So perhaps this is getting serious. Doctors Object to Gathering of Drug Data
If the A.M.A effort succeeds, "legislators will turn their attention elsewhere, and the industry can hang on to one of its most valuable data sources," according to an article this week in the industry trade magazine Pharmaceutical Executive, which was co-written by an A.M.A. official and an executive with the leading vendor of prescription data. Even many critics concede that patients’ privacy is apparently not an issue, because the tracking systems identify only the prescribing doctors, not patients. But many doctors find the use of the data by sales representatives an intrusion into the way they practice medicine."These doctors were outraged that people came into their office and talked to them about how many times they prescribed a particular drug," said Dr. John C. Lewin, the chief executive of the state medical association in California, one of the states where complaints about the current system arose. The California group is beginning its own program under which doctors who do not opt out under the A.M.A. system will get comparisons of their prescribing patterns in 17 classes of drugs from the data companies, said Dr. Lewin, who added that the program was being started as a pilot effort that he hoped would be extended statewide.
This latest dose of outrage is almost hysterical. In both senses of the word.
There are some doctors who are vehement in their opposition to drug companies. They won’t take the free lunch. There are some who take advantage. For most, they have a fairly neutral opinion of drug reps. But the concept of not allowing anyone to know their prescribing patterns doesn’t exactly smack of the transparency that we’ve heard so much about. And frankly if the drug companies don’t know how to detail docs as efficiently as possible (and for that they do need the data) it’s likely that their marketing efforts will get more unfocused and more onerous on the system as a whole. And in general I’m of the belief that useful targeted marketing & sales is better than blanket non-targeted efforts. So unless we are going to ban ALL pharma marketing (which will mean tossing a great deal of useful babies out with the bath-water) and fundamentally change how information about drugs is communicated to physicians, then getting rid of the IMS type data is not helpful.
Categories: Uncategorized
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my web-site … coach outlet sale
Are Drug Reps Really Necessary?
One of the main functions of pharmaceutical representatives is to provide free samples to doctor’s offices presently instead of authentic persuasion, and these samples in themselves cost billions to the pharmaceutical industry. Yet arguably, samples are the most influential tool in influencing the prescribing habit of a health care provider. Let me be clear on that point: Its samples, not a representative, who may be the top influencer of prescribing habits.
Yet considering that drug promotion cost overall is approaching 20 billion a year, combined with about 5 billion spent on drug reps themselves, what if there is another way for doctors to get free drug samples, which is what they desire for their patients to initiate various treatment regimens? What if prescribers could with great elation avoid drug reps entirely?
There is, actually, a way to do this, but it is limited. With some select, smaller pharma companies, doctors have the ability to order samples by printing order forms on line for certain medications through certain web sites associated with the manufacturers of these samples. Some examples are such medications that can be ordered in this way are keflex, extendryl, and allerx. Possibly several more can or are available to prescribers in this way. Others, however, cannot be acquired by this method.
So in some situations, a doctor can go on line, print off a sample order form, fax it into a designated fax number after completion of the form, and the samples are shipped directly to the doctor’s office with some products thanks to their manufacturers who provide this avenue. There is no review of the doctor’s prescribing habits. No embellishments from reps actually sounds pretty good.
Usually, this system is available for those smaller companies with very small sales forces to compensate for what may be vacant territories, but can be applied to any pharmaceutical company who, upon discretion, could implement such a system.
Now, why is this not done more often? Apparently, it is legal to obtain samples in this manner. If samples are the number one influencer of prescribing habits, why spend all the money on reps to deliver samples personally? It’s worth exploring, possibly, since the drug rep profession has evolved into those who become UPS in a nice suit.
Think of the money that could be saved if more pharma companies offered samples to doctors in this manner. Furthermore, additional benefits with this ideal system are that there is no interruption of the doctor’s practice. And again, there is no risk of bias presented to the doctor by a rep, as they would avoid contact with reps if they order samples through this way- to have the samples directly to be shipped to their office.
When samples are shipped to doctors’ offices in this manner, prescribing information of the particular med is included with the samples shipped. Doctors can order and utilize samples according to their discretion, and would be free of interference from the marketing elements of pharmaceutical corporations. Patients benefit when this occurs.
