Transcript Slide 1

Revitalizing Professionalism
AMSA’s PharmFree Initiative
Overview
I. The Pharmaceutical Industry
II. Marketing to Physicians
III. AMSA’s PharmFree campaign: What
YOU Can do!
Part I: The Industry
Drug Industry Profitability
Drugs are expensive because of R&D
right?
M ark e ting/Adm in vs . R&D
18,000.00
16,000.00
14,000.00
12,000.00
10,000.00
Marketing & Administration
m illions of dollars
R&D
8,000.00
6,000.00
4,000.00
2,000.00
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Top 5 U.S. Pharm ace uticals
Source: Data compiled from 2006 annual reports
NO! It’s advertising and freebies to doctors
Source: From Kaiser Family Foundation Report on
Trends and Indicators in the Changing Health Care
Marketplace http://www.kff.org/insurance/7031/ti2004-120.cfm
But it costs $802 million…
-Using PHRMA’s own data, and incorporating a period 7
yr R&D period and 7 yr approval period, it was found that
the cost of an approved NME was about $150 million
(and that’s assuming you take the most recent period)
-That number is for a NME, a supposedly innovative
drug. It must be significantly less for a me-too drug
Source: Rx R&D Myths: The Case Against The Drug
Industry’s R&D “Scare Card”, Public Citizen Full Report:
http://www.citizen.org/documents/rdmyths.pdf
But, we have so many new drugs
Inflation
adjusted R&D
Expenditures
New Drug
Applications
------ New Molecular
Entities
-1993-2004, industry reported annual inflation-adjusted
research and development expenses steadily increased
from nearly $16 billion to nearly $40 billion—a 147 percent
increase.
-In contrast, the number of New Drug Applications (NDA)
submitted annually to FDA increased at a slower rate— 38
percent over this period.
-The number of New Molecular Entities (NME) has
declined by 40 percent between 1995 and 2004
Source: GAO Nov 2006
Report: New Drug
Development: Science,
Business, Regulatory, and
Intellectual Property Issues
Cited as Hampering Dug
Development
Where is the innovation?
Proportion of 1,264 NDA’s submitted by innovation potential, 1993-2004
-60% of the drugs submitted to the FDA
from 1993-2004 are strict me-too drugs
Source: GAO Nov 2006 Report: New Drug Development:
Science, Business, Regulatory, and Intellectual Property
Issues Cited as Hampering Dug Development
YOU do the research, we get the money
• At least 1/3 of big pharma’s drugs are now licensed or
otherwise acquired from outside sources – including
smaller companies around the world1
• For the 5 top selling drugs in 1995, the NIH found that
16 of the 17 key scientific papers leading to the
discovery and development came from outside the
industry2
Foreign Academic
Institutions, 30%
Industry, 15%
NIH Funded Labs,
55%
Sources:
(1) The Truth About Drug Companies, Angell 57
(2) The Truth About Drug Companies, Angell 65
The research smells a little funny
• Study examined 4 peer reviewed journals
(NEJM and JAMA included)
• Many funded by private industry 21.6%
• Relevant conflict-of-interest disclosures
omitted at least 8% of the time (only first
and last authors studied)
Source: Goozner M. Unrevealed: Non-Disclosure of
Conflicts of Interest In Four Leading Medical and
Scientific Journals. CSPI: 2004.
Clinical Practice Guidelines:
The Standard of Care
• 87% of authors surveyed had ties to drug makers
• More than half had relationships relevant to specific
drugs considered by the guidelines
• While only 9% of the authors believe they were
influenced, 19% felt others had been influenced
• The majority of personal financial conflicts of interest (42
of 44) were not reported in the final publications.
Source: JAMA 2002: 287 (5); 612-617.
Publication Bias
• Research funded by drug companies was more likely to
have outcomes that favor the sponsor’s product than
research funded by other sources
• Positive results were more likely to be published than
non-significant or negative results
• Results were more likely to appear in non-peer-reviewed
symposia
Source: BMJ. 2003; 326: 1167-1170
One on One
• In 2001, the industry's sales force of drug detailers,
whose job is to meet individually with physicians and
promote company products, numbered nearly 90,000
in the United States — 1 salesperson for every 4.7
office-based physicians1
• In 2001 the major pharmaceutical companies had 623
lobbyists, that is about 1.2 lobbyists per member of
congress2
Sources:
(1)N Engl J Med 351(18): 1886-1890
(2) Public citizen: The Other Drug War II
http://www.citizen.org/documents/Drug_War_II.pdf
Part II: Marketing to Physicians &
Physicians in Training
White coat of the future?
