Wednesday, June 10, 2015

Money, Drugs Companies and your Doctor

Over the last couple blogs we have spoken about different how science and medicine sometimes provides misleading information to the public. Many times, this misinformation is because of financial or personal gains.

Now I want to talk about the marketing aspect of medicine. This is a very important facet of the medical business, and it may surprise you how this has progressed over the years.

As you know, I am the author of "Legend of the Mystic Knights", a fantasy novel, based in a medieval world. It was my research about the middle ages that I located several instances of medical marketing.

During the medieval period, the plague ran rampant through Europe. There were several “preventions” for the plague sold by conmen throughout Europe. One of these was to sell flowers, which were to be placed in your pockets, and this would ward off the plague.

As a result of this “flower cure” people continued to drop dead of the plague, and then their bodies were burned in mass pyres. From this tragedy the nursery rhyme was created, “A ring around my rosie, a pocket full of posies, ashes, ashes we all fall down.”

Recently, there has been some historical research that has tried to discredit the above explanation for the nursery rhyme. Even if it is not true, it does make my point about drug marketing.

There have been numerous changes in the way pharmaceutical companies market their drugs. Once, it was directed solely to the doctors themselves, informing the medical professional of how their drugs work, and how effective it is. They continue this process, (see below) but now the marketing is more geared toward the patients, this is called Direct-to-Consumer Advertising.

This type of marketing has grown over the last several decades. In 1997, the Food and Drug Administration (FDA) eased regulations dealing with pharmaceutical companies and Direct-to-Consumer ads. This opened a flood gate of advertisements geared toward patients who suffer from a condition, and those who don’t.

There are several arguments for and against this type of advertisements. The pro, is that it educated consumers about the products which are available to them. The con is that patients are now going into their doctor’s office demanding drugs they saw on TV, and the physician is no longer making the medical decisions.

Although both arguments are compelling, the increase in the Direct-to-Consumer ads is remarkable. The majority of drug companies now spend more on the marking of their drug then they did on the development and research of it. Consider Johnson and Johnson, in 2013 they spent 8.2 billion dollars for research and development. As high of a number this may seem, consider that they spent 17.5 billion on marketing over the same period.

Even though pharmaceutical companies now use Direct-to-Consumer advertising, they have not forgotten the consumer’s doctors. Direct Marketing is where these companies’ representatives visit or advertise directly to doctors. These reps often provide meals to the doctor’s office while they are pitching their drugs.

There are other ways the representative pitches the product, including giving the doctors free samples to give to their patients. They may also invite doctors to educational and promotional meetings to support their products. Some of these are conducted at restaurants where these companies provide free meals to the physicians.

To know the scope of Direct Marketing, in the United States, there is 1 pharmaceutical representative for every 7.9 doctors. On average, a doctor in the United States sees 20 patients a day.

For doctors who play ball with the pharmaceutical companies, can become tools for these companies. The drug companies identify these doctors and refer to them doctors as “thought leaders”. The medical reputation of these thought leaders help establish the validity of the drugs. Furthermore, the companies rely on them to promote their products to other doctors. These “though leaders” are invited to more conferences and promotional meetings.

The reason why these drug companies can establish if a doctor is prescribing a drug is made by them, is because these companies have access to the sales at your local pharmacist. They can access this information as part of a regulation that was supposed to protect your privacy.

The Health Insurance Portability and Accountability Act (HIPAA) were conceived as a protection, so your personal medical information was not released, however, this has turned into a database used by pharmaceutical companies.

When you go into a pharmacy to obtain a prescription, you were given a HIPAA form, which informs you of your rights and release of information about you. This HIPAA form also includes information that health care providers, health plans, and their business associates or contractors can use your information without your consent for purposes of treatment or payment.

What does this mean? The pharmaceutical companies end up knowing which medicine your doctor proscribed. So if your doctor changes your prescription, and this drug is made by another company, the pharmaceutical company that produced the original drug will know about it.

Although just knowing if their drugs are being prescribed does not seem harmful, consider the relationship that these pharmaceutical reps have with their doctors. This is a rep who brings free drug samples, and free meals to the doctor’s office. Having the doctor’s assistants, receptionists, records keeper, etc., getting a free meal so they do not have to pay for lunch is almost like giving them raises, that is a large pressure for the doctor to be under.

