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The Physician-Pharma Relationship

PharmedOut.org Georgetown University Medical Center January 2008

The Physician-Pharma Relationship

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Is very old and very close But are the goals of pharmaceutical companies and medicine the same?

supplements. e-detailing . rounds. monographs. throwaways) Advertising and reprints Direct mail.Promotion includes      Detailing Meetings and events (dinner meetings. CME. symposia) Publications (symposia.

0 $3.1 $3.2 $3.6 $5.0 billion billion billion billion billion billion billion billion billion billion IMS national sales perspectives.9 $3. 2006 (IMS Health)           Lipitor Nexium Advair diskus Aranesp Prevacid Epogen Zocor Enbrel Seroquel Singulair $8. IMS Health.Top 10 products by US Sales.9 $3. 2007 Mar. Table .5 $3.1 $3.0 $3.

2007 Feb 5.The costs of promotion In 2004. Changing lanes. Pharm Exec. Full text *NIH summary of the FY 2008 president‟s budget. Summary **Summary of FDA‟s FY 2008 budget. 2005 May.25(5):154-162. Summary . total promotion cost for Rx drugs was almost $30 billion  About $7 billion spent on detailing  NIH budget FY 2008 is $29 billion*  FDA budget FY 2008 is $2 billion**  West D.

25(5):1503-17. Clin Ther 2003.000 drugs in the US pharmaceutical market More than half of promotional expenditures are concentrated on the top-selling 50 drugs* *Ma J et al.Promoting the profitable   There are more than 10. Abstract .

New drugs are not necessarily better drugs   Most new drugs are me-too drugs. generic drugs are safer than branded drugs simply because more information is available about them . or combinations of old drugs In general.

Abstract **Sigworth SK et al.5(3):240-243. Abstract Wazana A.271(9):684-9. 2001 Sept 5.“Doctors are too smart to be bought by a slice of pizza“   Studies consistently show that promotion increases prescribing* Studies consistently show that physicians do not believe that promotion affects prescribing** *Chren MM and Landefeld CSl. Abstract . Abstract McKinney WP et al. Abstract Lurie N et al. J Gen Int Med 1990.286(9):1024-5. JAMA 1990 Oct 3.264(13):1693-7. JAMA. JAMA 1994 Mar 2.283(3):373-80. JAMA 2000 Jan 19.

Detailing    In 2005.000 doctors and about 100. al. there were about 600.5 targeted docs* Targeted docs are high-prescribers.000 drug reps in the US Actual ratio about 1 rep per 2.24:40-5. Pharm Exec. 2004 Jan 1. Abstract . or docs who control market share *Goldberg M et.

The AMA Physician Masterfile   Contains demographic data that the AMA has sold to industry continuously since the 1940s* In 2005.146:742-8.354(26):2745-7. NEJM. 2007 May 15. Ann Int Med. Full text **Steinbrook R. licensing Masterfile information and other database product sales provided about 16% ($44 million) of the AMA‟s revenue** *Greene JA. Abstract . 2006 Jun 29.

AMA’s Prescription Data Restriction Plan (PDRP)    Few physicians know about it < 1% of doctors have signed up "Just giving them an option [to opt-out] alleviates their concerns. Pharm Exec Direct. 2006 Jul 19." explained the AMA‟s senior VP of publishing and business services to Pharmaceutical Executive Herskovits B. Full text .

Pharm Exec 2006 May 1.” Musacchio RA and Hunkler RJ.AMA’s Opt-out plan  “The restrictions do not apply to    (a) deciles at the market or therapeutic class level (b) segmented data that are not likely to reveal the actual or estimated activity of an individual physician. or (c) data on products ordered by physicians from pharmaceutical companies. Full text .

Med Ad News. Pharm Exec. 2005 May. 2005 Jan 1. Full text . *Goldberg M and Davenport B.000 ( primary care)  $330.700* Per rep per annum.24(5):1-4.8% of revenue** **Niles S.25(1): 70. pharma spends  $150.000 (specialty)  Sales force costs are 5% .What drug reps cost   Average annual income for a drug rep is $81.

when you‟re out to dinner with a doctor. 2007 Apr 24.297(3):82-93.Ex-reps speak out  During training. You are eating with a client”. I was told. James Reidy *Fugh-Berman A and Ahari S. PLoS Med. “The physician is eating with a friend. Atlantic Monthly. 2006 Apr. Full text . Full text Elliott C.4(4):e150.” Michael Oldani  You are absolutely buying love. Shahram Ahari*  “The essence of pharmaceutical gifting…is „bribes that aren‟t considered bribes.

“I don’t listen to the reps”  <1 minute of a sales reps interaction with a doctor results in a 16% prescribing change 3 minutes with a doctor results in a 52% prescribing change Prounis C. Full text (also downloadable pdf)  . vol 7. Best foot forward. Communique.

“I only see reps for the samples” .

Why docs like samples     Start treatment immediately Test tolerance to a new drug Reduce the total cost of a Rx Provide free medication to those who can‟t afford it .

most promoted drugs .Why drug companies like samples     Increases “new starts” on a new drug Encourages switches from other drugs Patients usually stay on the sampled drug Increases prescriptions of the most expensive.

The real purpose of samples     Gain access to physicians Habituate physicians to prescribing targeted drugs Increase goodwill by enabling doctors to give gifts to patients Serve as unacknowledged gifts to physicians and staff .

2006 Feb.41(2):52-8. Medical Marketing & Media. .” Tsang J and Rudychev I.Samples are a marketing tool  “…the manufacturer needs to figure out the right amount of samples the rep has to drop off in order to maximize the number of paid prescriptions written.

Pharm Exec.Meetings and events  “Nearly 30 percent of physicians who attend association meetings refuse to see reps in their office…a no-see strategy is critical for companies to overcome” Rehal D. 2007 Mar 1. Full text . Successful Product Manager‟s Handbook.7:8-15.

2007 Jul 6.Pharma controls CME    In 2006. Table 7. over $2. Report .3 billion dollars was spent on CME  More than half of this came from pharmaceutical manufacturers Medical Education and Communication Companies (MECs)  76% of income is from firms that manufacture FDAregulated products Medical schools  62% of CME income to medical schools comes from pharma (ACCME) ACCME Annual Report Data 2006.

PLoS Med. Alladin K.Advertising in medical journals     More than 95% of JAMA ads are for Rx drugs 5 of 6 physician organizations raised at least 10% of annual revenue from ads in affiliated medical journals Pharma companies also purchase “sponsored” subscriptions And are the largest purchaser of reprints Fugh-Berman A.3(6):e130. Full text . Chow J. 2006.

“I Never Read the Ads” .

Correct message retention by media mix      No promotion 14% Detail only 21% Detail and print [ads] 36% Detail and sales aid 33% Detail and print and sales aid 44% Paul CM. 2006 Dec.41(12):60-2. Medical Marketing & Media. Full text .

46(6):24-6.What about R&D costs?  Pharma spends 2-3 times as much on marketing as it does on research Edwards J. Brandweek. . . 2005 Feb 7.

23(3):1 . the average return on investment per dollar spent on promotion was $12.70** *Robins R. Successful Product Manager‟s Handbook.7:38-41. the ten best-selling global pharma brands made $53. **Niles S. Med Ad News 2004 Mar. Pharm Exec 2007 Mar 1.Is promotion worth it?   In 2006.5 billion* In 2001.

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