http://www.latimes.com/features/health/la-he-effectiveness6aug06,1,4029145.story?ctrack=1&cset=true
THE PAYOFF
In short, marketing works
By targeting consumers and doctors -- directly and indirectly -- drug makers
are driving sales. Why argue with success?
By Melissa Healy
Los Angeles Times Staff Writer
August 6, 2007
PART 3 (of six)
THE pharmaceutical industry defends its promotional spending as a service to
science, physicians and patients. Advertising to patients helps motivate
them to improve their health, manufacturers say, and detailing doctors keeps
them abreast of new therapies and scientific advances.
Those activities also, indisputably, boost sales. As marketing budgets
climbed toward a 2006 high of $28 billion, sales of prescription drugs have
never been higher. According to estimates published by the Kaiser Family
Foundation, the number of individual prescriptions filled in the United
States rose from 2.9 billion in 1999 to 3.7 billion in 2006; in 1994, Kaiser
calculated that each American filled on average 7.9 prescriptions per year,
including refills; by 2005, that number had risen to 12.4.
For every 10% increase in direct-to-consumer advertisements within a class
of similar drugs, sales of drugs in that class (say, antidepressants or
erectile dysfunction drugs) went up 1%, Kaiser found in a 2003 study. In
2000, direct-to-consumer advertising alone boosted drug sales 12%, at an
additional cost of $2.6 billion to consumers and insurers.
Of more than 10,000 drugs on the U.S. pharmaceutical market, half of all
marketing budgets are used to promote 50 brand-name medications, according
to a 2003 study in the journal Clinical Therapy. And those 50 drugs are the
ones that sell the best.
Prodding patients to prod their physicians, apparently, works. In 2006, a
Kaiser Family Foundation survey of 834 office-based physicians found that
28% of doctors said patients "frequently"; asked for prescription drugs by
name after seeing an advertisement. Although about half said they typically
responded by suggesting lifestyle changes, 14% of the physicians said they
would, in many cases, prescribe a different drug in the same class as the
one the patient requested. And 5% readily acknowledged that they frequently
would prescribe the drug the patient requested.
Physicians see marketing's effects on their patients every day. But ask the
doctors whether the marketing influences their clinical judgments or
prescribing behavior, and a chill will descend upon the room, say those who
have run the experiment.
"Physicians are heavily socialized to believe that they have risen above the
normal human foibles," said Harvard University's David Blumenthal, co-author
of the most recent survey detailing doctor-drug company interactions. "They
clearly recognize that physicians are human and subject to normal human
influences; they just have a lot of trouble seeing themselves as subject to
that."
Not immune to marketing
BLUMENTHAL finds it revealing that most physicians do not extend to their
colleagues the same trust. In a widely cited 2001 study published in the
American Journal of Medicine, 84% of young physicians surveyed said they
believed that drug industry promotions, including gifts and meals,
influenced the prescribing practices of fellow physicians. Although most of
these doctors acknowledged they were besieged by back-slapping,
sample-toting, gift-giving drug representatives, 61% said they considered
themselves immune to marketing's effects.
They are not. A 1994 study found that hospital-based doctors were more
likely to request the addition of brand-name prescription drugs to their
institution's medicine chest after they had met with sales representatives
detailing those drugs.
Studies published in 1988 and 1992 found that physicians who attended
continuing medical education programs sponsored by drug companies, or who
accepted funding for travel and lodging to attend them, were significantly
more likely to prescribe that company's drug than those who did not.
Several studies have found that physicians who accept and hand out free
samples to their patients are far more likely to prescribe those drugs than
those who don't take or have no access to samples.
Last April, the online medical journal Public Library of Science published a
study tracking the effect of doctor-detailing by sales reps working for
Warner-Lambert, maker of the anti-epileptic drug Neurontin. The study showed
that, following even a brief encounter with a marketing representative
detailing Neurontin, almost half of the 97 physicians examined found their
briefings highly educational (even when research evidence presented was
scant or poor) and indicated they would step up prescriptions of the drug.
Dr. Andrew Leuchter has spent much of the last two years heading a UCLA
committee convened to redraft guidelines for physicians' interactions with
drug companies. He has faced the skepticism of physicians when the subject
of drug company influence is raised.
"They ask, 'Do you really think that my medical decision-making can be
influenced by the fact that someone bought me a pizza?' " Leuchter said.
"They're quite sobered" when confronted with the mounting pile of evidence
that it can, he added.
Subtly powerful
DR. Kurt Stange, the editor of the Annals of Family Medicine who called for
an end to consumer advertising of drugs, said the effects of a detailing
visit can be subtle. But, he added, these encounters are made all the more
powerful when physicians either deny or ignore their influence.
";You're not overtly thinking, 'I'm going to prescribe this drug because I
got a pen," Stange said. "You're just thinking, 'What will help this
patient?' and you've been bombarded with advertisements, and the name is
always before you. . . . You have to have a fair amount of self-awareness to
notice that.";
In the end, advocates of reform say, there is no stronger evidence that drug
marketing influences behavior than the simple fact that drug companies do
market their products -- and that they are spending more money doing it than
ever before. The makers of the nation's bestselling drugs field on average
4,000 sales representatives to detail doctors, staff booths at medical
meetings and organize trips and meals for doctors, and spend more than $1
billion per year to market drugs to physicians alone. They spend, all told,
roughly $5 billion a year to advertise directly to consumers. Though they
are not counted in marketing budgets, the funds they dispense to support
research, medical professional organizations and patient-advocacy groups run
into the billions.
In terms of cold, hard return-on-investment, that money was well spent, says
a study unveiled in 2001. Tracking prescription sales for 391 drugs and
company marketing budgets from 1995 through 1999, Dartmouth College
marketing professor Scott Neslin has calculated, down to the penny, how well
increases in marketing pay off.
Each additional dollar spent on advertising in medical journals brought $5
worth of sales of a drug, Neslin found, and an extra dollar devoted to
sponsorship of continuing medical education and professional meetings
yielded an average of $3.56 in sales. A dollar spent on physician-detailing
generated sales, on average, was worth $1.72. But in the case of the most
aggressively marketed drugs, that dollar generated sales of more than $10.
Appealing directly to consumers was lucrative, Neslin found, but a little
less than wooing physicians. Each dollar spent on direct-to-consumer
advertising generated, on average, increased sales of $1.37.
Such calculations flesh out a self-evident truth, said, UCLA's Dr. Martin
Shapiro, a past president of the Society of General Internal Medicine and an
advocate of reform in the relationship: "These are large and sophisticated
organizations. . . . They would not be spending that money if it didn't
work."
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