Prescription Information Availability

I got a little excited when I read that Congress might limit Big Pharma's ability to use doctors' prescription behaviors for their marketing. Of course, the proposed idea was quickly eliminated.

Pharmaceutical companies spend incredible amounts of money on marketing. Besides outright bribes to doctors with free food and paid speaking opportunities (averaging $3900 per targeted doctor), the marketers use information on which doctors are prescribing what and how often to custom-tailor their pitches. They can tell which of their sales techniques are most effective by looking at the spikes in prescriptions after each sales pitch. They know if a doctor was a waste of bribes, and they can focus their efforts on the ones who respond well to incentives.

The companies will claim that their behavior is to help keep doctors up to date on what works, but that is an outright lie. The marketers push the new, still under patent, expensive drugs over the cheaper drugs regardless of effects. Expensive drugs that do not work better are touted. There is no good reason that doctors should listen to the obviously biased salesmen of a drug instead of looking at peer-reviewed research articles in selective journals. There are problems even with those articles, but they are better.

I have attended drug rep presentations at medical facilities. They use anecdotes about outlier cases to hype up the drug, and lay out some lunch and branded office supplies. The MDs in the room didn't look at the fine print, which revealed to me the variance in the drugs effects (40% of participants for one drug got worse, and those who got "better" were still severely ill, so why use this expensive drug with lots of side effects?). A medical degree is no guarantee that a person is going to be careful or attentive, or even understands statistics, or keeps up to date with research. There is practically zero oversight of doctors in most settings because they run the show and they only listen to each other. Doctors are fallible and subject to manipulation. Smart hospitals have banned drug reps.

I am all for accurate and complete information about drugs being disseminated to prescribers. It should be done by unbiased parties, and be presented in a way that doctors can understand, comparing the risks and benefits of the drugs, and I would also include the costs. The PDR is obviously inadequate, and tends to just collect dust on a shelf. No drug marketing should be allowed, ever. Until that happens, let's keep prescription information from the marketers so they are less able to target unethical and mentally weak doctors.

Consumer Reports, an independent organization, may be a good resource. They have a free website about drugs. For example, recent 60-study analysis showed that $10/month Doxazosin is as effective as $246/month Flomax. Flomax is heavily advertised because it is new and expensive, not because it is more helpful.

Drug Samples - The First One's Free

There is a new article on Free Drug Samples in the Public Library of Science.

Summary: Drug samples are bad. Doctors are people, and are subject to manipulation by marketers the same as anyone else. The multi-billion dollar pharmaceutical companies give out samples in ways that make them more money, increasing awareness of expensive new drugs, irrespective of the effects on national health. These companies lobby the government to make sure they can keep doing this, even though it is bad. Samples are not used to help the poor, and are often used by the doctors or given to friends since they are not monitored. Lack of monitoring and involvement of pharmacists also leads to negative drug interactions and a lack of consumer education. Socialized health care systems are relatively impervious to manipulation by samples.

If you follow the link, also read the comment by Ken Johnson, Senior Vice President of Communications for the Pharmaceutical Research and Manufacturers of America. Obviously biased, he presents some data that does not really contribute to his argument. He supports the idea that drug samples give people treatment for their problems, ignoring that the main article already discussed this, and how poorer patients often discontinue these drugs cold-turkey when the freebies run out. Ken argues that most prescriptions are still for generics, which is a distraction from the problem that still more expensive new drugs are being prescribed than should be. His argument is like saying that it's okay to set some houses on fire because most houses will still not be on fire. Was the KRC survey of prescribers? Of course they don't think they're influenced by marketers over journal articles and clinical formularies. Ken goes on to point out that drug expenditures have gone down, and payers influence prescription decisions, both of which may be true, and neither of which counters the points of the main article. Then he says that 75% of physicians report using samples to reduce costs for patients, which combined with the main article means that they're reducing costs mostly for non-poor patients. Remember that the samples also work as a hook to get people using who can actually pay for more. Finally he repeats that free drugs are good, again ignoring long-term ramifications of only temporary and undermonitored, underexplained free drugs.