As always, comments are encouraged and welcome!
Guest Blogger Sarah Fudin’s current title is Director of Inbound Marketing at 2U, Inc. She is just weeks away from a Masters Degree in “Branding” from the School of Visual Arts (New York, NY). This timeless “re-post” on April 30, 2014 is by request…
As originally posted March 12, 2013
Sarah Fudin is the community manager for the George Washington University’s innovative online Masters in Public Health program. Sarah enjoys working with GW as a way to positively effect change and become a life long learner. Follow her on twitter at @sarahfudin and @GWonlineMPH. After reading some recent articles about pharmaceutical spending on marketing, it sparked an interest because of the connection to public health. Most of us have seen those annoying advertisements on television that are followed by a litany of drug side effects. And many of us are affected by the high cost of pharmaceuticals which sometimes is the reason that patients in need of them are noncompliant. 
According to a recent report, “Drug companies spent nearly $84 million marketing pharmaceuticals in the District of Columbia in 2011, including an outlay of nearly $19 million for gifts given to physicians, hospitals and other health care providers, according to a report by researchers at the George Washington University School of Public Health and Health Services (SPHHS).” Looking at this more globally, there are many advertising expenditures common to the pharmaceutical industry, who for purposes here we’ll call “Big Pharma”. These include direct-to-consumer marketing, payment to healthcare professionals, and payment to competitors to keep its product off the market. Perhaps the latter is most bothersome, but all of these costs may have legitimacy if it is critiqued purely from a business perspective. I personally have very mixed feelings because my education background is in business (and competitive sports), I come from a family of healthcare professionals, and now I’m looking at things from a public health perspective. The fact is, that depending on goals, assertions can and have been made for or against any of these three marketing domains. Before we criticize all that Big Pharma does, perhaps we need to put things in perspective.
- In 2011, Big Pharma spent $2.4 billion direct-to-consumer (DTC) television ads, a 23% drop from the $3.1 billion spent in 2007.
- In 2006, the most recent available data indicates that five of largest cigarette manufacturers spent a total of $12.49 billion – or over $34 million dollars a day for DTC advertising.
- As of 2012, “the NBA, NHL, MLB, and NFL are worth, combined, more than $12 billion. Furthermore, over the next decade, the value of professional sport teams is going to rise to unpredictable levels.”
All of these statistics are important. Obviously, there is greater than 5 times as much spent in direct-to-consumer advertising to encourage people to smoke –public health risk for sure. Big Pharma does spend a lot of money in DTC advertising, but those ads are highly regulated by the FDA. And one can argue that with the current obesity academic within the U.S. (a significant public health risk), perhaps the professional sports industry should pay money towards encouraging healthy lifestyles and exercise instead of sitting on a couch hours on end watching these highly paid athletes. What’s the connection between paindr.com and this post? During the recent FDA Hearings to change the indication for opioids, it was quite obvious that many advocates believe that deaths associated with prescription opioids are somehow a result of Big Pharma marketing. In fact, such stories implicating pain specialists as receiving “gifts” are ubiquitously spread throughout the Internet and in professional journals. So, I decided to research this and find out just what constitutes such “gifts”. Here’s what I found out… Gifts to doctors include “fee for service”, “continuing education”, and “grants for research”. Fee for service usually involves a “marketing program” in which Big Pharma arranges a dinner meeting or other gathering where their product is discussed in relation to its FDA approved indication. In this case, physicians are often paid $1,000-$2,000 to give a one hour lecture excluding time to prepare and travel to the venue. Considering that a single (less than one hour) spinal injection easily brings a fee of around $1000, this may not be so unreasonable. According to my sources, these speakers must go through an extensive training process and must sign documents acknowledging that they have no conflict of interest, that they will not base any patients medication selections on their speaking affiliation, and that they will adhere to all FDA guidelines-failure to adhere may result in removal from the speakers bureau or a law suit. All of these presentations are highly regulated by each company’s legal department and approved in advance by the FDA. Continuing education comes in many forms. A physician or other healthcare provider may be paid a fee to write a monograph that generally involves collaboration with an accredited college. This is a long peer-reviewed process that requires writing time, meetings, and collaboration among many healthcare providers and writing experts. Physicians are paid for their time spent to develop such monographs, but the money is paid first to a third party that monitors all of the content to ensure that all aspects of the subject matter are fairly covered and that no bias is giving to the supporting company or companies. Similar activities may occur with professional organizations, colleges, or hospitals, where a live lecture or lecture series is offered. In these cases, more than one Big Pharma company may add to the money pot, but they are all “hands off” in terms of the content. Their money is solely for the purpose of education and to acknowledge their interest to educate healthcare professionals – they are not allowed to market their product within the presentation venue. Paranoia among Big Pharma has become so prevalent that now they are precluded from providing pens or note pads containing the company logo at any of these events or to physicians upon a marketing call. Grants for research are variable. It may include a clinical research project that specifically studies a Big Pharma drug already on the market, one that has not yet come to market, or an available drug being studied for a new indication. Any of these are highly scrutinized and must gain approval from the investigative body within an institution, among other approvals. Often times Big Pharma will fund laboratory research in a disease state that interests them with regard to drug development. Before bashing Big Pharma, perhaps it is worth looking at the bigger picture.
