Only two countries in the world allow drug companies to market their products directly to consumers: New Zealand and the United States. It’s a problem on many levels, the least of which is what’s become our routine nightly bombardment by ads for depression, sleep, and erectile dysfunction drugs. Apart from being boring and tacky, it actually ends up raising the cost of the drugs we actually do buy by significant percentages.
What researchers have discovered, though, is that this direct-to-consumer marketing only accounts for less than a tenth of what pharmaceutical companies are spending on marketing: in reality, more than 70% of the drug industry’s marketing efforts are directed at getting doctors to prescribe its various products.
According to Marc-André Gagnon and Joel Lexchin, who reported extensively on this issue in PLoS Medicine, the almost $60 billion that pharmaceutical companies spend on marketing each year is mostly made up of what amount to bribes to doctors. Not only do drug companies foot bills for doctors’ fancy dinners, trips around the country, sporting event or concert tickets, they hire doctors as private “consultants” with six-figure salaries in addition to their regular salaries. They invite them to give talks at conferences for $5,000 to $10,000 a day; they pay bonuses for meeting prescription quotas, and to doctors who out-prescribe their colleagues.
The costs of this, of course, are passed right through the health care system on the consumers. And as we are seeing, in the Vioxx-type situations where doctors, in exchange for rewards, are super-prescribing a blockbuster drug that turns out to be dangerous, more patients end up getting needlessly hurt.
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, has argued that even the small gifts that companies routinely doll out, such as free lunches, coffee mugs, flash drives, binders, book bags, and free samples, affect doctors’ prescribing behavior. A 2003 study Caplan coauthored and published in the American Journal of Bioethics found “indisputable [evidence] that small gifts had a tremendous power in influencing favorable attitudes toward products.” Accordingly, the University of Pennsylvania, along with Stanford and Yale Universities, now prohibits faculty and medical staff from accepting “even small gifts” from drug company reps.
Last year, New Jersey Attorney General Anne Milgram set up a task force to explore the problem of doctor gift-giving by pharmaceutical companies and medical device makers, and determine what impact, “if any,” such practices have on patient care in New Jersey. We have not yet heard the results—and we need to now, so that more medical schools and hospitals can take action.
Pharmaceutical gift-giving to doctors has to stop immediately—not just in the progressive states who’ve begun to speak out against the drug companies, and not just for large-scale gifts. Federal laws need to be put in place to end doctor bribery and perk-based marketing of all kinds. Our doctors are trained in medicine, not in how to avoid psychological manipulation, and can’t be reasonably asked to resist marketing pressures on good faith. Significant legal action needs to be taken now.