Persuading the Prescribers: Pharmaceutical Industry Marketing and its Influence on Physicians and Patients

In 2011, the pharmaceutical industry spent nearly $29 billion on drug promotion¹ — more than $25 billion on marketing directly to physicians and almost $4 billion on advertising directly to consumers (mainly through television commercials).² This multi-pronged approach is designed to promote medical products by influencing doctors’ prescribing practices.³

How Does the Pharmaceutical Industry Market its Drugs and How Much Does It Spend?

Direct Marketing

Detailing: This marketing approach refers to face-to-face sales and promotional activities directed toward physicians and pharmacy directors. Pharmaceutical representatives typically visit a doctor' s office to make a sales pitch for a particular drug. However, detailing also often includes providing meals and gifts in the form of medical textbooks and medication samples. As of 2012, there were approximately 72,000 pharmaceutical sales representatives in the United States.⁴

Samples: Providing free medication samples to physicians has been shown to cause significant increases in new prescriptions for the promoted drug.⁵ While companies assert that samples benefit indigent patients, research indicates that most are given to insured patients whose medications are covered.⁶ Indeed, patients given free samples ultimately have higher prescription costs than those who do not receive them because they are then prescribed the sampled drug rather than its less-expensive generic alternative.⁷

Educational and Promotional Meetings: Sales representatives invite doctors to meetings during which an industry-paid physician discusses the use of a particular drug. These speakers are often leaders in their fields, which increases the appeal. According to a ProPublica analysis, eight pharmaceutical companies provided over $220 million in speaker payments to physicians in 2010.⁸ The companies often host these meetings at restaurants where they provide free meals to physician participants.⁹

Promotional Mailings: Companies send unsolicited promotional materials to most doctors' offices. Typically, these brochures tout a drug’s benefits and positively describe the results of recent clinical trials often funded by the same company. One study of such promotional mailings found that their coverage of the medical literature was highly biased in favor of the company’s products, mainly by selectively reporting trials in which the sponsored drug outperformed competitors.¹⁰

Journal and Web Advertisements: These are standard promotional techniques that provide an important source of revenue for medical journals. The accuracy of statements in such ads is regulated by the FDA. According to one study, between 1995 and 1999 journal advertising generated the highest return on investment (ROI) of all promotional strategies, with a reported ROI ranging from $2.22 to $6.86 in income per advertising dollar spent.¹¹

Direct-to-Consumer Advertising: In 1997, the FDA issued guidance that enabled pharmaceutical companies to more easily advertise to the public directly. Since that time, spending on these direct-to-consumer (DTC) ads has nearly quadrupled.¹² One study showed that 43 percent of respondents thought that only “completely safe” drugs were allowed to be advertised. DTC advertising has proven to be effective in motivating patients to ask for the branded product, even when generic equivalents exist;¹³ furthermore, these ads encouraged one-third of respondents to speak to their doctors about the promoted drug and one-fifth to request the prescription.¹⁴ In one study, doctors were more likely to prescribe a branded antidepressant when asked for it by name than when patients simply asked for any treatment for depression.¹⁵ The United States and New Zealand are the only two Organisation for Economic Co-operation and Development (OECD) countries in which drug companies can advertise prescription drugs directly to consumers. (The OECD is comprised of 34 of the world’s most advanced and emerging countries in North America, South America, Europe and Asia.)

Indirect Marketing

Continuing Medical Education (CME): In 2011, the pharmaceutical and medical device industries provided 32 percent of all funding for CME courses in the United States — $752 million out of $2.35 billion.¹⁶ In an effort to prevent these courses from functioning as veiled advertisements, they are regulated by the Accreditation Council for Continuing Medical Education. However, a 2007 Senate Finance Committee report found that "drug companies have used educational grants as a way to increase the market for their products in recent years."¹⁷

Grants to Health Advocacy Organizations (HAO): Consumer advocacy groups can mobilize large numbers of people on behalf of a specific issue. Manufacturers benefit when these organizations advocate on behalf of industry issues as part of their efforts to help the groups they represent. One study found that HAOs often endorsed positions in support of their funders’ products, while groups that received minimal financing focused their advocacy on the potential side effects of these drugs.¹⁸

References:

¹Cegedim Strategic Data, 2011 U.S. Pharmaceutical Company Promotion Spending, 2012.

²Ibid.

³A Wazana, “Physicians and the pharmaceutical industry: is a gift ever just a gift?” JAMA 283 (2000): 373-380.

⁴JD Rockoff, “Drug reps soften their sales pitches,” The Wall Street Journal, 10 January 2012.

⁵MY Peay and ER Peay, “The role of commercial sources in the adoption of a new drug.” Social Science and Medicine 26 (1998): 1183-9.

⁶Ibid.

⁷CG Alexander, J Zhang and A Basu, “Characteristics of Patients Receiving Pharmaceutical Samples and Association Between Sample Receipt and Out-of-Pocket Prescription Costs.”Medical Care 46 (2008): 394-402.

⁸C Ornstein, T Weber and D Nguyen, “Piercing the Veil, More Drug Companies Reveal Payments to Doctors,” ProPublica, 2011, www.propublica.org/article/piercing-the-veil-more-drug-companies-reveal-payments-to-doctors (21 May 2012).

⁹Ornstein, C. (2011) "Doctors Dine on Drug Companies’ Dime." ProPublica.

¹⁰Letters to the Editor, “The characteristics of unsolicited clinical oncology literature provided by pharmaceutical industry.” Annals of Oncology 18 (2007): 1580-1582.

¹¹S Neslin, “ROI Analysis of Pharmaceutical Promotion (RAPP): An Independent Study.” 2011, http://www.pharmxpert.net/web/board/b_ne01upload/RAPP%EC%A1%B0%EC%82%AC.pdf.

¹²JM Donohue, M Cevasco and MB Rosenthal, “A decade of direct-to-consumer advertising of prescription drugs,” New England Journal of Medicine 357 (2007): 673- 81.

¹³M Peyrot, et al., “Direct-to-consumer ads can influence behavior. Advertising increases consumer knowledge and prescription drug requests,” Marketing Health Services 18 (1998): 26-32.

¹⁴ RA Bell, RL Kravitz and MS Wilkes, “Direct-to-Consumer Prescription Drug Advertising and the Public,” Journal of General Internal Medicine 14 (1999): 651-657.

¹⁵RL Kravitz, et al., “Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants: A Randomized Controlled Trial.”JAMA 293 (2005): 1995-2002.

¹⁶Accreditation Council for Continuing Medical Education, ACCME 2010 Annual Report Data, 2011.

¹⁷Noelle C. Sitthikul, “Senate Finance Committee Releases Report on Drug Industry CME Grants,” FDA Law Blog, 2007. http://www.fdalawblog.net/fda_law_blog_hyman_phelps/2007/05/senate_finance_.html (31 May 2012).

¹⁸Jessica Marshall and Peter Aldhous, “Patient groups special: Swallowing the best advice?” New Scientist, 27 October 2006, 18-22.