of scientific articles cited in patent
applications, 1998
Angell, p. 65
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Research and Development?

• Of the 415 new drugs approved by the FDA from
  1998 to 2002
• 14 were truly innovative
• 9 were old drugs that were changed to make
  them significantly improved (according to
  the FDA)
• 77 were me-too drugs classified by the FDA
  as being no better than drugs already on the
  market to treat the same condition

Angell, p. 75
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Comparison of median revenue dedicated to RD,
profits, and marketing/administration, Fortune
500 drug companies, 2000 (n11)

Source Public Citizen, 2001
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Drug Company Profits, 1995-2002
www.pnhp.org
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Comparison of median revenue dedicated to RD,
profits, and marketing/administration, Fortune
500 drug companies, 2000 (n11)

Source Public Citizen, 2001
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Pharmaceutical Marketing

• The marketing expenditures of the drug industry
  have been estimated variously at 12 billion to
  15 billion yearly, or 8,000 to 15,000 per
  physician.
• In 2001, there were 90,000 drug detailers total.
  That is 1 salesperson per 4.7 office-based
  physicians.

N Engl J Med 351(18) 1886-1890
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It is up to us!

• In many ways, the ultimate arbiter of the nature,
  extent,
• and consequences of interactions between drug
• companies and physicians is the medical
  profession
• itself. As a for-profit business, the
  pharmaceutical
• industry should be expected to market its
  products
• aggressively within legal boundaries. It is then
  up to
• physicians to decide whether to accept the
  proffered
• information and enticements.
• -- David Blumenthal, MD, MPP

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References
www.nofreelunch.org www.pnhp.org Angell, Marcia
The Truth About the Drug Companies
Random House, 2004. Kassirer, Jerome. On the
Take Oxford University Press, 2005. UCSF Med
Students. Pharmatrix. AMSA video, 2004.
http//www.ufpremed.org/pharmatrix/ Brody,
Howard. The Company We Keep Why Physicians
Should Refuse to See Pharmaceutical
Representatives. Ann Fam Med. 2005 Jan-Feb
3(1)82-5. Sierles, F. et al. Medical Students
Exposure to and Attitudes about Drug
Company Interactions. JAMA. 2005
2941034-1042.

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References, Contd

• Blumenthal, David. Doctors and Drug Companies N
  Engl J Med 2004 351(18) 1886-1890.
• Caudill TS et al. Physicians, pharmaceutical
  sales representatives and the cost of
  prescribing. Arch Fam Med 19965201-6.
• Chew LD et al. A Physician Survey of the Effect
  of Drug Sample Availability on Physicians
  Behavior. J Gen Int Med 2000 Jul 15(7) 478-83.
• Lurie N et al. Pharmaceutical representatives in
  academic medical centers J Gen Intern Med
  19905240-3.
• Peay MY et al. The role of commercial sources in
  the adoption of a new drug. Soc Sci Med 1988
  261183-1189.
• Sigworth SK et al. Pharmaceutical Branding of
  Resident Physicians. JAMA 2001 Sep 5 286(9)
  1024-1025.
• Steinman MA et al. Of principles and pens
  attitudes and practices of medicine housestaff
  toward pharmaceutical industry promotions. Am J
  Med 2001 110(7)551-557.
• Wazana A. Physicians and the pharmaceutical
  industry is a gift ever just a gift? JAMA 2000
  283(3)373-380.