Pharma’s Reputation Sinks A Little More
55 CommentsBy Ed Silverman // June 27th, 2008 // 11:24 am
The latest Harris Interactive poll that examines American attitudes toward corporate America offers a sobering view of and for the pharmaceutical industry. Only 26 percent of Americans view the industry favorably which, of course, means that 74 percent have a negative or neutral impression. And 52 percent are firmly negative, which places pharma slightly below big oil, and above tobacco.
Bob Ehrlich of DTC Perspectives notes the warning signs: “The drug industry must decide what improving their reputation is worth. They could accept the second lowest ranking or decide how to make it better. Clearly their current approach has fallen short and anyone charged with making it better has largely failed, unless the goal was a controlled decline. I know all the good things the drug companies do, and why prices are higher, but you need not convince me.
“It is the 74 percent of Americans who do not like you that need the convincing. Will it happen? Maybe it will if a bunch of new wonder drugs get discovered or if prices are drastically reduced. Otherwise,” he writes, “do not look for the second-to-last reputation spot to be vacated soon. It is a challenge that must be dealt with by the ceo’s or they risk significant legislative and public backlash.”
Of course, this is not new. Unfortunately, the industry has been slow to respond these past few years and only recently has shown signs that the message has been received. Bob makes an important, however, which is that the ceo’s must deal with this. Ironically, most ceo’s are increasingly remote and, when they do appear, rarely deviate from a carefully controlled script. So here’s a hint to the ceo’s - tell the lawyers to relax and go engage your customers in a series of candid discussions.
Nathan
Interesting the “pharmaceutical” is not associated with “technology”. What do they think we do? What exactly is a “technology” company anyway? They place #1, so consumers clearly have some idea of what it is. I’m kindof at a loss, however.
Ryan Soh
Hear, hear!
Justice in MI
I’m assuming “technology” means stuff like Google. But, I agree, weird category.
In any event, no ambiguity about pharma. The polls had gone up slightly post 2005, so this bad indeed. When preemption is upheld, the industry will probably drop further.
That really _not_ what I want to see. Just the opposite, which is one of the reasons I oppose preemption so strenuously. It’s industry suicide, as I have relayed.
Nathan
By the way, Ed, at least based on this chart, I don’t think you can say that “74 percent have a negative impression”. It would be more accurate to say that 74% have a negative or neutral impression. Most people I talk to from outside of the pharma industry are rather ambivalent — neither a positive or negative impression.
Jaynesday
Nathan,
But the negative impression is on the rise. There is a point some have called the “tipping point” in which almost over night, relatively speaking, a nation’s awareness become acute. One day no one knows about it and the next it’s common knowledge. Much to late to react to.
bob ehrlich
The actual number who have a negative view is 52%, with 22% neutral. That 52% is second only to tobacco in negative ratings according to Harris.
Justice in MI
Bob - Holy cow! That’s considerably worse than I would have guessed, based more or less on Nathan’s sense of the ambivalence.
What has been striking about these polls is the velocity of pharma’s decline. As we’ve discussed, before ‘97 it was up near the top.
No other industry has fallen at this rate over a decade or so.
To say the obvious, it is a terrible thing for all of us.
Jaynesday
This is when the competition’s mouth begins to water. Take the auto industry for example.
Nathan
Jaynesday, what competition are you talking about?
Ed Silverman
Hi Bob,
Thanks for the fine-tuning. I’ve added that point for clarification. Nice essay today, by the way.
Regards
ed
Jaynesday
Nathan,
Any competition that sees a weakness
and feels it can capitalize, whether that be in the US or otherwise. When there’s that much money to be had someone will find a way or die trying.
I refer to the auto industry as an example. It wasn’t that long ago that a Japanese car in America was uncommon. Now they are build some of the best right here in America. By the way they’re claim to fame began with an intense, to the point of fanaticism, focus on quality and low cost. Before they came on the scene American car builders thought they could pawn anything off on the American buyer and we would gladly buy it. It wasn’t long before we American manufacturers were partnering with the Japanese just to find out how they did it. In the mid to late 70’s If you would have said that the Japanese would be the standard for auto manufacturing you would have gotten a full bellied laugh and a hardy course of cursing.
