Pharmaceutical marketing

It’s worse than wasteful. And $70 billion is a lot of money.
It wouldn’t be necessary if we made physicians keep up with the literature.

No, it’s not the case that half of drug companies’ marketing expenditures are for “free samples.” Remember, most drugs don’t cost much of anything to make &#8212 and of course no one gives away free samples of the expensive biologicals such as the blood growth factors &#8212 so the replacement cost of the samples (as opposed to the monopoly prices drug companies can charge due to patent protection) is trivial.

The half of the money that doesn’t go to putting dishonest ads on TV or to treating physicians to junkets at which they can be propagandized about the latest nostrum gets spent on “detail men,” the door-to-door salesmen of the pharmaceutical industry.

I had a good friend who graduated with a degree in economics from a fancy college and decided she wanted to go into marketing (at which she has had a very successful career). As it happened, the best offer she got was from one of the big pharmaceutical outfits, which gave her a couple of months’ worth of training and sent her out to do detailing.

Her job was to visit physicians, one by one, and give them “information” on whatever her employer was pushing that week. Did I mention she’d never had a course in biology or chemistry? Yes, she did indeed hand out free samples, which was one way to get her foot in the door.

So pharmaceutical marketing, when it doesn’t involve selling emotion to ignorant patients, involves pushing bullsh*t on ignorant physicians. (Look, pharmacology is hard, and most docs haven’t studied it since they left residency.) I wouldn’t call pharmaceutical marketing “wasteful”: that would be too generous. It’s health-threatening, and at times life-threatening.

The right approach would be to make a physician’s authority to prescribe any class of drug dependent on his passing, and repassing at (let’s say) three-year intervals, a tough exam about the mechanisms of action, effects, and side-effects of various drugs in that class: an exam drawn up by professors of medicine and pharmacology, not by FDA officials, and based on the most recent research (including the stuff the drug companies pay for but don’t want published, and which sits in FDA files, for example studies showing that the SSRI’s are only barely better than placebo at relieving depression). If your patient needs a drug you aren’t authorized to prescribe, then you call your colleague who is so authorized, who looks at the chart, asks the appropriate questions, and tells you what to prescribe.

If every physician prescribing a drug actually knew what it was good for and what the attendant risks were, then we wouldn’t have to leave it up to the FDA to decide whether the research showed a drug to be safe and effective. The FDA would supervise the clinical-trials process, make sure that all the information was out there for prescribing docs, kill the obvious losers, force recalls when post-approval monitoring showed an urgent problem, and otherwise get out of the way of the practice of medicine. That would drastically curtail the approval process, thus reducing the cost of getting new drugs to market &#8212 and the value of Big Pharma’s existing patents, since “me-too” products would be available much earlier in a drug’s patent life.

Y’know, sorta like capitalism. Yes, yes, it would never work: the docs don’t want to do the work, the drug companies love their patent protection, and the FDA loves its power. But it’s nice to think about, isn’t it?

In the meantime, of course we could save money by getting rid of pharmaceutical marketing. $70 billion ain’t chump change, even in the context of the going-on-$2T the country spends on health care, and there’s this little device called the Internet that potentially gives physicians access to more, and more accurate, information than the detail men can provide.

But that’s na ga ha pen, either.

Update Of course, detailers are selected entirely for their intelligence. It’s merely a coincidence that so many of them (unlike my friend) were cheerleaders in college.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com