- They are a business for sure, and as such will advertise to make money.
- Big Pharma is highly regulated and like any other large companies, spend a significant amount of revenue on advertising and lobbying efforts.
Considering that Big Pharma must adhere to strict internal and external regulation, be mindful of these decisions politically and from a public health perspective, perhaps they are not the untamed animal some would have us believe.
For all the Anti-Pharma Zealots and people who think opiates are evil seems your time would be better spent on something worth wile. Some cancer patients have very little time left to live; for them opiates give pain relief they need so badly . I watched a uncle of mine die of lung cancer caused from smoking cigarettes and morphine gave him pain relief, this was the only thing doctors could do for him. Have any of you opiate-haters seen a person coughing and gasping for their next breath of oxygen, its a terrible sight to see, its frightening to say the least.
A lot of doctors refuse to see industry representatives at all not because they don’t value their information, but because they don’t want to be pilloried later by anti-pharma zealots.
The first Doc up top Dr. SACHY. That just scared me to death. I have received oral Fentanyl for many years now. ONLY THING THAT GIVES ME REST with my NON CANCER Arachnoiditis. I also take sixty mg of Methadone a day. I was just notified this morning that my mail order pharmacy in Fla. will be transfered to Walgreens mail order in Arizona . I’m shaking in my shoes. The warehouse pharmacy in Fla. were always kind, and I added that comment to each time I talked with them. “Thank you for your kindness.”
When I had to deal with Walgreens back in “01-02” before the mail order, Walgreens made me feel like a street junkie. I have never, ever abused my medicines. I have had the same two doctors for 14 years, and they have never had to warn me for over taking medications, or trying to get away with something. One example. I went to Walgreens back in 02. I put down my prescription and the tech literally through the script back at me. I was shocked, due to the fact I’m a BIG GUY, and an old soldier. I asked for the Pharmacist. It was straightened out eventually, but , I pray their mail order pharmacy is better than their over the counter CREEPS. NOW, we will see. I’m so sick to my stomach at having to deal with these folks,,,,,,,,,,,,,,,,Herb “doc” Neeland
No Joke, I recently had a drug rep come in and flat out tell me that if I did 3 Rx’s a day of his oral Fentanyl breakthrough pain product, I could “speak” up to 3 times a week and make an extra $100,000 a year…
I was a little stunned, but I listened and nodded and made pharmacological small talk, but I summarized with…”the way Prior Authorizations are going, and the way insurance companies will not cover “cancer” pain meds for non-cancerous conditions, I would be lucky to get 3 prescriptions of this through a quarter, or year!”
So Big Pharma…I don’t care about you or mean pharmacists (sorry) or slandering DEA agents anymore…I just want my patients to be able to get what works for them….and this is getting more and more impossible to do…
WOW! If it were me, I’d report that to the company and the the FDA!
I really don’t understand all this.But what I do understand is the price of my prescription this month the Percocet went from $135 dollars to $240 dollars in 1 month. I also take OxyContin 10 mg 2 times a day.The pharmacy were I have been getting my prescription’s filled for over 5 years now told me she would no longer fill the OxyContin 10 because no one else uses that low dose and she would not order them anymore. That was bad enough but because of the cost of the Percocet I gave them my insurance card and because my copay was only $40. dollars along with what the insurance would pay them she no longer will fill my prescription. So I had to take my insurance card back and pay the full $240 dollars or that would be the last time she filled that one. So now after taking These prescription’s the way I have for 7 years I have no OxyContin and I don’t know how much longer I will be able to walk. It sure was nice these past 5 years being able to sleep go out with my wife shopping and going out with my grandkids. Aside from the withdrawal that I know is coming going back to the way I was makes life not worth living. Sorry if this is the wrong place to vent but there it is. thanks Terry
Terry,
What state are you in?
Florida . I am going to try cutting back to half on meds. When their gone I guess will see?
Good article. Well thought out and well written. It is unfortunate how many people , for their own selfish reasons, portray pharmaceutical companies as evil and greedy. The alternative medicine industry is one of the largest industries that unfairly maligns and slanders pharmaceutical companies. They love to promote their “natural” cures and treatments , which are never FDA approved, while slandering pharmaceutical companies. The anti- opioid pain medicine groups like PROP love to portray pharmaceutical companies that make opioid pain medicines as greedy and evil, yet they prescribe other medicines these companies make. A lot of the people who disparage pharmaceutical companies make absolutely no sense at all.