So think before you conclude it’s impossible.
Outside the Box
We do not see health insurers or any other element of the health industry on the list and I cannot help thinking that “pharmaceuticals” are getting it right in the back of the head for the entire health industry. Now, if we split that insurance number up and showed health insurance as a separate sector and THEN pharmaceuticals were still second from bottom I would agree that we had a bigger problem than ever.
Doc
Pharma - an industry that does much good. All the companies have to do to figure out why their reputation is in the dirt, is look in the mirror. Pricing, exec pay, off-label promotion which leads to greed in the public eye - these are just few issues the industry has done to itself. Way too much spent on A&P vs R&D doesn’t help either.
Just A Thought
Pharmaceutical companies remind me of an auto insurance agent telling you to never admit guilt. If you’ve backed into another car how can you deny it?
Stop blaming and trying to disqualify the patient. It’s rediculous. These are the people ingesting your magic formula. Once you tell them their problem is BS they are not going to believe that you won’t do it again.
Self inflicted disapproval if the customer is never right or has to sue to be made right when the problem is glaring.
Bob Freeman
Just a Thought, a very good point. With so many companies under the watchful eyes of the OIG, lawyers are running the public discourse with the standard “deny, deny, deny” until the last second. The PR firms are all more than willing to support that tactic.
Dr. Sal Giorgianni
Doc.
Physicians also make a pretty good income and last time I listened to the TV and radio, and checked the web, physicians, hospitals and dentist also advertise directly to the consumer.
No, I don’t think it is just this. Maybe if PhARMA was as critical of the provider community mistakes as the provider community is of PhARMA….just a random thought.
Justice in MI
Dr. Sal writes: “last time I listened to the TV and radio, and checked the web, physicians, hospitals and dentist also advertise directly to the consumer.”
In our area, certainly there are magazine ads for clinics and some Lasik and related procedure ads on TV. And some hospitals run DTC ads.
But the scale of bombardment is nothing compared with pharma ads. I realize that this has to do with entirely different scales of budgets. But if someone dropped a similar amount of money into the hands of physicians, and they spent it running DTC ads (probably 3/4 of all adds during the evening news), I am willing to give large odds that the medicine’s respect as a profession would plummet in a very short time.
What they would mostly gain is ridicule.
Dr. Sal Giorgianni
Listen to the radio or TV in someplace like Fort Myers FL! LOL
I agree scale matters and maybe that is fundamental to the issue of why folks hate PhARMA…too much. Yet, I would harken back to other eras I have personal experiene in (back, I am proud to say into the late-60’s) and folks were not exactly in love with the industry then either. The debate was much less public though.
Margaret
Have you been noticing an increase in the number of articles and features on television giving the negatives of Pharma? The numbers of deaths caused by drugs whose makers hid the lethal evidence? Books telling the truth of the sleeze of the industry? Combine this with phony, repetitive, and inappropriate TV ads and what do you expect. What used to be hidden under a rock no longer is.
Dr. Sal Giorgianni
Margaret. Because the debate was not the grist of blogs like this, or TV shows or ads does not mean it was not a serious debate, nor did I mean to infer that. What I was, I suppose inarticulatly, trying to convey is that the dissatisfaction with PhARMA that we see evidenced as a general part of the public discourse has been ongoing for a very long time.
Please don’t misinterpurt the next point. Just because the debate is public does not mean that more progress to identify, review, address and correct problems will be made. I am not sure that is the case. What I was comenting on was the question why there is so much public outcry. That’s all.
Lili
Margaret you have the answer and the truth.
Doc
Dr. Sal,
Why the public outcry? How many articles must be written that point to hiding side effects, THEN denying is was done. Training sales forces to ‘neutralize’ bad aspects of drugs if brought up.