Considering the high costs associated with the pharmaceutical industry, having samples shipped directly to doctor’s offices should be utilized more than it is presently- regardless of the size of the pharmaceutical company.
Something to think about as one ponders cost savings regarding this issue.
“The new source of power is not money in the hands of a few but information in the hands of many.”
—- John Naisbitt
Dan Abshear
I agree. R&D has become more of a challenge, but the industry is focusing to a greater extent on categories such as oncology, to a great extent based on profit motive. But that profit incentive is based on the fact that payers won’t pay for me too drugs. The market wants real cures for serious diseases and thus goes the industry’s focus. I think you will see cuts in marketing budgets over the next few years, particularly in the bloated sales forces. It’s tough, along the lines of nuclear disarmament. Everybody knows it needs to be done but every company is afraid to unilaterally disarm. Part D has certainly helped seniors (cutting the out of pocket of the previously uncovered by 50%), and I suspect the industry will (for better or worse) slide down the slippery slope of price negotiation the next time the Democrats wield the levers of power.
I’m no big fan of DTC, to tell you the truth, especially the Dorothy Hamill Vioxx genre. But to the extent that it makes the general public aware of issues like high blood pressure granted not a big DTC category) and even ED (which gets many men into doctors’ offices whose first encounter with the healthcare system would otherwise be the ER, I think it has at least the potential to be a force for the betterment of public health. The industry has wisely moved to a more sober tone and more of a disease awareness approach of late, in my opinion.
Thanks, Terry! Well said.
Well, Terry, you are disliked by honest physicians because of what drug marketers do. There are some decent drug reps who provide information and drug samples, as requested by physicians. However, the fact is that the drug industry spends more money on marketing than research. The U.S. health care system is the most expensive in the world, but it is falling apart at the seams because of all the non-productive costs. We all pay for drug marketing costs.
The collection of physician prescribing information is an invitation to corruption. Physicians who prescribe expensive drugs have, in the past, been rewarded extensively by some drug reps. Hopefully, this practice is over, but as long as physician prescribing data are provided to drug co’s, the temptation for various forms of kickbacks exists.
If you want to subsidize journals and CME’s, fine. But how do you justify spending billions on consumer oriented marketing? You overcharge seniors for drugs, spend millions lobbying Congress so that Medicare can’t negotiate fair prices, and you want to be liked?
Get back to the business of developing new drugs that are major improvements over old ones, cut your marketing budgets and give the old folks and the taxpayers a fair price and maybe your image will be positive.
Is there anyone out there who would be interested in starting a march on our state capitals to protest our enslavery by health insurance companies. I think the 4th of July would be a great time to do this so that we could ask for our freedom from health insurance companies running our lives.
All we do is pay rising rates every year for very little if nothing. Then when we get a preexisting condition we can’t even change to another insurance company. We small business owners cannot afford health insurance anymore. Surely there are a lot of other people without insurance at all and those of us who are fed up with paying it and then having our hands tied and being forced to pay ever-increasing rates every year. And also those that can’t even leave their town or job because of needing their existing insurance that must be extremely upset about this. We need to all get together and march to protest this never ending problem. Who out there is interested.
Thanks, Terry! Well said.
Matt, I scrolled through this whole debate just to tell you that I think you’re spot on regarding prescribing data availability. While it can be misused, it certainly helps marketers operate more efficiently when used properly.
I was, as always, dismayed by the vitriol directed toward pharmaceutical marketing. I am in the business myself, as a supplier of data to the industry. I can assure the correspondents that pharmaceutical marketers do not knowingly market drugs that kill people. For the more charitably minded, the rationale that they are human beings may suffice. For the prejudiced, the cold hard fact that it’s bad for business may prove grudgingly compelling.
Pharmaceutical marketing has sufferred its share of malpractice, as has every profession, medicine definitely being far from without sin. However that does not make it inherently evil. To the contrary, it is necessary. If drugs sold themselves, companies would spend zero on marketing. New drugs are risky. Many doctors are cautious, no doubt with good reason. Drugs must be sold. Dr. Tuteur argues that doctors should thoroughly educate themselves at their own expense. Many, if not most, don’t. Many, if not most, journals are funded by drug ads, as is most CME, even that provided by specialty societies. The AMA used to publish a book called Drug Evaluations, unbiased and comprehensive information about drugs. Now it dosen’t, because doctors wouldn’t pay for it–they use the PDR instead, because it’s free. The Medical Letter, another paid subscription (thus unbiased) struggles for the same reason.
