Drug Companies Spend Almost $60 Billion On Marketing, $30 Billion On Research. What?

It’s okay for drug companies to spend oodles on advertising because they spend even more making sure their drugs are safe and effective, right? Not so much, according to a study in PLOS Medicine.

The study shatters the accepted myth that pharmaceutical companies spend more on research than on marketing. In reality, drug companies pour $57.5 billion into marketing, dwarfing the comparably paltry $31.5 billion devoted to research.

Billions of marketing dollars go toward television ads that implore us to “ask our doctor” about drugs we don’t need to treat ailments cultured by public relations firms. Yet even more money is spent convincing doctors to prescribe costly medicine—an astounding $61,000 in “promotion per physician.”

For the last 50 years, say the authors, there has been an ongoing debate as to which image of the drug industry is most accurate. The industry promotes a vision of itself, say the authors, as “research-driven, innovative, and life-saving,” but the industry’s critics contend that the drug industry is based on “market-driven profiteering.”

The study confirms the more cynical view that drug companies are out to profit first, and save lives second. And there’s nothing wrong with that.

We think there is something severely wrong with a system that emphasizes marketing over research. Profit is good, but profit at the expense of the public health is dangerous.

Don’t be ashamed to ask your doctor if a drug company recently paid for any meals or ski trips. Instead of mentioning the latest drug splashed across the screen, ask how they would use their expansive medical knowledge to treat your condition. Ask how they would treat their child.

Do drug companies do more marketing or research? [SciGuy]
The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States [PLoS Medicine]
(Photo: rabbit.marshall)

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  1. johnva says:

    They really need to re-ban direct-to-consumer advertising of prescription drugs. Not only is there no reason for it, and not only does it encourage drug companies to focus their research only on “marketable” drugs, it makes our drugs much more expensive. And most other countries do not allow it. Doctors should make the decisions about prescription drugs anyway.

  2. TomK says:

    Don’t get me startd on these fuckwits.

    Most of what they do spend on RD goes to finding ways to extend patents on profitable drugs. If your allergy pill patent is about to expire better find a way to modify the formulation and extend your patent another few years, then do a study that shows a 3% improvement over the last formulation. Then design an ad campaign that plays up the advantage, taking advantage of the fact that most american are scientifically and statistically illiterate, then put those ads everywhere and who cares if thats the best way to spend the health care dollars from a medical point of view.

    Prescription Drug advertising should be forbidden. ” I SAW IT ON THE TV AfTER THE AMERICAN GLADIATORS I WANT” is not a great way to do medicine.

    In a system without advertising and bribes to doctors, the medicines that work best make the most profits. In systems with ads and bribing doctors (what we have now) whoever is best at advertising and bribing doctors makes the most profits.

  3. LAGirl says:

    i was seeing a pain management doctor for my migraines. he always pushing new drugs. after experiencing some very negative side effects from a few of those drugs, i decided to stop blindly taking whatever he prescribed.

    i also started to question:

    * why was he always traveling (Hawaii, NYC, San Francisco, etc + staying in five star hotels) to give ‘lectures’ about drugs?

    *why were there always fully catered lunches at this office?

    *why was there drug company ‘swag’ all over this office i.e. note pads, pens, posters?

    *why was there a photo of my doctor, smiling, with a group of drug company reps framed + hanging in his office?

    when i finally figured out he was a drug company ‘shill’, i fired him.

  4. skatanic says:

    “Profit is good, but profit at the expense of the public health is dangerous.” I think its a sever lapse in judgment to assume that companies have some sort of conscience. It’s called capitalism. The whole point is to make money, not to help people. As long as there are enough people to buy their products, the pharmaceutical companies couldn’t care less about public health. Capitalism has never been on the side of public wellbeing and never will be. Regulations do little to tame the beast that is capitalism, and the only real solution is to slay it.

  5. ARP says:

    Skatanic- I don’t think the solution is to end capitalism, just to regulate certain components of it to balance the public interest.

    I agree with other posters that we need to stop direct to consumer advertising of drugs. We also need to stop (or at least have full disclosure) of all the bribery going on at doctors’ offices.

    The problem is that behind the oil and pro-Isreal lobby, the drug lobby is the most powerful group in Washington.

  6. Aphex242 says:

    @skatanic: That’s patently silly. As previously stated, if you end direct-to-consumer marketing the best drugs will generally sell best.

    Capitalism involves making things people want and selling them for a profit. Right now we ‘want’ the crap they advertise on TV, rather than new cures, new drugs, etc. Legislation can end that vicious cycle and make drug companies innovate once again.

    That would be capitalism, and it’d work just fine.

  7. ARP says:

    I should clarify lest I be viewed as anti-semetic. I’m not suggesting that the pro-Isreal lobby is a good thing or bad thing (unlike the oil and drug lobby- they are bad), only that they are well organized and very powerful.

  8. ceriphim says:

    I agree the whole pharmaceutical industry is pretty much f**ked here in the U.S.

    However, I was recently very sick for an extended period of time, and in seeing no less than 5 different doctors at more than one clinic NOT ONE of them prescribed me a brand name drug. In fact, every one of them were generic. So I might have felt a little out of place grilling them on accepting drug company money…

  9. skatanic says:

    So i suppose you would be the one lobbying in congress to get legislation passed? The fact that they have billions of dollars is going to outweigh your concerns.

  10. snoop-blog says:

    why spend money on a valtrex commercial? are there really that many people with herpes who call in when it comes on?

    why advertise a drug that i need a Rx just to get? if i was getting a Rx from a doctor, wouldn’t he tell me about my choices? i would think i could at least ask.