Here is an easy way to test my concept that pharma has done this to itself. Ask your average office based practicing physician that sees sales reps, how much of the rep’s time is spent touting the benefits of their product vs reviewing the warnings and other safety information?
The ratio is 100 to 0 in most cases. Reps virtually never review the important safety info that MDs are on the hook for from a liability perspective. Risk info IS NOT covered on 99% of sales calls.
That alone shows the continued focus of pharma cos on profits to the neglect of all other aspects of the business.
Nathan
When was the pharma industry admired in the general public? I’m to young to even remember a time. Back in the 80s and early 90s we were admired due to our quick progress in AIDS treatments — but even then there was a huge amount of criticism due to the pricing of those same treatments. Derek Lowe ran a nice blog entry a few weeks ago about this phenomenon. It seems that no one really knows when the “golden age” of the pharma industry was. It was always “sometime before my time”. Maybe back in the 40’s and 50’s?
Then again, I wonder if our reputation really even matters. Look at the oil industry. They are loathed. But we still continue to buy record amounts of the product they sell and they continue to rake in money hand over foot. People will always be mad at companies that provide necessary and high-priced services that they really don’t understand.
Sam
There was a time (a long time ago) that when a PHARMA rep came
into the pharmacy I would greet as someone who would tell me
about their new drug. Today, they just want to know if we are
going to stock the drug and who is writing for it. They even refuse
to tell how much it cost.
Some times they will show me charts that indicate how great their new
drug is better than a placebo. Pharmacists look at the formulation of
the drug; read journal articles and have a pretty good idea whether
this is a break-through drug or just another “me too” drug.
Best example was when a sales rep came in to tell me Abilify is now in
liquid form. She game me hard time about giving me the cost to the
pharmacy. When she did, I quickly figured at that a year’s use by a
patient would cost the pharmacy about $15,000. I said to her how can anyone afford this drug? Oh, she said as she turned to walk out,
“it is covered by insurance”. And you wonder why the healthcare soars!
If you think the public’s opinion of PHARMA is low, it is not as low as
it is with pharmacists.
Jaynesday
I honestly feel that in general companies and industries waste a huge amount of money and effort because they can. Untold amounts. We go along until things get difficult for what ever reason then get to work. We cut costs, improve efficiency and temporarily save ourselves until the next emergency. We really don’t know the total amount of fat and happy that we support. Truely the world would be in a good percentage better condition if we could react *before* we had to.
This goes for oil, auto, pharma, goverment, probably all large concerns that have grown to the point that its easier to hide inefficiency/effectiveness than fix it.
Dr. Sal Giorgianni
What if MDs and lawyers had to post their own Package Inserts and Disclosures?
Interesting concept here; apply the same labeling and study standards to individual practices as to individual pharmaceutical products. Let me play with it a bit on Pharmalot as a bed time tail for me.
I don’t see medical societies or legal bars advertising or actively promoting actions against physicians or lawyers. I don’t see Mayo Clinic, Kaiser or Mt. Sinai taking out full page ads talking about the number of malpractice suites. I suppose that no average family physician recounts for their patients or has a list of mistakes they have made sitting on the waiting room table. Cosmetic surgeons do not provide photos of rhinoplasties gone bad to prospective customers. Lawyers do not post a list of procedural errors they have made or deadlines they have missed or arguments they have lost. Pharmacists do not post a list of dispensing errors made or drug-interactions missed on the counter. Sure, sure…docs et. al., practice. It is part art-part science. Results cannot be guaranteed because of the complexity of medical/legal practice. Medicine is different and special. On and on…these are, to some extent true. A lot of that is true for medicines as well. Just because they are a tangible product instead of a service they are a product used within that service and thus as subject to the “practice” part of the equation as any other part. But if full disclosure, transparency and promotion of mistakes or problems were the requirement for you how would you do it.