In the real world, doctors are extremely reluctant to pay for information about drugs. If marketing is outlawed, doctors will get their information primarily from their health plans. As a patient, I prefer he status quo.
As a marketer, it saddens me that some physicians and others have been driven to such extreme hatred of pharmaceutical companies, and particularly marketers.
I believe the companies have saved more lives than perhaps any other industry, yet they are reviled with opprobrium associated with the merchants of death who market tobacco.
Clearly, there is a need for reform and rapprochment. Doctors of medicine need medicine, and makers of medicine need doctors.
As for DTC, again, there is good and bad. I am no fan of DTC, but I believe many lives have been saved as patients see their doctors about diabetes, hypertension and even ED who, absent DTC, would never have made the trip.
Are there nightmares such as Vioxx? Yes. Is the system perfect? No. But are pharmaceutical marketers murderers? Should marketing be illegal? I think not. Given our Constitution, such extremism is beyond Quixotic. I would encourage the participants in this debate to curb their enthusiasm and work toward realistic reforms that recognize the realities of the situation. Pharma may not be angelic, but it is hardly demonic.
Matthew writes in response to my question about the manner of prescribing:
> Therapeutic substitution is not allowed yet
I can see that what I have in mind will probably fall under this ruberic, but as “therapeutic substitution” is apparently defined right now, it isn’t quite that.
The doc would not prescribe “Nexium” and leave the patient/pharmacist free to substitute Prilosec. No: the doc prescribes “proton pump inhibitor” or “statin” or whatever, and there is complete freedom to pick one from among the FDA approved drugs in that class. This is not “substitution” — it is “choice”, or “empowerment” or “personal responsibility”. Whatever floats your boat.
Under this scheme the notion of “prescribing patterns” takes on a completely different hue. Docs would not prescribe brands any more, and pharmacists wouldn’t really do it either. Them that want the advice of a pharmacist or doctor about the relative merits of the various drugs of this class can get it, and in a way they’ll be forced to because they do not have a prescription with the name of a drug on it. Them that want brand names for whatever reason will choose the best-marketed (from their point of view) version. Under a well-constructed benefit design, they’d pay for (most of) the difference out of their own pockets, and who besides Jack Daniels will say there’s anything wrong with that? I bet lots more people would end up with the white pill called omeprazole for 20 cents/dose.
Here, by the way, is the top 200 Rx of 2004 by $$$
and here is the top 300 Rx of 2004 by number of fills
According to this article, generics accounted for 56% of Rx dispensed last year, but only about 10% of total $$$ spent. Pretty stunning.
My understanding this is pretty much what the original intent behind the FDA was: a regulatory scheme that would make it safe (and effective) for people to medicate themselves. A combination of influences prevented this coming about, but maybe now is a time to reexamine the way drugs are controlled.
I think this furthers Matt & Barry’s goal of transparency, by forcing people to look at the now translucent glass, and trusting they will demand it be wiped clean.
t
Arguments are what I’m interested in. There is data every which way you look pointing in any direction you want. Even so, I’m going to cite more in a second.
Healthcare should be run by the federal government? At all levels? Congratulations, you’ve hit my hottest button. You cannot be serious. Medicare is failing. Medicaid is failing. My previous posts were not unfounded.
http://hspm.sph.sc.edu/Courses/ECON/CLASSES/Friedman.html
The fresh pool of ill-managed money available from government programs has hurt us. A lot. Giving control of healthcare to the feds is like giving a bottle of gin and car keys to a pack of hormone-raged 14-year olds. I guess you haven’t been reading any news about the FDA for, I don’t know, about three years.
Fiscal policy aside, politics will get more in the way of healthcare if you give the government control, and it has no place in research. I don’t think there’s any good response to this fact. Read my AIDs vaccine concern? How naive can you be?