  11. XTC46 says:

    As much as I dislike that big pharm are money hungry and are in it for the profit, I can’t help but think “so is just about every other business”

    Everyone needs to make a living, and the fact is, the vast majority of people won’t work for free, and if you are really good at what you do, you demand a high pay for it. If there was no money to be made in medical research, some of the industries top groups wouldn’t do it.

    Now, there is a huge difference in making a living and swimming in pools of money like some of the top execs, but good leadership costs money, and if it takes billions of advertising dollars to make the money for the companies who do the research to sell the drugs that cure and treat disease, then I’m ok with that. Anyone who doesn’t like it is more than welcome to get into the field, and start their own non-profit drug company.

  12. snoop-blog says:

    slow COMMENTS day? lol.

  13. XTC46 says:

    @snoop-blog: the advertisements are there for 2 reasons. 1) so you think you have the symptoms they treat (typically they only list the most general symptoms) A good example of this is for the commercials for people with restless leg syndrom. The symptoms are so common that millions of people will think they have it, but in reality the condition is no where near that common. These people then see a doctor, and out of that group and handful will refuse to believe the doctor when he says they are nuts.

    2) so when you have a condition, you request their drug becasue it sounds familiar. If a doctor tells you 3 names you never heard of you will have no opinion of them, especially if he says they are all equal. If he lists 3 and you have heard of 1 from TV commercials, you will pick it (even if you don’t realize that is why you are picking it).

  14. @LAGirl: “he always pushing new drugs.”

    This should be a red flag generally. I teach medical ethics, and ethically, the best practice is to start with drugs with long track records that are generally known to be safe and have a wide body of research behind them (and the side-effects are well-understood).

    Only if the older drugs don’t work to you move forward to newer ones. Because even once they’re approved, it takes years, even decades, to build up the kind of real-world side effects and long-term effects and efficacy data that helps make for good decisions for specific patients in specific circumstances.

    If a doctor wants to START you on a new drug (say Vioxx instead of naproxen for osteoarthritis pain), the doctor should be telling you WHY he or she feels the drug is so superior to naproxen for your specific situation to warrant the new drug. Because sometimes the new drugs truly are vastly superior, but often they’re just better-marketed.

    I didn’t really think anything of it until I started teaching medical ethics, but I’ve always had doctors that did this: “I want to try you on a newer antibiotic. Amoxicillan would clear your sinus infection, but we find we get better compliance from college students with the Z-Pak since there are 5 dosses instead of 30. However, it might be harder on your stomach. It also costs more.”

  15. topgun says:

    Do you realize that very few drugs actually CURE anything. They mostly maintain a certain acceptable level. Of course the drug companies don’t want you to get better. Then you would have no need to buy their product. When their exclusive rights to produce a drug runs out and the generic equivalent becomes available they IMPROVE the original drug. Case in point is GSK’s Coreg CR. Cogeg CR is taken once a day with a cost of $148 for 30 capsules. Take the generic Carvedilol twice a day and 60 tablets will set you back only $4.

  16. skatanic says:

    @aphex242: This is the point i am trying to make: In capitalism, money is always going to be the bottom line, and everything, like public interest, is going to take a back seat to money. Millions and millions of people may be concerned about an issue, but if they don’t have money, they will be at a huge disadvantage to any opposition that has money. As much as we may dislike direct-to-consumer advertising of prescriptions, we are going to have a hard to being heard. It would take us thousands on man hours to inform the public, raise money to be heard, and still the majority of the public isn’t going to care. All the pharmaceutical companies have to do is lobby a bit to congress and create a clever ad campaign explaining the “benifits” of direct-to-consumer marketing and the “risks” of not having them.

  17. Trai_Dep says:

    In line with TomK’s comments, even Big Pharma’s “research” is misleading. The vast majority of their funds – as high as 80% – go into reformulating existing drugs to extend their patent, or on “lifestyle” drugs that treat hair loss or limp dicks. NOT saving lives.

    For example, Malaria drugs aren’t researched, even though they’d save literally millions of (brown-skinned) lives, because they can’t charge Third World people enough to get Wall Street excited. Same with flu vaccines.

    So not only do they spend WAY more on amoral marketing than research, but even their research is skewed away from helping those that need the most help.

  18. topgun says:

    @snoop-blog:
    Excellent point. As always “word of mouth” is always the best advertising. Take Oxycontin for example. I would ask my doctor for that.

  19. woertink says:

    @snoop-blog:

    Not necessarily, there are a lot of new drugs coming out and doctors do not always take the time to keep up with the advances.

  20. floydianslip6 says:

    You don’t need to spend mad amounts on research, you can just steal it from academia!

  21. VicMatson says:

    About a year ago I saw an article that told a story of a drug company. Apparentally they hire college cheerleaders straight out of school and pay them 6 figures(pun intended), then they relocate them to new, to them, areas to do what they do. The problem was these girls didn’t know they were candy for the doctors…and sues their employer.

    In the same article it said the research cost was about 17%, naturally I howled!

  22. TechnoDestructo says:

    So the depiction of the drug industry in “Brain Candy” is spot-on, then.

  23. JustRunTheDamnBallBillick. says:

    @VicMatson: Every rep Ive ever met has a Biology or Chem degree. Yes, a lot of them are buxom blondes, but they know the drugs. I dont see a problem with reps coming to my doc and providing him with lunch in order to get time to present him the facts about their companies products. I did the same when I did business to business sales, you need to make it worth the time it takes to hear you out.

