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Recent Articles
Rx Industry Marketing in the News
A couple of major stories yesterday took aim at the drug industry's direct-to-physician marketing. BusinessWeek reveals how several doctors "routinely" failed to tell their patients about payments they took from Pfizer while prescribing Chantix, the company's smoking cessation drug. CBS News uses the death of a pre-teen girl who'd been prescribed Zoloft for minor anxiety to highlight the parents' anger that they had never been told their doctor was taking payments from the manufacturer, also Pfizer.
Both stories touted Sen. Charles Grassley's Physician Payments Sunshine Act, which would require that any payment to physicians greater than $500 be reported on a publicly available database. I'm all for it, but ask yourself this: next time you're at your doctor and he/she prescribes a drug, are you going to go online to look up whether they took money from the manufacturer (first you may have to look up the name of the manufacturer, since that is usually not clearly marked on the prescription or the label) before filling that prescription? And if they did, will you not fill it?
The estimated cost of direct-to-physician marketing has now reached $57 billion annually, according to the story (this is taken from a recent estimate that appeared in PLoS Medicine). It's not just direct payments, it's advertising, journal reprints, free samples, trade show exhibits, a sales force (about 90,000 reps at its peak) that alone must cost $10 billion a year in salaries.
Transparency is good. But wouldn't a total ban on such payments and tighter restrictions on the rest be better?
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The BusinessWeek article also discusses a commentary published in the April 1 issue of the Annals of Internal Medicine by these same doctors (Michael Steinberg and Jonathan Foulds, with two co-authors). The commentary, entitled "The Case for Treating Tobacco Dependence as a Chronic Disease," advocates continuing behavioral and medication treatments "as long as is necessary to achieve successful outcomes." One of the main objectives of the paper is to encourage insurance companies to pay for extended courses of treatment with smoking cessation medications, in the same way they pay for treatment for chronic diseases such as diabetes. Such improved insurance coverage would, of course, be very beneficial for the manufacturers of smoking cessation medications. Both Steinberg and Foulds were selected by Pfizer in 2006 to be "key opinion leaders," promoting the use of Chantix in talks given to doctors.
Adriane Fugh-Berman and Douglas Melnick wrote a critique of the Annals commentary, published online on April 25 (http://www.bioethicsforum.org/smoking-tobacco-chronic-disease-drug-treat...). Fugh-Berman and Melnick point out that information on the long-term effects of smoking cessation aids is limited, and that "[t]o subject countless patients to the unknown risks of medications prescribed outside their approved labeling, or beyond the treatment durations for which they have been approved, is to conduct a large, uncontrolled, and unconscionable experiment." They also question the comparison to diabetes, since the goal of smoking cessation treatment should be to get smokers to quit. They conclude:
"Casting smoking as a 'disease' disempowers those who want to quit; willpower may conquer a habit or addiction, but a disease calls for doctors and drugs. The positioning of nicotine dependence as a chronic condition requiring lifetime use of medication can only damage public health."
PM