Sounds like you narrowed your argument to doctor-marketing, I noticed. Do you concede that DTC to consumers is useful? Dr. Amy never responded to that one either. And still, _still_ nothing on fewer drugs getting onto the market and to patients. Or destigmatization. I guess you’ve abandoned these arguments.
I never said I want more spending on healthcare. Based on what I’ve said so far, that doesn’t seem like something that I would say, now does it? I’m the most fiscally conversative poster here. The wheel of healthcare is spinning too fast for a variety of reasons including overutilization (the tragedy of the commons, as it were), tax benefits, defensive medicine, and a bunch of other reasons.
A right wing nut, huh? I didn’t know right wing nuts were for Plan B as much as I am.
Banning doctor marketing (in sales rep details) is not the solution. Should it happen less? Yes. Yes, yes, yes. I agree with you that, as I’ve been saying for some time now. It’s not even cost-effective from the industry standpoint, as I’ve noted. Banning marketing in journals is simply a terrible idea. Banning DTC marketing, is, apparently, something you’re not willing to argue about anymore either, unless you’ve finally decided to respond on that.
In terms of overall healthcare costs, by far the biggest cost contributor that I see is Medicare and Medicaid. By far. How much? Well, roughly, 1 out of every 3 of our tax dollars is spent transfers of wealth through either Social Security, Medicare, or Medicaid. And the middleman in that equation? The government (and not just any government…ours. The US government. There are differences). We can see how well that’s been working so far. These levels are totally untenable. At these rates, Medicare will be bankrupt by 2015, and insolvent by 2020. Medicare is actually my biggest beef right now.
I’m a whopping 24 years old (but I’ve been studing healthcare since I was 18). The Medicare money out my pay is likely going to older folks with more twice the wealth that I have. How is that equitable? If I asked my parents if they’d like me to subsidize their medical care when they came of age (and maybe throw 10% of that money out the window from the start to pay for the government to administer it), they would probably say, “But son…you’re poorer than us. That doesn’t make any sense.”
We need massive, massive reform in these areas. Government programs and transparency are the two hot buttons in healthcare right now, by far.
I agree Berry, which is why drug research should be run by the federal government, not by private enterprise.
TAke all the money we spend on drugs, and restructure it. Have the NIH fund all drug trials and drug research at all levels, from conception to phase IV clinical trials. Currently the modus operandi is that NIH funds all the basic science research, which big pharma picks up on and funds all the way thru clinical trials.
Its well documented that the vast majority of truly revolutionary drugs were developed in academia by NIH funded research, NOT by big pharma. We should disband the private sector drug industry and have everything controlled by the NIH/FDA.
Free markets have failed in healthcare. For people to pretend that MORE free markets will fix the problem is a pipe dream. Healthcare at all levels, including drug research, should be run by the federal government.
I agree with Tom that there is not a lot of gold to be mined here. As he has pointed out more than once, prescription drugs are only about 10% of healthcare spending. DTC advertising is about $4 billion or so out of $200 billion+ spent on drugs. Drug retailers and PBM’s are already incentivized to switch brand scrips to generics if one is available and the doc has not specified DAW. When a me too drug is far more expensive than its competitor for little or no incremental efficacy, insurers can and do either exclude it from their formulary or require an extra layer of approval. Finally, the elderly, who consume 3-4 times as many scrips per person than the rest of the population are not equipped to do a lot of internet research or medical journal reading, especially when there may be interaction or contra-indication issues. And they shouldn’t have to.
If cutting healthcare costs is the goal, there are plenty of more promising areas to explore. In fact, if we did a better job of reducing utilization whether by malpractice reform (health courts), living wills, QALY metrics, EMR’s in hospitals (to reduce errors), trying to bring about some convergence in practice patterns (like Medicare spending 3 times more per person in Miami than in Minneapolis), we might be able to afford to not only cover the uninsured but increase doctor reimbursement rates as well!
http://www-rohan.sdsu.edu/dept/schlcomm/-Riskier.pdf#search='most%20commonly%20advertised%20drugs‘
Most consumers are successful in obtaining the requested
drug. Survey data estimate that between half and three-quarters of all requests are approved by a physician (Brody, 1998, ““National Survey,ÏÏ 1998). Moreover, there are indications that consumers who are unable to obtain an advertised drug from their own physician meet the denial with “suspicion and hostility” (Neergaard,
1999) and “shop around” until they Ðnd a physician willing to prescribe the desired drug (Cohen, 1990 ; She†et & Reece, 1994).”