  24. floydianslip6 says:

    @JustRunTheDamnBallBillick.: The point is that it’s medicine, not a vacuum cleaner being sold door to door. The product should be used because it does the job, not because you took Dr. No out golfing.

  25. deb35802 says:

    I used to work for a family medicine residency program which had 36 residents in it. The amount of advertising, doodads, and seminiars that are shoved at these doctors is obscene! Also they were REQUIRED to attend daily (Monday – Friday) lunches at which pharm reps would come in and push their latest product. After working with docs I only go to see one if I’m in severe pain or running a high temp.

  26. DoctorMD says:

    Direct advertising should be banned again. There was no health reason to allow it. If they want a educational commercial that spotlights a disease and says “treatments are available” or “medication may help” that is all that should be allowed.

    If a drug is developed at a public institution, with NIH funds or other gov’t funds there should be a cap on % markup (profits) able to be gained by selling the drug. (Really on all drugs but it would be a start)

    “Me too” drugs in the same class (mechanism of action) should have to prove superiority in efficacy or side effects before a patent is granted.

  27. SkyeBlue says:

    (LAGIRL: Try seeing a chiropractor for your migraines. Mine has worked miracles for me. I used to get BLINDING migraines but now get maybe 1 or 2 mild ones a year now and I see him at the first sign of one and he fixes me right up.)

    Does anyone know if physicians get an actual “kickback” on the medicines they prescribe?

  28. arby says:

    @ARP: If you’re going to cast aspersions, at least learn how to spell what you’re casting them at: it’s Israel and semitic.

  29. woertink says:

    @doctormd: I would prefer it not be banned since I am a big fan of freedom of speech.

  30. Elviswasntmyhero says:

    “In reality, drug companies pour $57.5 billion into marketing,”

    When someone translates this for the poppy farmers of Afghanistan, U.S. troops better watch their backs.

    —-

    “We think there is something severely wrong…”

    And the award for understatement of the year goes to…

  31. Boberto says:

    @ARP: “You’re a rabid anti-dentite”

  32. thing_vs_thing says:

    @EYEBROWS MCGEE
    Three cheers for the medical ethicist! May I ask where you teach? I’m always looking for some book-learnin’.

    With regard to being prescribed the Z-pak for a sinus infection – I was shocked. Most physicians I know will always prescribe the older (and cheaper) antibiotics before throwing the Z-pak or even Cipro at an infection, unless a culture specifically shows an antibiotic resistant infection.

    Besides keeping costs down, the practice reigns in antibiotic-resistant infections. Why risk creating azithromycin resistant bacteria if amoxicillan would kill the critters in your boogers? I’ve only ever heard of the Z-Pak prescribed for the most severe infections and painful venerial diseases, so prescribing it for a sinus infection sounds like overkill.

  33. Boberto says:

    @SkyeBlue: It’s all non cash with exception to inviting MD’s to become research board members or medical directors of studies. Beyond that, it’s a conference here, a golf outing there, a cruise etc. It’s like a time share pitch that starts in the Doctors office. Results are tracked by how many prescriptions are written and to which Patients. (Yes, the drug manufacturers know that Dr. X wrote an Rx for your RLS and that you’ve had it refilled three times at CVS. They know the dates and even what your copay was.

    Those MD’s that produce results (as referenced above) get the “educational” invites. You fly in on day one and all attend the mandatory conference. Sign in for your CEU credit (Another Scam), and your free to do what you wish for the remainder of the trip.

    All expenses paid.

    THIS IS WHY IMPORTING CANADIAN DRUGS CAN BE SO LIFE THREATENING!

  34. topgun says:

    @JustRunTheDamnBallBillick.:
    My experience is just the reverse. I know 4 drug reps that have no background in chemistry or biology. My friends wife who is a rep barely made it out of high school and can only spell drug if you spot her the D & the G. She does however have a great ass and an ample rack.

  35. @SkyeBlue: “Does anyone know if physicians get an actual “kickback” on the medicines they prescribe?”

    It’s supposed to be illegal and in most states ethical canons specifically provide for loss of license if doctors take kickbacks.

    The problems come in with “what constitutes a kickback?” Schwag? Food? Trips? Free samples? Or only clear and direct monetary pay-outs to doctors who provide X prescriptions a month?

    The other problem is that technically a doctor-owned pharmacy is a “kickback” machine, as the doctors get the profits from the pharmacy and therefore have an incentive to unethically overprescribe. However, in many rural areas, the doctor’s in-house mini-pharmacy may be the only place to get drugs for 50 miles, and it’s absurd to prevent doctors from stocking common prescription antibiotics and painkillers in that situation. (It also raises questions about hospital pharmacies that are open to the public.)

    So the trick is defining “kickback” in such a way that it prevents drug companies from unduly influencing doctors’ clinical judgment (which DOES happen, there are dozens of studies on it), but doesn’t a) prevent education (drug companies can provide valuable educational material to doctors) or b) create scenarios like the one above where patients have to drive 50 miles because their doctors can’t take “drug kickbacks” by making a small and regionally-standard profit on pharmaceuticals.

  36. @thing_vs_thing: “Three cheers for the medical ethicist! May I ask where you teach? I’m always looking for some book-learnin’.”

    I teach at a local college, Illinois Central College, which I’m sure you’ve never heard of. It’s a community college; we have a lot of medical technician programs and a full RN degree.