PhARMA does what it is compelled to do regarding disclosure. I am not saying that they could not do more, but sometimes I am rather frustrated by applying a different standard to this one sector of the health industry. Reflect on this, all the professionals out there if you were to have a package insert written about your practices what would it look like? Would the same level of disclosure applied to PhARMA companies apply to you? Certainly, the public has the right to know about all of your mistakes. Should they know what your licensure board scores were? Should they know what your score was on that last CME course on diabetes care you took? How about the AAFP recertification exam…should you publish the results prominently in your office and discuss them with each patient that you bring into your practice? PhARMA does some dopy and some dangerous things. I am not a blind-defender of the industry. But I do think that the standard that PhARMA is held to is a rigorous one, for all its limitations. It is far more rigorous, farm more transparent and far more open to public debate than that of almost any other sector in the health care industry.
Next time Dr. So-And-So or lawyer Mr. This-And-That assert that PhARMA is not fully disclosing ask yourself… What would my package insert look like? If someone did a study of my practice and published the results would it stand scrutiny and would my practice survive? Would I promote the results to my community? That hospital operating suite I work in if all that went on in there were captured on video how would Mr. Smith like it? The discussions in Chambers, how would those look and sound? This could be the Third-Circle of Hell for many practitioners. Now, let’s add in some counter-detailing by the physician down the block or the hospital chain across town or the law firm in the next building to the mix. Well that could be pretty interesting and certainly would be information the public would be interested in.
All right, enough beating this dead horse…,for tonight.
Pleasant dreams all.
Doc
Dr. Sal,
Interesting concept, but it leaves out one critical point. Pharma has legions of well funded sales reps promoting their wares to physicians daily.
The vast majority of these sales reps have NO scientific background, but they do have the ’sophisticated’ training provided by their employer (which also happens to manufacture and profit from sales of these products - any conflict of interest? HMMM, you tell me).
I have worked with the sales and marketing end of pharma for 30 years at more than one company and known countless reps from other companies. The crass pursuit of profit, without regard for patients by untrained pharma sales people is rampant.
Full disclosure is the law in pharma promotion per federal regulations and rightly so.
If you are going to entrust ethical promotion to non-medical people who are incented by cash bonuses, fully paid exotic trips (Carribean cruises, Paris, Hong Kong, Rome, etc), prizes(40 inch LCD TV good enough for you?)and annual evaluations which directly influence rep salary increase (8% ok with you for 2008?), based almost exclusively on their market share increase, then more power to you.
As I stated originally, pharma does much good, it helps many patients - but the industry has no one to blame for their poor public image but themselves.
Until the old marketing and promotional model changes, pharma’s image will continue to suffer. Until it moves to more scientific based promotion and gets rid of the gimmicky, Madison Avenue promotional campaigns, it is destined to be viewed as the snake oil sales industry. This is unfortunate, but the companies continue in this vein by their own choice.
Dr. Sal Giorgianni
All good and appropiate points, sir, which to some degree or other I large agree with.
The debate is application of the principles of disclosure. I don’t believe that the matter of how many sales folks are employed is relevent to the point of full disclosure. If it is one sales rep (the practitioner themself) of 3,000 the item up for discussion is disclosure of safety and efficacy.
Hoping to stay on point, Doc. do you agree that physicians, pharmacists, nurses etc should disclose mistakes and levels of competency (analogus to package inserts and studies)?
Dr. Sal Giorgianni
Doc, PS,,,Mayo, Kaiser, Delta Dental and the like spend lots of $$ on “Madison Ave.” style promotions and also have legions of highly trained sales reps….so the question behind equivelent disclosure also flows to them, and thier service providers….physicians.
Nathan
Jaynesday writes: “I honestly feel that in general companies and industries waste a huge amount of money and effort because they can.”