Also, your dad was spot on at the FDA hearing on calling out people and groups with serious financial motives. At the hearing, many anti- pain medicine people kept spreading lies and rumors about various pain management doctors and the “gifts” they receive, yet many of them had received gifts and money from special interest groups. We all know the workers compensation speaker was being paid and rewarded for trash talking opioid pain medicines. The same goes for various members of PROP who attended. A few members of PROP have investments in rehab clinics and facilities( more patients= more money). And I’m sure quite a few of them get gifts for prescribing and promoting Suboxone.
Thanks Sarah for your report.
People in general will always down Big Pharma that’s just the way people are.
When new medication is synthesized the general public will either praise it or
say it’s the worst most expensive medication ever made. People are never satisfied and will find
fault in anything new. Most people don’t like change. Big Pharma spends tons of money getting a new medication to market,they pay for clinical trials to advertising and patent extensions.
These companies are out to make money ,profit is what they look for and this is what drives these companies. How can we blame Big Pharma for wanting to profit.
When Purdue Pharma first came out with OxyContin it was a very good time released opioid medication. Then people found they could defeat the time release mechanism and that ended a very good long lasting medication.
Regards,
Mark S. Barletta
I don’t think the pharmaceutical companies should be forced to change anything. Moreover, a lot of pain patients ( including myself) cannot take the reformulated versions of opioid pain medicines. For whatever reason, the anti- abuse chemicals make me very sick. A lot of patients have also reported that the reformulated versions do not work as well as the original versions. I don’t think people realize how expensive and time consuming it is to research and develop a medicine and then bring to clinical trials and hopefully the marketplace. It costs tens of millions of dollars to develop and release a medicine and it often takes years or sometimes decades to develop medicines.
Drug addicts/abusers will find something to abuse no matter what. Ever since the harsh crackdown on pain management clinics, the drug addicts/abuser have just gone back to using heroin. Law abiding pain patients should be given preferential treatment over criminal drug addicts/abusers. I’m still having a hard time understanding why so many people and groups want to coddle and baby drug addicts. I’m still having a hard time understanding why so many people are wiling to sacrifice chronic pain patients in order to attempt to save drug addicts/abusers. There is no point in punishing pain patients and altering/restricting medicines that work for them because of drug addicts. It is a pointless futile action. When did so many people suddenly develop a hero complex? You can’t help or save a person who doesn’t want to be helped/saved.
Very nicely done, Sarah. I think there are 2 interesting aspects in addition. Firstly, it isn’t clear in healthcare who the customer is. Other businesses are allowed to wine and dine and entertain and market. But when pharma wines and dines doctors are they really the customer? And when they do DTC to patients, are they really the customer? if the patient goes in and wants a new expensive med they saw on TV or a prescriber wants to rx what they heard about at a steakhouse but a third party (or all of the taxpayers) actually foot the bill because of whatever payment plan the patient is on …you see what I mean. This creates a lot of ambivalence. Also, if GM makes a new car and knows there are X number of licensed drivers, their potential target is to get all X to want to drive that car. They arent supposed to say, this car is too fast for you because you are an impulsive guy….when pharma looks at all the pain patients and the total number is Y they arent really allowed to say that they want all Y on that drug (especially not when its a potentially abusable controlled substance) because for individual patients they or someone has to consider that the risks might outweight the benefits. Again, ambivalence is created because some people think that marketing is supposed to be different in this arena. Im not saying I agree with either point it is just that I understand that selling meds are a different kind of business and that’s why there is so much ambivalence about these issues.
Steve Passik (comments and opinions my own, not my employers).
You make a great point Steve — thanks so much for adding your insights here. Not every industry can be compared apple to apples.
I would add, with respect to the citizen petition to change the labeling on opioids, that the group behind that effort is saying that their real aim in doing so is to prevent pharma companies from engaging in promotional activities beyond the petition’s proposed limitations.
Bravo, Sarah, for bringing some common sense perspectives to this volatile topic. Compared with many other large industries — like tobacco, which you name, and probably alcoholic beverages — ‘Big Pharma’ firms are actually conservative in their spending on advertizing and promotion. Plus, are there any other industries that are more extensively and tightly regulated than pharmaceuticals in terms of what they can and cannot do or say? I can’t think of one.
Thanks for commenting Stewart! What might be more interesting is to look at what the food industry is spending on advertising. As a public health issue, obesity has become an epidemic that our population is combatting every day. There was a great article in the NY Times recently that taps into top executives in the largest food companies: http://nyti.ms/ZGuxRw