    “With regard to being prescribed the Z-pak for a sinus infection – I was shocked. … Besides keeping costs down, the practice reigns in antibiotic-resistant infections.”

    You’re absolutely right. They were actually engaged in a clinical practice experiment that I understand was being carried out across several college campuses. They were having problems with drug-resistant common infections like strep and sinus infections on campuses because students don’t keep normal schedules and were wildly unreliable about taking all 30 doses of a “3x day for 10 days” regime. So they were researching to find out if a) compliance was higher with 5-dose antibiotics and b) if compliance on the 5-dose regime fixed more drug resistance problems than it created.

    This was also a few years before “superbug” was getting national press as an issue (about 1998, I think); I’ve read that antibiotic compliance has gone up generally as people have become more aware of the “superbug” issue.

  37. JustRunTheDamnBallBillick. says:

    Here is one question I have about those numbers. How much of that ad budget is free samples? I know most doctors keep closets FILLED with samples. When I was going through a rough financial patch I got almost all my meds free that way, and a friend of mine got the expensive baby formula she needed the same way.

  38. ChristopherDavis says:

    I say we just reduce the patent protection period for a drug by one month each time the company does any direct-to-consumer advertising. That’ll take care of it.

  39. Asvetic says:

    If you haven’t yet, watch Sicko.

    In the meantime, I’m moving to France, Canada, England or Cuba, or really any of the other 37 countries with better health care than us.

  40. ClayS says:

    @Asvetic:

    See ya. Don’t let the door hit you in the ass.

  41. psyop63b says:

    I never bought the political/corporate propaganda that drugs cost so much due to research costs/slow-ass FDA/etc, and not advertising.

  42. NickRB says:

    I think the consumerist really missed the mark on this one. Developing a single drug that is successfully brought to market costs…ready?…. Billions!!! If they don’t sell a lot of drugs that are VERY VERY VERY profitable they would have NO MONEY to develop any drugs. Think about it. AIDS patients would suffer horribly. No new cancer drugs would be developed. Kids couldn’t get vaccines. Drugs are very expensive to make and the companies need to spend that kind of $ on marketing to make enough profit to fund the R&D. Don’t forget you also have bullshit lawsuits. You know, like the kind that put Dow Corning out of business over leaking breast implants. Forget that there was NO SCIENCE OR FACT AT ALL to back up the prosecutions claims. Every drug company has to be prepared for these kind of lawsuits as well. That means they NEED a stockpile of $$$. If the drug companies spent more on R&D than they did on marketing they would go out of business. No new drugs would be developed and existing ones would eventually stop being produced in this country, leading to importation from the lowest bidder. Say China? What a horrifying thought that is.

  43. NickRB says:

    @Asvetic: If Canada healthcare is better than why do so many patients come to the United States and pay cash for life saving treatments? Perhaps before you take Michael Moore (He was the guy that’s been caught TIME AND AGAIN MAKING STUFF UP in documentaries right?) you should talk to people from those countries.

  44. Hambriq says:

    @Eyebrows McGee:

    I like you. Everyone else in this post, not so much. And I may have had some wine with dinner, but I’m always good for wading into a raucous pharmaceutical debate.

    Here’s my stance: New drugs are almost invariably better than old drugs.

    Now, I will be the first person to point out the million and one bullshit medicines out there that have no business being prescribed. Zegerid. Doryx. Solodyn. Tussionex. The countless “XR” formulations of existing medicines: Effexor XR, Toprol XL (prior to it going generic), Coreg XR, Ambien CR. And that’s just off the top of my head.

    But when it comes down to it, if I had high cholesterol, I would want to be on Crestor or Lipitor, and not on an older statin. If I had high blood pressure, I would rather be on an ARB (Diovan, Cozaar, Benicar, etc.) than an ACE Inihbitor (lisinopril). If I were manic, I would rather be on an atypical antipsychotic (Abilify) than a typical one (Haldol).

    Why? Because these newer, more expensive medicines are better.

  45. Hambriq says:

    Okay, and second of all:

    All that marketing money isn’t being spent convincing doctors to upgrade from cheaper medicine to more expensive medicines. Why? Because any doctor worth his salt is going to prescribe the best possible medication within reason.

    No, Pfizer is spending all their money to ensure that doctors prescribe Lipitor over Crestor. And Astra Zeneca is spending all their money to make sure doctors prescribe their patients Crestor over Lipitor. Why? Because Lipitor and Crestor are clearly superior to older statins like Simvastatin, Pravastatin, and god forbid, Lovastatin. The only real reason to be taking an older statin is because of financial issues. If all the medicines cost the same, there is no reason I can think of not to take a newer statin.

    So, what it boils down to is, doctors aren’t being convinced to prescribe a more expensive medicine over a less expensive one. They’re being convinced to prescribe one expensive medication over ANOTHER expensive medication.

  46. Hambriq says:

    Someone should stop me before I break something.

    Don’t get me wrong. There are a lot of bullshit pharmaceutical companies. But it just seems intellectually dishonest to talk about “drugs we don’t need to treat ailments cultured by public relations firms” from one side of our mouth and then decry the growing obesity, diabetes, and various other dietary problems ailing our country from the other.

    Most of these drugs are beneficial. There are plenty of bad apples. Believe me. I know. But for the most part, most of the drugs that get advertised in medical publications and pharmacy journals and to directly to doctors and pharmacists are the kind that genuinely help people. High blood pressure and high cholesterol are the two leading contributors to the majority of the non-cancer deaths in America. And in my mind, anything that can help with that, I’m in support of.