I absolutely agree. I’ve worked for a small biotech (75 people) and now a company of 30,000. Both wasted money. The larger company wasted more ABSOLUTE money, but the smaller one wasted just as much (by percentage). Government research (I would argue) wastes just as much or even more. We can complain — but in reality the companies would waste just as much if you or I were in charge. If you don’t believe me, then just look at our own household finances: How much money do we “waste” on frivolous expenses, food that spoils before we use it, clothes that we rarely wear, toys that our kids break after one use, etc? It’s human nature to spend money frivolously. We can complain, but I’m afraid there really isn’t a lot we are going to be able to do about it. Hindsight is always 20/20. It’s not always clear in advance what a “wise” decision will be.
Doc
Dr. Sal,
I fully support MD, hospital, etc full disclosure. JACHAO is driving hospitals that way. MDs have for too long hidden their mistakes. Hopefully the AMA can get it’s act together eventually and have a system that vets MD problems and labels them appropriately for the public to investigate their providers.
Your comment about Kaiser et al having reps is a good point, however my experience with ‘counter detail reps’ from managed care, etc is that they are usually RNs or PharmDs. Most of your local pharma reps were selling cell phones a year ago and now they are advising your local physician how to treat your kids, parents, friends - OR heaven forbid YOU! Oh yes and they are being heavily incented to do so, as I previously mentioned.
Doc
Dr. Sal,
PS - most pharma reps earn significantly more than RNs. RNs as you know, have gone through a rather in depth medical training program, both academic and clinical.
The industry needs to require pharma reps get some kind of third party certification or it is going to self destruct.
Nathan
Doc says:
“Most of your local pharma reps were selling cell phones a year ago”
and
“most pharma reps earn significantly more than RNs”
From what I’ve seen, I would disagree with both of those statements. Do you have some sort of evidence to back up your assertions, or is that just your general impression? Most people I’ve met in pharma sales have at minimum a BS in biology/chemisty. I do agree that some sort of third-party certification system would help out both the reputation and the quality of pharma sales repts.
Doc
Nathan,
You must be joking! I have been in pharma for 30 years and hired many, many sales reps. A small percentage have any kind of science degree. Most are business, communications or other liberal arts degrees.
I have also hired a number of RNs over the years, they have always been offered more in pharma than their current nursing salary. They do make better reps, because they understand medicine.
The evidence does not support your statement that most have a BS in biology/chenistry - they are the exception, but certainly not the rule!
Atlex
Nathan,
In general, Doc is right (although a bit over the top with the cell phone reference). In some companies a large percentage, particularly of the older reps are ex-military. Whether or not their undergraduate degree is in bio or chemistry though doesn’t mean reps aren’t well trained. I would argue that the science training program offered by most of big pharma prepares reps about as well as most undergraduate programs. Also, I think that there is a resurgence in reps with strong science backgrounds (pharmacists, nurses, dietitians, and folks with masters degrees in science). It may take a while to get there, but I suspect that the remaking of pharma will mean smaller but more scientifically grounded field forces.
Atlex
anonymous
Doc,
Your nasty remarks about drug reps aside, specialty reps (which is where most of the actual selling goes on these days, in specialty) weren’t selling cell phones a year ago. I’ve been a specialty rep for 10 years, with a BS in biology and several years of doctoral research. I am certified by a third-party association. We receive in-depth training in both disease states and pharmacology in specialty, and we continue with on-going training, journal clubs, preceptorships, etc.
Someone referenced Goodman & Gilman on this site, I believe…I have a current copy, and can easily understand the information it contains. Maybe you need an update on your knowledge of specialty pharma sales.
anonymous
“If you are going to entrust ethical promotion to non-medical people who are incented by cash bonuses, fully paid exotic trips (Carribean cruises, Paris, Hong Kong, Rome, etc), prizes(40 inch LCD TV good enough for you?)and annual evaluations which directly influence rep salary increase (8% ok with you for 2008?), based almost exclusively on their market share increase, then more power to you.”
I don’t know what company you work(ed) for Doc, but I want to send my resume.
Carol
Dr. Sal,
You said “Cosmetic surgeons do not provide photos of rhinoplasties gone bad to prospective customers. Lawyers do not post a list of procedural errors they have made or deadlines they have missed or arguments they have lost. Pharmacists do not post a list of dispensing errors made or drug-interactions missed on the counter.”