Professionalism
• Free pens, notepads and office supplies
“commercialize” physicians
• Gifts, consulting fees and paid vacations
create a conflict of interest
• Free samples, create a cycle of
dependence and poor health delivery
Thought Experiments
• Who bears the burden of the pens, bottles, post-its,
free lunches, paid vacations, etc?
• Who subsidizes the cost of the “education” which the
industry purports to provide?
• Why would each company require billions of dollars of
marketing if their products made such a great
difference in the lives of patients? Wouldn’t they just
sell themselves?
Pharmaceutical Branding of
Resident Physicians
• Survey of 181 primary care residents; 164
(91%) responded.
• First asked to complete survey, then asked
to empty pockets of white coats.
• 98% had eaten drug company-sponsored
meal within the past year.
• 97% of residents were carrying at least one
item with pharmaceutical insignia.
Source: JAMA 2001;286:1024
Characteristics of GP’s that
regularly interact with drug reps
• When new drugs became available, these
physicians started using the new drugs
quicker
• Relied less on unbiased, published
sources of evidence regarding drug
efficacy
Source: BMJ. 2003; 326: 1178-1179.
Perceived influence of pharmaceutical reps on
prescribing practices
A Lot
33%
A lot
1%
A little
38%
None
16%
None
61%
“You”
A Little
51%
Source: Am J Med 2001;110:551
“Other Physicians”
A Physician Survey of the Effect of Drug
Sample Availability on Physicians’
Behavior
HTN scenario:
• 92% said they would prescribe a diuretic or bblocker as initial therapy.
• When samples were made available, 32 of the 35
physicians who said they would give a drug
sample selected a drug that differed from their
preferred choice.
Source: J Gen Int Med 2000;15:478
Effects of using Free Sample Medications
on the Prescribing Practices of Family
Physicians
When comparing a clinic with samples to others
without, doctors at the clinic with samples:
- Wrote more scripts for brand name medications
- Had a higher average cost per script written
- Wrote fewer preferred or formulary brand name drugs
- Wrote more scripts for the medicines in the sample
closet
Source: J Am Board Fam Med. 2006: 19; 443-9.
Medical Students’ Exposure to and
Attitudes about Drug Company
Interactions: A National Survey
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1143 surveys to 3rd years in 8 schools
93% required to attend at least 1 sponsored lunch.
69% believed gifts would not influence practice.
86% had accepted at least one gift.
86% did not know if school had policy on relationships.
Source: JAMA 2005;294:1034-1042
Not-so-Modest Meals
• Despite industry guidelines published in 2002 requiring
the meals provided by the industry be modest,
• Meals provided to one Internal Medicine Residency
program in Philly over a 6 month period averaged
$42.08 per person.
• Most of the sponsored restaurants were rated as
“extraordinary to perfection” by Zagat Survey.
Source: JAMA 2003: 290 (9); 1151-1152
A New Law- Early results from VT
and MN Gift Registries
• The majority of payments
were not reported
because they had been
designated as “trade
secrets”.
• The data was poor in
quality and not easily
accessed by the public
• Average Payments in
VT were $177 (max
$20,000).
• Average Payments in
MN were $1000 (max
922,239).
Source: JAMA. 2007;297:1216-1223.
The Bottom Line…
• The Top 5 U.S. pharmaceutical companies
would not have spent $41.3 billion dollars
in 2006 for marketing and administration
purposes if did not work
Source: Analysis of 2006 Annual Reports
III. AMSA’s PharmFree campaign:
What YOU Can do!
www.amsa.org/prof/pharmfree.cfm
• Hold a Pharm Free Week event at your school
October 22-27, 2007
• Use unbiased sources of drug information like
The Medical Letter
• Work for policy at your school to limit contact
between drug reps and students
• Take the Pharm Free pledge
Contact Paige Hatcher at
[email protected]