  47. courtneywoah says:

    Look around your doctors office, if there are pens, clocks, notepads, anything with a prescription drug brand on it, than you can be assured that they were visited by a PR person pushing their brand of drug on the doctor to get him to prescribe it. @HAMBRIQ I believe that research shows that new drugs are not better than old drugs and this is because new drugs are tested against a placebo NOT against the old drug its supposed to be replacing. Also, doctors are very willing to prescribe you a drug you do not necessarily need for a number of reasons, 1. they are being bribed by PR companies and 2. patients are insisting that they have these problems and need the drug. There are woman asking their doctor for Cialis (erectile disfunction medicine) just because the commercials. The public is being shown this happy illusion that a prescription drug is going to change their life, look at the arthritis commercials, I have never seen someone so happy to be diagnosed with a painful condition. Also, when a patent is about to run out on a drug the company will come up with a “new drug” to extend the paten life and to get new customers, the best example of this is Prozac, which is now used to treat women who suffer from PMS (the drug is called something else but I can’t remember). I think thats absolutely crazy! Lastly, the people that research and test these drugs to get them into the market quickly are paid by the drug companies themselves. I say get a second opinion before taking anything.

  48. taka2k7 says:

    @NickRB: Maybe you should talk to the American’s who go to other countries for treatment… Sure, if you’ve got the money, you can get quicker service here. But if you don’t have the money, you get no service here (except ER).

    I live under the “socialized” medicine given to the military (no copays except for family dental). It’s currently underfunded/understaffed (something about a war), but other than that it’s pretty good.

    But just a little off topic.

  49. l0pher says:

    Being in the medical industry and knowing a good deal of doctors in my area, I have to get on my soapbox here.

    Are there pharmaceutical representatives out there that couldn’t spell their name of their drug if you asked them? Maybe a few

    Are there doctors that would write a drug based solely on their relationship with a pharmaceutical company? Very possibly

    Are there drugs out there that probably should not be on the market because they have relatively little value? Yes

    Do pharmaceutical companies spend a lot on advertising (direct-to-consumer, pharmaceutical reps, lunches, etc…? Probably

    BUT…

    We forget that healthcare is a business, just like anything else. You take away the ability to make money and no one would do it. Sure it would be nice to say that everyone from your local doctor all the way to the CEO of Pfizer is doing their job out of the goodness of their heart… but let’s be realistic here. If I told you that you can work your rear off to make a boatload of money (that you earned) or work for free, which would you choose? Yes, you will say that I am speaking in extremes… but am I really? If it wasn’t healthcare but some other industry, would we still be burning everyone at the stake?

    Some of you guys will argue that doctor trying to “upgrade” you to a “better” medication is a bad thing. If I told you that you could have two drugs, one cheap but works 30% and has a 25% incidence of side effects or one that is more expensive but works 35% and has only 5% incidence of side effects which would you choose?

    Remember, your doctor is giving you options, if you say “no, I want a generic” they will prescribe you a generic. Like I said, I know a lot of doctors personally and while some of them may be kind to pharmaceutical reps, they are definitely shills or puppets of them and their company.

    One last thing, a new drug may only marginal differences in efficacy but do not forget about tolerability. drug profile, etc… Regardless of what is may be, NO DOCTOR I KNOW OF would EVER prescribe a drug that is LESS EFFECTIVE and WORSE for the patients just because it’s more expensive and because they go on trips or because they got free pens and pads, etc. For god’s sakes, you all make doctors seem like they’re homeless and destitute. Willing to jeopardize their license, get sued for malpractice just for a free lunch or pens with the drug’s name on them.

  50. @NickRB: “If they don’t sell a lot of drugs that are VERY VERY VERY profitable they would have NO MONEY to develop any drugs. Think about it. AIDS patients would suffer horribly. No new cancer drugs would be developed.”

    Except that most AIDS and cancer drugs are developed using US government grants paid for by our tax dollars, not discretionary research dollars from drug company profits. And then patented by drug companies who make ridiculous profits off drugs that were funded by taxpayer dollars in the first place.

    Drug companies research lifestyle drugs. Life saving drugs are much more often researched because of government grant dollars. Saving lives simply doesn’t bring in the bucks that extending erections does.

  51. @Hambriq: “Here’s my stance: New drugs are almost invariably better than old drugs.”

    I will agree with that (and you’re sweet for liking me!), with one caveat: New drugs are almost invariably better than old drugs FOR A SPECIFIC SUBSET OF PATIENTS. Vioxx is CLEARLY better than naproxen … for patients who don’t respond to naproxen. For the majority of osteoarthritis patients who respond perfectly fine to naproxen (or ibuprofin, for that matter), Vioxx simply wasn’t necessary … and as it turned out, had dangerous side effects that weren’t anticipated, and the drug should have been confined to the patients who didn’t respond to the older, safer drug. But it wasn’t, largely because of advertising.

    “Why? Because any doctor worth his salt is going to prescribe the best possible medication within reason.”

    One hopes this is true, but countless studies show that doctors also respond to drug advertising. It’s honestly only natural, because if they’re already working a 60-hour week, they’re probably not reading and closely comparing every single drug study in every English-language journal; they’re going to respond to drug reps who provide them with timely, topical information, and they’re likely not going to have seen any (very limited) studies that may suggest side effects outweigh benefits. Add that to drug companies buying studies, buying doctors’ names to put on studies, and suppressing data on negative effects … it’s seriously problematic.