That is so true. But, you do not see cosmetic surgeons being able to say, Oh well, to bad, so sad, I have permanently disfigured you but I have a licence from the AMA you can not touch me. Or the lawyer saying because I passed the bar exam you can not question me. Or the phamacist…you get the point.
That is where we are with the medical device companies and may soon be with the drug companies. Oh well, to bad, so sad, our product was aproved by the FDA…suckers….
so you can’t do anything about it.
Doc
Anon,
You are the exception.
Justice in MI
Have been away for a few days having my cake and eating it too…
Based on poll data, there really is no comparison between the pharma’s “reputation challenge” from the 60s through mid 90s compared to what it became from 97. The Harris polls demonstrate a precipitous drop, and at a rate incomparable with any other industry. That’s the data.
Of course, there were responses related to thalidomide, etc., at particular moments. But no comparable decline - either in amount or in speed - of overall trust and reputation.
pharma PR hack
1997 was a pivotal year for the pharmaceutical industry- after much lobbying the Clinton FDA revised the disclosure rules allowing for DTC..as Bob Ehrlich wrote when looking at the next election and the possibility of that being reversed….
“We have only had easy-to-do mass DTC for 11 years, so going back to pre-1997 is not a stretch in scenario planning,” he writes. “I would hate to see an end to mass media DTC, but thinking that First Amendment protection guarantees it long term is a mistake.”
Wonder if the industry can make the connection between easy to do DTC and the decline of trust and favor with the american consumer
James
pharma PR hack,
That’s an interesting point–I’m convinced DTC, as it has been handled, is part of the problem. See for comparison the liquor companies–when they ended their moratorium on TV ads, they did not see a significant drop, that I am aware of, in reputation.
I also wonder about the impact of another form of advertising–attorneys on television. We’ve seen a big change from the classic “have you been injured?” ad to “have you been injured by _____?”, the blank being Vioxx, Heparin, pacemakers, etc etc.
Perhaps the blanketing of ads by James Sokolove et al have contributed to the perception that drug/device companies are bad.
Justice in MI
Yeah, as discussed before, it is hard not to view DTC as handled as part of the issue.
Re: Sokolove, et. al., there is a potential study to be done. Because of our Michigan full preemption law - going back to 1995 - one could survey whether the patterns related to to pharma’s rep are any different in our state. Since there are no personal-injury lawsuits (and no such law firm ads) in Michigan, one could see if there is any correlation.
My hypothesis is that you wouldn’t see a difference, but would be interesting. It is at least conceivable, possibly related to our preemption law, that one would find an even more negative perception of the industry in Michigan. Anyway, here is a potential study.
Anyone at Tufts want to take it on?
Dan
Pharma clearly seeks those to join thier cult based on thier popularity, yet obviously cares little about thier own beliefs about how others feel about themselves, as illustrated by thier actions and inactions.
Jack2
Here’s my thinking for the reasons - in order…but just my personal order. I try to reduce my list to only things that changed since the late 90s.
1. Cost
People think drugs cost too much, and that drugs are driving the cost of healthcare.
Fact: Insurance companies cover 97.5% of a patient’s hospital or doctor visit, but only 67% of a patient’s medication bill. This creates an illusion in the patient’s eyes about what drives healthcare costs (namely drugs). Drugs actually cost about 10% of total healthcare dollars in 1965, and they cost 10% in 2007. The perception changed.
2. DTC advertising.
People watch DTC advertising and they think “these drug companies spend so much money on DTC advertising that must be why my drugs are so expensive.” Also, despite the regulations on DTC advertising, the DTC advertising leaves an impression in the viewer that the drug is only good news.
Fact: The entire pharmaceutical industry spent 5 billion on DTC advertising in 2007. Pfizer* (and Pfizer alone), along with a few other companeis, spent more than 5 billion on research in 2007. Consumers incorrectly think that the DTC budget rivals the R&D budget. As for my latter point, about creating false expectations in the consumer, I can’t disagree with that and I think it’s an unfortunate ’side-effect’ of DTC.