The research on big pharma marketing to doctors is clear and conclusive:
1) It changes script habits of doctors (duuhhh, big pharma wouldnt use it unless it worked)
2) Changing script habits of doctors has NOT resulted in better patient outcomes or more suitable drug matching.
3) Changing script habits HAS resulted in increased healthcare costs.
Now, Holts and others response to this is “well those doctors took an oath, they ought to be ashamed of themselves”
Being a doctor is a job just like every other job sector. They are influenced by the same nefarious factors that others are influenced by. I dont know where Holt and others got this idea that doctors are all Nietzche-like supermen who are immune to outside pressures.
McDonald’s advertising affects Holt the same way drug reps affect doctors. So why are we so surprised that doctor-directed marketing changes their script habits?
Holt’s response is a non-starter. He essentially says “too bad, thats the doctors fault and the doctors problem.” Its really missing the point. I’m not concerned about placing blame, I want solutions. The SOLUTION is to ban doctor-directed marketing and remove the nefarious influences that plague the profession. Apparently Holt is happy with the status quo on doctor-marketing as long as he can wag his finger at the evil doctors. I’m not satisfied with that.
There is absolutely, positively no UPSIDE to doctor-directed marketing. Removing doctor influences would force them to rely on more appropriate sources of information. Is the scientific literature and professional association guidelines perfect? Nope, but they are damn sure better than outright misleading marketing directed towards docs
“Still no response to the fact that banning DTC marketing would hamper drug development.”
Ohhh thats rich. You do know that funding to R&D, when adjusted for inflation, has DECREASED since 1997 correct?
99% of DTC ads are for “me too” drugs, whose value is MARGINAL if anything. DTC ads are NOT about introducing new classes of medications, they are about introducing “me too” drugs that are vastly more expensive than existing drugs and in which healthcare outcomes data shows no improvement over the existing pharmacopeia.
Come on man, that report was written by an extremist right wing republican who believes that free markets are the “cure” to medicine. NOthing more than a long winded, non peer reviewed diatribe, with idiotic logic such as “since advertising reduces costs in other markets, it will also reduce costs in healthcare”
Do we really think that healthcare is a free market? Only a fool believes that.
I think this whole debate comes down to a more fundamental debate that comes down to one question: is the US spending not enough, enough, or too much money on healthcare. I believe its obvious to all now that teh answer is that we are spending TOO MUCH on healthcare, for a variety of reasons. What we need is a total revamping of the health care system, and INCLUDED IN THAT IS pharmaceutical reform. Nobody is arguing that pharma reform BY ITSELF will cure american healthcare, but certainly its part of the problem.
Americans pay up to 10X more for drugs than our counterparts in other nations, yet we have WORSE HEALTHCARE OUTCOMES than those other countries. Yet the right winger free enterprise nuts want to rail on and on about how our massive spending on healthcare leads to a better system, which is just false by any measure.
Jack,
Restating your argument does nothing. Still nothing on search activity or opportunity costs.
http://www.ftc.gov/ogc/healthcare/calfeedtcjppm.pdf
Evidence, and there’s more where that came from. We can quote studies at each other all day long, or we can argue at each other’s responses.
Still no response on who pays to spread all this drug information. Still no response to the fact that banning DTC marketing would hamper drug development. And the fact that you honestly expect sick people to wade through journal data (many of those studies are paid for by guess-who, incidentally) doesn’t pass the smell test.
t,
I think your plan would be a good one, but as Mr. Holt points out, we’re not ready to give the patient that much latitude.
“Because the good outweighs the bad. Oh, and then there’s that pesky civil-liberties thing.”
What evidence do you have that the good outweighs the bad? The only evidence presented here was by me, showing that DTC and doctor-marketing makes healthcare WORSE, not better. If you’d like to convince me otherwise, then by all means supply your evidence.