    Even if they’re only seeing excellent, third-party studies of a Brand New Drug (BND), it takes years for adequate side-effect and long-term use data to become available on BND. If older treatments are effective for a patient, there’s no good reason to expose them to the risk of the BND until there’s a substantial body of real-world data on the BND. It’s when existing treatments are NOT effective that BNDs become an excellent idea.

  52. Hambriq says:

    @courtneywoah: I believe that research shows that new drugs are not better than old drugs and this is because new drugs are tested against a placebo NOT against the old drug its supposed to be replacing

    Then you need to read the research.

    “Also, when a patent is about to run out on a drug the company will come up with a “new drug” to extend the paten life and to get new customers, the best example of this is Prozac. which is now used to treat women who suffer from PMS.”

    This is just patently false. Yes, Prozac (and all other SSRIs) is being used now as a line of treatment for women with severe PMDD. But Prozac has been generic for quite some time. Tacking on another indication to a medicine does not extend the life of the patent. You can still get generic Fluoxetine for 4 dollars and the only people who profit from that are the generic drug manufacturers and Wal-Mart, not Big Pharma.

  53. Hambriq says:

    @Eyebrows McGee:

    I will agree with that (and you’re sweet for liking me!), with one caveat: New drugs are almost invariably better than old drugs FOR A SPECIFIC SUBSET OF PATIENTS. Vioxx is CLEARLY better than naproxen for patients who don’t respond to naproxen.

    Here’s where I disagree. As I mentioned in an earlier post, if a patient has high cholesterol, I cannot think of a single reason to prescribe an older statin over Crestor/Lipitor besides cost. I wouldn’t say Crestor/Lipitor is better only for patients who don’t respond adequately to Simvastatin. It’s better, period.

    Now, regarding Vioxx specifically, I think it’s a huge stretch to say that Vioxx is unnecessary. Taking an NSAID (especially Naproxen) every day is going to wreck severe havoc on your GI system, especially in the age group of patients who tend to have arthritis. COX-2 inhibitors, on the other hand, have a significantly lower incidence of disturbances. By taking an NSAID daily, you are basically forced to tack on a PPI like Nexium every day in order to prevent a GI event, and the costs of that are going to end up being about equal to what it would cost to just pay for the Vioxx or whichever COX-2 you’re using.

    Now, the increased risk of MI is truly unfortunate, and obviously it represents a risk disproportionate to the reward. But to say that COX-2 inhibitors are unnecessary, considering the huge GI issues that stem from long-term NSAID use? I really have to take issue with that.

    One hopes this is true, but countless studies show that doctors also respond to drug advertising.

    Also very true. I think this stems more from the fact that doctors are constantly searching for better medications and better options to treat their patients. Despite this, they still have to remain prudently skeptical, to a point. So when a rep comes in touting the latest, greatest treatment option, the doctor is obliged to play the role of devil’s advocate. Of course, this is a losing proposition. Even the most well-informed doctor will not have the kind of off-hand knowledge to go toe-to-toe with a good sales representative. A doctor’s job is to know about everything out there. A sales representative’s job is to know absolutely everything about the one or two medications they are selling.

    Unless the doctor researched everything before hand and developed the same level of familiarity with the drug that the rep has, there’s no way he’s going to “beat” them. Therein lies the other problem. The doctor isn’t looking to prove the rep wrong. He’s looking for the best medicine out there. So if a rep can address all of the doctor’s potential misgivings in a satisfactory manner, then why not prescribe the medicine? Again, the doctor isn’t looking to show the rep why Simvastatin is better than Lipitor, or even why Crestor is better than Lipitor. He’s looking for the best possible medication to prescribe his patients.

  54. Hambriq says:

    @Eyebrows McGee:

    Drug companies research lifestyle drugs. Life saving drugs are much more often researched because of government grant dollars. Saving lives simply doesn’t bring in the bucks that extending erections does.

    I’m not sure I agree with that. The average patient at our pharmacy who regularly uses Viagra or Cialis goes through about 4 to 5 in a month. They both cost about $13 a pill, so the companies are making about 60 to 75 dollars a month off of these regulars. Now, compare:

    Viagra/Cialis: ~$60-75 a month.
    Crestor/Lipitor: ~$110-150 a month.
    Nexium: ~$190 a month.
    Diovan/Cozaar/Benicar: ~$120-130 a month.

    Granted, these figures are just off the top of my head, and when I go into work today I can figure out exactly how much more money pharmaceutical companies are making off of maintenance medicines over lifestyle medicines.

    The main reason behind it is, maintenance medicines have to be taken every day for the rest of your life. Get a customer stuck on a statin, and you have a customer for life. Lifestyle medicine, on the other hand, is taken on an as-needed basis. And when people start to cut costs, the first things that go are the lifestyle medicines, not the maintenance ones.

  55. jamar0303 says:

    @NickRB: So what exactly has Moore made up in Sicko? I get the feeling that he’s hiding something in that bit about the trip to Cuba, but what?

    I had to watch it in my high-school Economics class (“the Economics of Health Care” was the unit being covered) and the teacher was an American immigrant to Canada, so he probably knew both sides of the issue when he showed it…

  56. Mr.Purple says:

    @NickRB: I recently went to a presentation by an advocate for support for kids with cancer (NOT Saint Judes or whatever). The drug companies spend less than 1 percent of children’s cancer. They spend most of their 10% budget for cancer on easily curable cancers that are common. The drug companies are NOT researching the proper drugs. AIDS drugs that cure AIDS are not the attention of the drug companies, drugs that will treat the symptoms are the ones getting the development.

