Online pharmacy weblog

FOR many Americans, a doctor’s decision to prescribe medication is
something of a sacred transaction. A physician considers the patient
and symptoms and chooses the best drug for the job, drawing upon years
of training and clinical experience. It is an exchange conducted in a
hushed sanctuary, far from the heat and noise of the marketplace — a
place where cool judgment reigns.

That sanctuary has been breached. Today, drug manufacturers do
everything in their considerable power to ensure that their brand-name
prescription medications are on the lips of patients and in the minds
of physicians every time the two meet across an exam table. A growing
chorus of critics says their efforts have begun to rewrite the
dialogue between patient and doctor, influence physicians’ judgments
and open the act of prescribing to forces more profit-minded than sacred.

In 2006, drug-makers spent almost $5 billion to reach out to consumers
with direct advertising. But the glossy magazine ads and
buzz-generating TV spots are just the most visible parts of a campaign
to build and nourish markets for brand-name prescription products. The
world’s pharmaceutical companies spend an estimated $19 billion
annually to woo doctors. They sponsor teaching programs and research
at universities across the country, gaining goodwill along the way.
They give money to patient groups. They hire public relations firms to
share patient stories of illness and triumph.

In a nation that consumed $279-billion worth of prescription
medications in 2006 — spending 80% of that on brand-name products –
their efforts appear to be paying off. Americans filling a
prescription choose brand-name products 37% of the time, even though
three-quarters of all prescription drugs in the U.S. are available in
cheaper generics.

“The most effective marketing is the marketing you’re not aware of,”
says Dr. Peter Rost, a one-time pharmaceutical company marketing
executive who has become an Internet-based industry watchdog. “If you
see an ad, you know it’s marketing. But if a friend or your doctor
talks to you about a drug, you don’t.”

Now the size, scope and apparent effectiveness of drug companies’
marketing efforts has begun to prompt cries of foul even from within
the medical establishment, which has long been silent about its
growth. In a handful of state legislatures across the country,
lawmakers already have acted to blunt drug-company marketing, and many
more are considering similar measures. Lawmakers on Capitol Hill have
suggested that federal legislation may come next.

At stake, critics say, are patients’ health, the nation’s healthcare
budget and, ultimately, the trust and esteem in which Americans hold
their physicians. Costs rise as more doctors prescribe brand-name
drugs when cheaper, older or more effective drugs might be available.

Under-treated conditions that threaten the lives and wellness of large
swaths of the population — illnesses such as diabetes and high blood
pressure — may get less attention than conditions such as erectile
dysfunction or insomnia, for which pharmaceutical firms have new and
potentially more profitable offerings. And patients may be steered
toward newer drugs with risks and side effects that are less
well-known, in lieu of medications with a longer history of safe use.

“There is nothing fundamentally wrong with advertising products,” Dr.
Jerome P. Kassirer, a former editor of the New England Journal of
Medicine, told a Senate committee recently. “But when financial
incentives yield inappropriate or dangerous care, when they
inordinately raise the cost of care, when they risk patients’ lives in
clinical trials, and when they damage the profession, they have gone
too far.”

The pharmaceutical industry counters by arguing that its marketing
efforts are needed to recoup the cost of drug development and that
they introduce Americans to medicines that can save lives and improve
well-being. The industry’s sponsorship of research and education
pushes the process of drug discovery and development forward,
drug-makers say. Companies’ marketing to physicians keeps busy
clinicians abreast of new therapies and scientific advances in a
fast-changing landscape. And their advertising of drugs in mass-media
outlets educates patients and improves their communication with
doctors, they add.

And drug marketing improves the economic vitality of the nation, a
representative of the drug industry’s largest trade group, PhRMA, said
at a recent Senate hearing. Prompted by drug industry marketing, more
patients in recent years have sought out a doctor, and more doctors
have looked for signs of under-treated conditions such as depression,
diabetes and asthma among patients, Marjorie E. Powell, an attorney
for PhRMA, said to the Senate Select Committee on Aging in late June.
Citing a pair of studies published in 2003, Powell said that in the
long run, increasing treatment of such chronic conditions should drive
down the nation’s healthcare bill.