Transcript The Physician-Pharma Relationship

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?
Promotion includes
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Detailing
Meetings and events (dinner meetings,
CME, rounds, symposia)
Publications (symposia, monographs,
supplements, throwaways)
Advertising and reprints
Direct mail, e-detailing
Top 10 products by US Sales, 2006 (IMS Health)
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Lipitor
Nexium
Advair diskus
Aranesp
Prevacid
Epogen
Zocor
Enbrel
Seroquel
Singulair
$8.6
$5.1
$3.9
$3.9
$3.5
$3.2
$3.1
$3.0
$3.0
$3.0
billion
billion
billion
billion
billion
billion
billion
billion
billion
billion
IMS national sales perspectives. IMS Health. 2007 Mar. Table
The costs of promotion
In 2004, 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**
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West D. Changing lanes. Pharm Exec. 2005 May;25(5):154-162. Full text
*NIH summary of the FY 2008 president’s budget, 2007 Feb 5. Summary
**Summary of FDA’s FY 2008 budget. Summary
Promoting the profitable
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There are more than 10,000 drugs in the US
pharmaceutical market
More than half of promotional expenditures are
concentrated on the top-selling 50 drugs*
*Ma J et al. Clin Ther 2003;25(5):1503-17. Abstract
New drugs are not
necessarily better drugs
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Most new drugs are me-too drugs, or combinations
of old drugs
In general, generic drugs are safer than branded
drugs simply because more information is available
about them
“Doctors are too smart to be
bought by a slice of pizza“
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Studies consistently show that promotion
increases prescribing*
Studies consistently show that physicians do
not believe that promotion affects
prescribing**
*Chren MM and Landefeld CSl. JAMA 1994 Mar 2;271(9):684-9. Abstract
Lurie N et al. J Gen Int Med 1990;5(3):240-243. Abstract
Wazana A. JAMA 2000 Jan 19;283(3):373-80. Abstract
**Sigworth SK et al. JAMA. 2001 Sept 5;286(9):1024-5. Abstract
McKinney WP et al. JAMA 1990 Oct 3;264(13):1693-7. Abstract
Detailing
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In 2005, there were about 600,000 doctors and
about 100,000 drug reps in the US
Actual ratio about 1 rep per 2.5 targeted docs*
Targeted docs are high-prescribers, or docs who
control market share
*Goldberg M et. al. Pharm Exec. 2004 Jan 1;24:40-5. Abstract
The AMA Physician Masterfile
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Contains demographic data that the AMA
has sold to industry continuously since the
1940s*
In 2005, licensing Masterfile information and
other database product sales provided
about 16% ($44 million) of the AMA’s
revenue**
*Greene JA. Ann Int Med. 2007 May 15;146:742-8. Full text
**Steinbrook R. NEJM. 2006 Jun 29;354(26):2745-7. Abstract
AMA’s Prescription Data
Restriction Plan (PDRP)
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Few physicians know about it
< 1% of doctors have signed up
"Just giving them an option [to opt-out]
alleviates their concerns," explained the AMA’s
senior VP of publishing and business services to
Pharmaceutical Executive
Herskovits B. Pharm Exec Direct. 2006 Jul 19. Full text
AMA’s Opt-out plan
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“The restrictions do not apply to
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(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.”
Musacchio RA and Hunkler RJ. Pharm Exec 2006 May 1. Full text
What drug reps cost
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Average annual income for a drug rep is
$81,700*
Per rep per annum, pharma spends
 $150,000 ( primary care)
 $330,000 (specialty)
 Sales force costs are 5% - 8% of
revenue**
*Goldberg M and Davenport B. Pharm Exec. 2005 Jan 1;25(1): 70. Full text
**Niles S. Med Ad News. 2005 May;24(5):1-4.
Ex-reps speak out
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During training, I was told, when you’re out to
dinner with a doctor, “The physician is eating
with a friend. You are eating with a client”.
Shahram Ahari*
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“The essence of pharmaceutical gifting…is
‘bribes that aren’t considered bribes.”
Michael Oldani
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You are absolutely buying love.
James Reidy
*Fugh-Berman A and Ahari S. PLoS Med. 2007 Apr 24;4(4):e150. Full text
Elliott C. Atlantic Monthly. 2006 Apr;297(3):82-93. Full text
“I don’t listen to the reps”
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<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. Best foot forward. Communique, vol 7. Full text (also
downloadable pdf)
“I only see reps for
the samples”
Why docs like samples
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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
Why drug companies
like samples
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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, most promoted drugs
The real purpose of samples
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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
Samples are a marketing tool
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“…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.”
Tsang J and Rudychev I. Medical Marketing & Media. 2006 Feb;41(2):52-8.
Meetings and events
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“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. Successful Product Manager’s Handbook. Pharm Exec. 2007
Mar 1;7:8-15. Full text
Pharma controls CME
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In 2006, over $2.3 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, Table 7. 2007 Jul 6. Report
Advertising in medical journals
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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, Alladin K, Chow J. PLoS Med. 2006;3(6):e130. Full text
“I Never Read the Ads”
Correct message retention by media mix
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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. Medical Marketing & Media. 2006 Dec;41(12):60-2. Full text
What about R&D costs?
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Pharma spends 2-3 times as much on
marketing as it does on research
Edwards J. Brandweek. 2005 Feb 7; ;46(6):24-6.
Is promotion worth it?
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In 2006, the ten best-selling global pharma
brands made $53.5 billion*
In 2001, the average return on investment
per dollar spent on promotion was $12.70**
*Robins R. Successful Product Manager’s Handbook. Pharm Exec 2007
Mar 1;7:38-41.
**Niles S. Med Ad News 2004 Mar;23(3):1
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Educational materials, news, resources, film
clips, slideshows, articles, book list
Links to reliable, free drug information
Links to 300 credits of pharma-free CME
Soon, our own CME modules on
pharmaceutical promotion
Funded by the Attorney General Consumer and Prescriber
Education grant program, created as part of a 2004
settlement between Warner-Lambert, a division of Pfizer, Inc.,
and the Attorneys General of 50 States and D.C., to settle
allegations that Warner-Lambert conducted an unlawful
marketing campaign for the drug Neurontin® (gabapentin).
Contact us at http://www.pharmedout.org or 202-687-1191.
Thank you
References