the physician-pharma relationship pharmedout.org georgetown university medical center january 2008
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The Physician-Pharma Relationship
PharmedOut.orgGeorgetown University Medical
CenterJanuary 2008
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The Physician-Pharma Relationship
Is very old and very close But are the goals of pharmaceutical companies
and medicine the same?
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Promotion includesPromotion includes
Detailing Meetings and events (dinner
meetings, CME, rounds, symposia) Publications (symposia, monographs,
supplements, throwaways) Advertising and reprints Direct mail, e-detailing
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Top 10 products by US Sales, 2006 (IMS Top 10 products by US Sales, 2006 (IMS Health)Health)
Lipitor $8.6 billion Nexium $5.1 billion Advair diskus $3.9 billion Aranesp $3.9 billion Prevacid $3.5 billion Epogen $3.2 billion Zocor $3.1 billion Enbrel $3.0 billion Seroquel $3.0 billion Singulair $3.0 billion
IMS national sales perspectives. IMS Health. 2007 Mar. Table
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The costs of promotionThe 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**
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
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Promoting the profitablePromoting the profitable
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
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New drugs are not New drugs are not necessarily better drugsnecessarily better drugs
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
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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. *Chren MM and Landefeld CSl. JAMA 1994 Mar 2;271(9):684-9. AbstractAbstract Lurie N et al. J Gen Int Med 1990;5(3):240-243. Lurie N et al. J Gen Int Med 1990;5(3):240-243. AbstractAbstract Wazana A. JAMA 2000 Jan 19;283(3):373-80. Wazana A. JAMA 2000 Jan 19;283(3):373-80. AbstractAbstract**Sigworth SK et al. JAMA. 2001 Sept 5;286(9):1024-5. **Sigworth SK et al. JAMA. 2001 Sept 5;286(9):1024-5. AbstractAbstract McKinney WP et al. JAMA 1990 Oct 3;264(13):1693-7. McKinney WP et al. JAMA 1990 Oct 3;264(13):1693-7. AbstractAbstract
“Doctors are too smart to be bought by a slice of pizza“
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DetailingDetailing
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. *Goldberg M et. al. Pharm Exec. 2004 Jan 1;24:40-5. AbstractAbstract
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The AMA Physician The AMA Physician MasterfileMasterfile
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
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AMA’s Prescription Data AMA’s Prescription Data Restriction Plan (PDRP)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," explained the AMA’s senior VP of publishing and business services to Pharmaceutical Executive Herskovits B. Pharm Exec Direct. 2006 Jul 19. Full
text
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AMA’s Opt-out planAMA’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.”
Musacchio RA and Hunkler RJ. Pharm Exec 2006 May 1. Musacchio RA and Hunkler RJ. Pharm Exec 2006 May 1. FullFull texttext
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What drug reps costWhat drug reps cost
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.
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Ex-reps speak outEx-reps speak out
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*
“The essence of pharmaceutical gifting…is ‘bribes that aren’t considered bribes.”
Michael Oldani 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
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“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. Best foot forward. Communique, vol 7. Full text (also
downloadable pdf)
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“I only see reps for the samples”
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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
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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, most promoted drugs
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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
The real purpose of samples
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Samples are a marketing Samples are a marketing tooltool “…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.
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Meetings and eventsMeetings 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. Successful Product Manager’s Handbook. Pharm Exec. 2007 Mar 1;7:8-15. Full text
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Pharma controls CMEPharma controls CME
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
FDA-regulated 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
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Advertising in medical Advertising in medical journalsjournals
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 reprintsFugh-Berman A, Alladin K, Chow J. PLoS Med. 2006;3(6):e130. Full text
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“I Never Read the Ads”
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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%
Correct message retention by media mix
Paul CM. Medical Marketing & Media. 2006 Dec;41(12):60-2. Full text
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What about R&D costs?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; ;46(6):24-6.
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Is promotion worth it?Is promotion worth it?
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.
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Thank you
References