  57. catnapped says:

    Topgun nailed it earlier in the thread…why bother curing anything when you’d just cut off the money train that just keeps on giving?

  58. ClayS says:

    @catnapped:

    Sounds like you’ve identified a significant market niche. Start a pharmaceutical company that will develop drugs that will actually cure disease. Clearly there is a conspiracy among the existing drug companies to keep patients on drug maintenance regimens without curative intent. Instead of pens and notepads, your drug reps can provide doctors with tinfoil hats with your company logo.

  59. Trai_Dep says:

    The thing about the for-profit drug model can best be encapsulated in a hypothetical. Imagine tomorrow, a $5 pill came out that cured AIDS, deep in a Big Pharma lab someplace.

    Which company, needing to exceed shareholder expectations, could, in good conscience, roll it out to the market at a price of $10?

    None. WAY too much money to be paid treating AIDS versus curing it. It would be “irresponsible” for them to do so.

  60. JustRunTheDamnBallBillick. says:

    @Hambriq: @Eyebrows McGee: Great exchange guys
    +1 each

  61. JustRunTheDamnBallBillick. says:

    @trai_dep: wow that is incredibly cynical. Especially since you would have to assume that every research scientist, lab assistant, executive, and cured test subject would have to keep it silent (real tough, as weve learned from EVERY OTHER PIECE OF EVIDENCE that secrets dont stay that way).

    More likely, they would release the cure, benefit greatly from customer good will, see a massive influx of research grants, then move on to other problems. If someone cured cancer tomorrow, there are still millions of other deseases that can be cured/treated. Plus if people live longer there are going to be more chances to sell Crestor/Cialis/other drugs like that.

    The only time that I see a true effort to treat rather then cure desease are in the mental health field. GSK would obviously lose a big chunk of income if suddently Welbutrin (which they reformulated to extend patent) wasnt needed. Psych drugs are lifetime-use, and a big chunk of the money pharmas make.

  62. MellowCat says:

    When I worked for a group of surgeons, we would have lunch brought in from these reps every now and then. Our doctors would almost never show up, and we would usually tell these reps the doctors more than likely wouldn’t be there. They kept bringing us food anyway. What astounded me the most is that a primary care office across the hall was served a full spread of breakfast and lunch literally every day of the week. Starbucks coffee, too. I find it very difficult to accept the prices these companies charge for their drugs in light of all this waste. It wasn’t just drug companies either. Home health agencies pursued our office more agressively than drug companies. They were relentless!

    The surgeons I worked for didn’t seem to give a crap who was pushing their goods. Patient satisfaction was what made their decisions, at least where I worked. I doubt many physicians prescribe any differently because of food and swag, but I just can’t imagine why these drug companies continue to spend huge amounts of money on this “bribery” if it isn’t working. The practice should be banned, or at least curtailed. Consumers shouldn’t have to pay for this kind of crap.

  63. ClayS says:

    @MellowCat:

    I doubt the bribery is what is working. Would you compromise your values and your efforts to do your job well for a free lunch? Even more so for health care professionals where patients’ lives and their quality of life is at stake.

    The value of the drug reps is more likely their ability to get literature and up to date information on drugs to physicians. Also the free samples give the office the ability to get drugs in the hands of patients that may have financial or insurance issues.

    Physicians sometimes have several drugs that are designed to treat a given condition. If all are known to be effective, which is the doctor likely to prescribe? Probably the ones that he is most familiar with and for which he has seen the latest studies.

    The free lunches may help the rep establish a good relationship with the office staff which may be a prerequisite to getting their literature and samples to the physician.

  64. Rusted says:

    @johnva: The interesting thing about the drug ads is all that small print. Or if audio, much fast talking about side effects.

  65. catnapped says:

    @ClayS: Actually there was an article a few days ago which said most of the samples were going to people who would have no problem affording the drugs (insured people) and most of it wasn’t getting to those who really did need them.

  66. SkyeBlue says:

    Today I got to see firsthand the results the what I have been hearing about so much in the media, that our nations kids are becoming hooked and ODing on the plethora or prescription pain medication that Doctors today hand out so freely to their parents and other adults. My best friends 16 year old son died this morning at 6:30 from what was most likely an overdose of Methadone.

    If you watch TV or read any magazine anymore you would think we Americans are totally unable to eat, sleep, have sex, pee, not pee, function in public, not stop eating…………………….without the help of the pharmacutical companies. At $150.00 for a 30 day supply of said medicine, of course.

  67. trollkiller says:

    We have to keep the direct to consumer marketing. If it was not for the commercials I would not know that 70% of the people that get genital herpes did not know their partner was having an outbreak, or as I like to see it, 30% hit it when it was all nasty.

    I would also not know that a certain restless leg drug will turn you into Britney Spears. (sexual and gambling impulses)

    I also would not know that a 4 hour erection was a problem called priapism and it needs medical treatment and not another BJ.

  68. Lawk Salih says:

    Marketing = Lobbying US Senate and Congress.

  69. @JustRunTheDamnBallBillick.: There’s at least something to what trai_dep says, although in a slightly different direction.

    For example, there’s some very promising work being done on arthritis “vaccines” (for the auto-immune varieties like rheumatoid arthritis, not for the osteo kind that’s a result of running out of cartilage when you’re old). However, it’s extremely difficult to get funding for this research, and most drug companies have shown little or no interest in the work.