*I only highlight Pfizer because it’s the biggest company. Other companies may spend more on R&D as a % of total revenue.
3. Clinical Data Controversy
In the 2000s more news stories focused on the pharm industry. Since most news stories are negative, an increase in stories is usually not good news. But why the increase? Is it an increase in bad behavior or an increase in coverage? I don’t know.
I hate to single people out, or declare anyone guilty without fair trial but here goes…and this is just my opinion.
I think some of these stories are ridiculous non-news (Jarvik’s hawking Lipitor and he’s not a cardiologist - who cares?), some unfortunate (delaying Vytorin data - doesn’t ‘hurt’ people, but doesn’t exactly engender trust), and some wrong (GSK moving Paxil suicides - although all I know I read here, I gotta admit that looks pretty bad).
I don’t know if this is new news, or sort of always happened. I list this point third though, because I think outside of the highly polarized blogosphere, I don’t think most people know anything about most of these issues. I don’t think the average person even knows what Paxil is (they probably have some idea of what Prozac is), let alone anything about this controversy.
Jaynesday
Maybe someone from marketing here (Pharma Marketing Exec?) could explain (at least to me) the idea behind advertising to the public.
Why is it needed at all, (much less after 6 months or 2 years from introduction)?
Is the intention to bypass the doctor?
At what point does advertising cross the line of presenting a product and convincing of an ailment?
I’ve heard that a given number of exposures to an add will more or less “cause” the consumer to purchase or at least be convinced he/she needs the product. If this is true how can we allow drug advertising?
Jack2
In a nutshell…
The traditional arguments for DTC drug advertising:
1. DTC advertising can encourage patient’s to see their doctor for a condition they might not have otherwise sought treatment, and presumably suffered through.
2. DTC advertising can raise patients general disease awareness, and knowledge, which can help lead to effective treatment (both drug therapy and otherwise).
3. DTC advertising is a right companies have, to legally present to the ultimate user of a product, factual information about that product.
The traditional arguments against DTC drug advertising:
1. DTC advertising presents the risks and benefits of drugs to consumers who (usually) cannot get that drug without a prescription from a doctor anyway (at least for prescription drugs).
2. DTC advertising creates a false impression in consumers mind that they may have diseases they don’t have causing them to seek drugs they don’t need.
3. DTC advertising wedges itself into the relationship between the doctor and the patient, where the patient goes in requesting a product instead of receiving the product the doctor thinks is best after seeing the patient.
I don’t think it’s to bypass the doctor. You’re post sounds like you’re pretty biased against DTC right now, but if you accept that at least some of the time my first point happens (someone goes to the doc to get a treatment for a disease they suffer from and had given up hope of fixing), then even the doc can’t get them on that treatment until the person actually gets off the couch and goes to the doctor. It reaches patients who don’t go to the doctor regularly (and that’s a lot of patients).
Atlex, got any others?
Bob Freeman
Jaynesday, the return on a DTCA for a new product that does not have a lot of competition is $4 for every $1 spent. As the class becomes both more competitive through the introduction of similar NCEs and/or via the older drugs going off patent, DTC’s returns fall to about $1 for $1. At that point the DTCAs are driving sales of the class of drug, not so much the specific drug that is advertised.
Doc
Jaynesday,
I have been in multiple marketing meetings where the statistic is thrown around that ~ 60% of the time a patient asks for a product by name, the MD prescribes it.
THAT is why pharma does DTC.
Jaynesday
Jack2, Bob, Doc - Thanks for the explanation. I am not real sure where I stand on this. I understand the issue of informing the public that a drug is available but have a problem with how easy it might be to cause people to need a drug that they really could do without. Aren’t some people easily persuaded that they have an illness (hypochondriac)?