As for civil rights, there is no civil right that guarantees freedom of marketing. If there were, dont you think big pharma would have sued the federal government on those grounds long ago when DTC marketing was nonexistant?
The US constantly regulates marketing and certainly has the power to ban certain sectors of it.
We already know for a FACT that marketing INCREASES health care costs. That is absolutely indisputable. Yet I see NO EVIDENCE that patients healthcare is better off.
We already know that marketing biases doctors prescription habits, and thats definitely NOT GOOD for healthcare.
So again, where is this evidence you speak of that shows the “good outweighs the bad?”
“Journals have subscription fees. It’s not public domain. The abstracts, maybe.”
First off, all you need are abstracts, and those are totally free to anybody.
Secondly, even the full articles are free. All you have to do is go to your local university library. They have paid subscriptions that anybody can access.
In fact, its even easier than that. Most university libraries set up proxy servers where anybody can use the university’s servers as a proxy and get free access to the full articles.
Therapeutic substitution is not allowed yet…but wait!
> Please go back and read the links I posted.
Here is one of your own summaries:
> 57% of DTC ads were found to have little
> or no educational value to patients(1*)
Which says almost half have more than a little, therefore some, educational value, even on the angelic standards of these researchers, which I am sure they disclosed completely and fully, and which you understand and concur with.
I don’t have a lot of energy for shouting and feeling OUTRAGED!!!!! over stuff like this. There are bigger fish to fry than some fraction of 10% of healthcare spending, that is spent on actual medicine that indisputably works.
> Now please explain to me, IN LIGHT OF THESE UNDISPUTED
> FACTS, as to why DTC and doctor-marketing should be
> allowed.
Because the good outweighs the bad. Oh, and then there’s that pesky civil-liberties thing.
There is one prescribing reform I have thought of, and I’d love to have feedback from the physicians here: instead of the “generic substitution allowed” box, how about a “substitution within drug class allowed” box, and let the decision of which molecule, packaging, price, etc. be decided between the patient, pharmacist, and PBM? What is this likely to hurt? Patient says “I want Nexium”. Doc decides patient can benefit from proton pump inhibitor, prescribes this class of therapy, tells patient “I am prescribing a proton pump inhibitor.” Patient gets to pharmacy and finds out he can have the purple pill for $60/month or something that’ll likely work just as well for $5. Let the pharmacist educate the patient, and let the patient decide. Or maybe you can already do this?
t
Sorry “I think the costs do not outweigh the benefits” is what I meant to say. The rest is right.
Jack,
In regard to your response to t’s post, you spend a lot of time on the cost-side of DTC marketing. There are costs. But do they outweigh the benefits?
I think they do. I’ll go into the costs of not having DTC, again.
Without DTC, I’m very sure that fewer medicines would be available and that prices would be higher, not lower. Patients would be less informed, because as you’ve stated, it would require additional effort on their part. Patients would be less empowered. There would be a smaller incentive to innovate new products. Forecasts would be more conservative. Less marketing means less R&D money because the potential market is smaller.
How many drugs undeveloped would be enough to make DTC worth it again for you? One? Two? What indications would you be happy to see untreated?
Jack,
I will respond line by line.
I didn’t say that it was only marketing. I’ve been saying it’s the beginning of the decision process for about three posts now.
Docs are not dispensing pills only because of pharma marketing. There is a correlation, of course, but it’s on the docs to, I dunno, adhere to the oath they took maybe? Again, banning DTC is not the answer. Take a look at t’s excellent post about the environment of prescribing.
“The vast majority of the time,” you need an idea of what treatment options are available to make a sound decision with your doctor.
If patients are motivated enough, they can understand journals as well as doctors? That’s an incredible claim. I was under the impression medical knowledge was cumulative. Maybe they can…after the equivalent of 2 years of med school. But is that really what they should have to do?
Journals have subscription fees. It’s not public domain. The abstracts, maybe. And then there’s the time spent reading them.
Isn’t engaging in all of that search and research activity forcing the patient to give something up? Isn’t that an opportunity cost that is presently avoided, or at least lessened? Are you still in favor of banning DTC? And who do you think pays for a significant portion of the ad space required to run WebMD and similar sites? Take a closer look at the sidebar next time.