In a previous article, I talked about how the FDA determines whether a drug should be allowed to be sold. It typically takes around 14 years and $1 billion to get each drug through the approval process. Actually, in the last 10-15 years, the cost has gone up significantly to over $2.5 billion (although the average time to approval has gotten closer to 10 years). That seems like a lot of money to be allowed to sell one little chemical. So how do these companies get their money’s worth? It may surprise you that many pharmaceutical companies spend far more money on marketing than they do research and development.
John Oliver did a segment on his show on pharmaceutical advertising to doctors (warning: coarse language). In the segment, he talks about all the ways, many of them rather sketchy, that pharmaceutical companies convince doctors to prescribe their drugs. For instance, pharmaceutical companies frequently spend many times more advertising to doctors than to the public; companies pay certain doctors to be “thought leaders” to hawk drugs to doctors who refuse to see pharmaceutical reps; and drug companies place enormous pressure on doctors who don’t prescribe their drugs in sufficient numbers. The previous article I wrote talked about how it’s important to trust your doctor, but if you watched the video, you may begin to feel that doctors are letting pharma money dictate all their decisions. This is why it’s important for you to find a doctor that you like and trust. In fact, as part of the Affordable Care Act (AKA Obamacare), there is a government website that requires all doctors to disclose money they have received from drug companies. This database is relatively new, but over the next couple years, it will publish comprehensive information on payments to doctors and hospitals. If you search for your doctor and they don’t come up, it’s likely they haven’t taken any payments from drug companies.
Should I be worried that my doctor is taking payments from drug companies?
That really depends on how much they are taking and from whom. Since it’s important to have open and honest conversations with your doctor, you could print out a list from the database above and ask them about money they’ve taken. (Note: This isn’t really worth it if there are very few payments/gifts for very little money. Think about what you’d be willing to change about your own life if someone bought you a $10 lunch one time.) The most important part of the doctor-patient relationship is trust. Give your doctor a chance to earn your trust, but if you don’t trust them, you should find a doctor that you do trust.
What can we do about all this money spent on marketing?
If you remember from my previous article on big pharma, drug companies are first and foremost companies. In 2012, Pfizer spent $130 million advertising the arthritis drug Celebrex and $108 million advertising Viagra. When these drugs came out in the late 1990’s, Pfizer had been spending an average of $100 million per year over the course of 10 years for FDA approval. They then continued to spend at least that much each year on advertising. For comparison, Sony spent $100 million advertising Playstation 4 when it launched in 2013. They do this because they know it will get people to consume their product. Sony is just trying to convince you that you should spend your free time playing their games, but in pharma’s case, they are trying to convince millions of Americans to take a drug that they may or may not need. They are also trying to dictate how physicians prescribe drugs. Here are a few ideas you may want to discuss with your friends, family, and local congressmen:
- Most developed countries limit how pharmaceuticals can be marketed, both to doctors and consumers, with reasonable success. The idea of government regulation tends not to go over well in the US, but if enough people pushed for regulation, it could happen.
- The government could spend more money on research and development through the National Institutes of Health, which fund much of the biomedical research in our country. This would would push drugs through that initial investment hurdle of FDA approval. FDA could then lease the patent rights to a company for manufacturing, with conditions limiting how the drug is marketed to doctors.
- The open payment database I mentioned earlier can be used to make pharma-physician connections more transparent. If patients show that they care about this issue, doctors will have incentive – keeping their patients – to avoid taking large amounts of money from drug companies.
- As with all sorts of social change, it can only happen if enough people know and care about the issue. If you think this is an important issue, start a conversation with your friends, family, and doctors about how much money is spent marketing pharmaceuticals.
What can I personally do about this?
Be educated about your health and medication! Sometimes, a particular drug will be right for you, not because a commercial told you so, but because you truly need that medication. If you ask your doctor to explain why the drug is needed and how it will fix the problem, you can understand why this specific drug is right in your case.
This is central to the mission of Science ACEs: no matter how much schooling you have, we want you, YES YOU!, to be educated about science. One of the reasons I am so passionate about this mission is that the more you know about science and medicine and the related social issues, the more you will be able to ask the right questions and have a productive conversation with your doctor.
You can follow Ben on twitter @bhornstein5189