I guess basically I feel that drugs should not be pushed to the consumer directly, that they should be pulled from the manufacturer through the doctor. If they can be successfully pushed to the consumer the temptation for the manufacturer would be (is?) to “invent” needs for the consumer.
Inventing a need for a drug is taking advantage of the consumer. Playing on weaknesses I guess.
Its one thing to invent the need for a new gadget like the latest TV, phone or computer, but to invent the need for a drug is too…… I don’t know, scary, dangerous, troublesome?
(Of course not all new drugs fit this description)
Therefore DTC’s should be much more controlled than they currently are.
Now I think I am sure where I stand on DTC.
Justice in MI
Re: Jack2’s list, I agree with some items and not with others. But we’ve gone around the DTC stuff many times.
I would just add this. It is rational that people react with more outrage and attentiveness when things “go wrong” in pharma. As I’ve said before, when a sociologist messes up, no one cares because, in general, no one is relying on things going right.
So, inevitably, there is a different standard and a different sensitivity.
Hypersensitivy? Maybe. But med technology in general can take out a lot of people very quickly - drugs and devices. So, as above, I believe there have been _enough_ bad actors that the balance has tipped, certainly since ‘97. And while DTC may get some folks to consult with their docs in useful ways, it also is an ad that says, “We’re not really about what you thought and what we said all those years we’re about. We’re about that stat that Bob cited - four bucks for one buck.”
Scott RPh
I am a pharmacist and have been in sales, training, management and consulting in the pharma industry for over 25 years.
The issue is all about marketing, but it is not about medicine, insurance or pharmaceuticals…it is about political marketing.
In an election year when every single night, a dozen times, we hear about the cost of health care, insurance, drug costs and that all candidates have a solution to give you everything you need and someone else is going to pay for it and that is great. It means more money for cigarettes, beer, fast food and what ever I want to spend it on…not what I need to spend it on.
Fact 1970 17% of the population had no medical insurance.
Fact 2006 17% of the population has no medical insurance.
Politics is the reason for the problem and they have no responsibility or accountability for what they say and do.
The federal government has been successful at crushing every world leading business segment the United States has ever had, we are no longer the leader in anything except political/legal interference.
But I bet Ted Kennedy is happy he can get all the medications he needs for his brain tumor and I bet he doesn’t insist on generics. I also bet he wishes he had supported the pharmaceutical companies more and all that money spent on over regulation could have been spent on research for brain tumors!
In the business too
Great commentary, all. As to those reps who mentioned third-party certification as a way to show value, congrats. Hopefully legislators and regulator will view certification as a way to verify that reps will bring valuable knowledge to the table–benefits AND risks–and not just an armload of samples.
Hospitals & Doctors $
True drug cost too much and
by the way, when did any drug company discover a drug that was so innovative, it sold itself?
A true breakthru drug would be the savior to the industry but I think that the 2nd coming is more likely despite the R&D billions being spent.
99% of the new drugs appear to me as just more ‘me toos’ despite all the Pharma hype.
That off my mind, why are US physicians and hospital earnings never brought up?
Is that not the real reason US medical costs are out of site?
Dr. Sal Giorgianni
Hospitals & Doctors
You ask “…why are US physicians and hospital earnings never brought up?” Do you remember that old Street Scam “The Three Shells”? (no, not the one in that Sci-Fi Stallone Movie). How about a master magician’s sleight of hand and the ole false-direction game?
One of my pet theories is that as long as other health industry lobbies (and please, I do hope no one will take issue with the fact that ALL of the interested stakeholders have lobbyists) and so-called guardians of health-ethics keep the American public and politicos focused on PhARMA and BIO and the media keeps giving it sensationalistic ink the attention stays off of them.
Besides, who is going to bell that cat? Would PhARMA? Though they have all that data they will not bring it into play to counter the verbiage that those in other parts of the health businesses use against them. Maybe I should start my own Syndicated Star Ledger Blog - “HealthCareAlot” and feature stories about the rest of health care industry groups a la Pharmalot.