    On the other hand, drug companies are delighted to fund arthritis TREATMENTS. Which isn’t a bad thing — advances in arthritis treatments in the last 10 years have been pretty spectacular and allow sufferers to live far more normal, less-painful lives — but every auto-immune arthritis sufferer I know would much rather have the CURE than the treatments.

    Some of the treatments run $1600/month, every month, for the rest of your life. The cure would be a one-shot deal. There is definitely a financial incentive to developing the treatments that doesn’t exist for the cure, which is part of why most of the research on the vaccines is being done in academic laboratories, not by drug companies.

    Still, that doesn’t necessary mean this is a BAD way of doing things, except for two things: First, it can be very difficult to get “orphan” drugs (needed by only a few people) or high-liability, low-profit drugs (e.g., vaccines) MADE by drug companies even once they’re perfected. Second, substantially more research dollars flow to drug companies than academic research, and “cure” research tends to occur in academia. (For a few reasons, not least of which is that “cure” research is often more experimental and has far less of a chance of panning out than research which tweaks existing drugs to come up with better maintenance/lifestyle drugs, and that is a fair reason for a public company to avoid “cure” research; hardly anybody since AT&T was a monopoly has allowed research with no apparent commercial applications.)

    So perhaps the solution would be to redirect government grant money away from drug companies (it bugs the heck out of me that they get to patent drugs discovered using US gov’t grants anyway and then charge so much for them, while other countries pay less!), or, in exchange for allowing direct-to-consumer advertising, require them to put X% of their ad budget towards producing orphan drugs or low-profit vaccines, which the federal government could parcel out among the companies to ensure adequate production. (They’re already willing to hand out liability waivers in the desperation to keep vaccines coming!)

  70. @ClayS: “If all are known to be effective, which is the doctor likely to prescribe? Probably the ones that he is most familiar with and for which he has seen the latest studies.”

    The problem there is that studies have been forged, fudged, and manipulated, since typically the drug company pays for them. There was a series of scandals a few years ago when it was revealed they commonly did their own research, fudged the bad numbers, then paid MDs huge chunks of cash to put the MD’s name on it when submitting it to an academic journal, to make it look like a 3rd-party study.

    The practice is better-known these days, and some of the journals actively guard against it, but it still happens, and it still happens a LOT.

    It’s not that drug companies “bribe” doctors; it’s that there are a lot of subtle ways they use to influence doctors, who are just as prone to being influenced by advertising as the rest of us (I myself am Pavlovianly trained to order pizza whenever a pizza commercial comes on), and a lot of ways to present them with falsified data that leads them to making less-than-optimal treatment decisions.

  71. ClayS says:

    @Eyebrows McGee:

    “The practice is better-known these days, and some of the journals actively guard against it, but it still happens, and it still happens a LOT.”

    A lot? I really hope you’re wrong, because that is beyond scandulous. If mainstream medical journals are being duped, then what truly reliable source do doctors have for efficacy data and side effects for drugs?

    Are you in the healthcare industry?

  72. @ClayS: “Are you in the healthcare industry?”

    I teach medical ethics. This article is outdated, but shows the scope of the problem:
    [medicine.plosjournals.org]

    The CSPI’s been continuously reporting on it; here’s an instance from two years after that article:
    [www.cspinet.org]

    The issue has become far more prominent since the WSJ’s story, but the problem does continue. And it is a very real question about whether there IS a truly reliable source of drug data for medical professionals; many GPs prescribe with this in mind. (Specialists have fewer problems with this, for a variety of reasons — they’re more likely to be involved in drug research/trials, they read specialized journals that aren’t targeted as heavily by drug companies, they prescribe (say) gastrointestinal drugs to 1,000 patients a year instead of 10 so have a good idea of the side effects simply from their own practice — but it is still a problem.) In some classes of drugs (luckily, mostly lifestyle drugs) that are heavily dominated by advertising, there simply isn’t much if any clearly valid data available.

    It’s a terrible thing, because there ARE fair players in the industry, but it paints them all with the same brush. If I’m a drug rep who genuinely is interested in getting good, valid information to doctors about a new drug, in the hopes they’ll prescribe it when appropriate, and the other drug rep visiting today has falsified studies in hand and is just interested in selling as much as possible … well, we both get tarred with the same brush, and my decent data is thrown out with his crap data.

  73. Hambriq says:

    @Eyebrows McGee:

    For example, there’s some very promising work being done on arthritis “vaccines”….most drug companies have shown little or no interest in the work…. On the other hand, drug companies are delighted to fund arthritis TREATMENTS.

    I think there’s a fair amount of financial incentive involved with producing a cure rather than a treatment, especially if you are the first out of the gate. See Merck’s Gardasil (the HPV vaccine).

    The biggest issue is that it has to work, and it has to be worth the side effects. The problem with all the -mab drugs being explored as an option for arthritis is that they haven’t been shown to really “cure” arthritis on a long-term level… yet. So right now, they are basically just another treatment option. A treatment option that not many people will look at because 1.) They are expensive as hell and most insurances require you to jump through many hoops to pay for it, if they even pay for it at all. 2.) It’s an injection, which most people are inherently resistant to, and 3.) The -mabs are basically systemic immunosuppressants, which can lead to a lot of serious side effects considering that most people with arthritis are elderly and therefore already have a compromised immune system.

    I believe that once they perfect those medicines, there will be a LOT more research dollars being thrown at them. But at the current stage in the game, there’s just too much wrong with them and not enough right for it to be worth it…

    …And therein lies the Catch 22. A drug won’t be researched if it isn’t promising, but most of the time it can’t be shown to be promising without a fair amount of research.