There are many other ways the pharmaceutical companies peddle their drugs. Marketing is a large business, and these companies are making huge profits. Americans spent 329.29 BILLION dollars on prescription drugs in 2013.

A final note: With money comes political power, the Supreme Court Ruled that the FDA has authority over drug companies, which means they are now exempt from any lawsuit. So basically, if you buy a drug and it makes you sick or even it kills a family member because this drug manufacturer made a mistake (or even did it on purpose), you cannot sue them.

Next time: Its Renaissance Festival Time


  1. I was with you until you said you can't sue a drug company. It's true the government has granted drug companies immunity under claims brought for harmful vaccines. However, you can sue a drug company under product liability laws.

  2. hi; thanks for sharing this historical information on how medicine has been marketed. i recently ran a fowl of a site moderator because i expressed my opinion that all the aggressive tv and radio advertising for new drugs gave me less confidence in them and made me feel most new drugs are more snake oil than effective treatments. thanks again, max

  3. Hi William - interesting points you brought up. First, the poem - ring around the rosie - we used to play that as kids but never knew the origin. Historians may deny it but with the background you gave, it makes a lot of sense.
    The second thing - if health information is available to drug companies, can this not be leaked to life/disability insurance companies?
    Finally, that drug companies can't be sued is ridiculous and I'm glad that Jeannette pointed out that they can be sued under product liability.
    Amazing the power money has, isn't it?

  4. I am going to address this: In "Karen Bartlett vs. Mutual Pharmaceutical Company" in 2013, the Supreme court ruled ruled that the FDA has ultimate authority over pharmaceuticals in the US. And if the FDA says a drug is safe, that takes precedent over actual facts, real victims and any and all adverse reactions.

  5. So very informative! I'll never feel the same way about ring around the rosie again! I have a close relative that sells medical devices...same story. But at least now they are getting closer for the consumer to check and see who their doctor is affiliated with! You can see how many "thought" leaders" are treating you...and with what!

  6. Wow! This is interesting. I am pretty familiar with the way pharmaceuticals go to doctors offices and such. I am in a big pharmaceutical area of PA. I didn't however, know about the pharmaceutical companies having access to our medical records. Thanks for sharing.

  7. I was aware of some of this already, but that doesn't make it any less disturbing. By the way, when we sang/played Ring Around the Rosie as kids, we sang "husha, husha", not "ashes, ashes".

    1. I also heard a variation with, A-tishoo! A-tishoo, So I guess it might be where you are from.

  8. It would be interesting to know what doctors really think about drug company representatives: if I were a doctor, I would think, "Oh God, not those people again." Although this probably wasn't your intention, William, your post has caused me to have some sympathy for doctors in this regard.

  9. What an eye opener! Change isn't always necessarily good as you demonstrated in this evolution. The drug companies whine about generics because of the cost of R&D but never mention the advertising costs. Interesting about Ring Around the Rosie. Certainly makes sense.

  10. Thanks for making us aware of the fact that if you choose the wrong doctor the prescription he gives you may be based on who bought him dinner the night before rather than on what's best for the patient. I think it is especially dismaying to hear that the drug companies have access at that level of detail to pharmacy sales.

  11. Another thought provoking post. I knew some of this info about the drug companies but not that much.

  12. Very interesting information William and no one can deny the aggressive advertising tactics in the market place these days. As far as doctors go, I know there are plenty of pill pushers out there but I've always avoided drugs of any kind and in fact even use a breathing exercise to ward off the rare headache rather than aspirin. Since I don't watch TV and prefer to save trees by getting my news online I miss pretty much all of that and can't say I'm sorry about it. Thanks for the fascinating read!

  13. How pharmaceutical companies behave, not only in the United States but globally, is shameful. People die as a result but they still keep on buying doctors with trips, bonuses and so forth in order to make them prescribe a drug with lethal side effects. In the European Union pharmaceutical companies, mainly from the US, lobby to have all kinds of alternative treatment such as homeopathy made illegal. They have even managed to get legislation in Europe that forbids vitamins with high doses. Is there anything they are not doing in order to sell more drugs and make profit?

  14. This is why it is important to pick your doctor carefully. There are some doctors who will help you find the right path for you and there are doctors that will push a certain drug. I personally see a D.O. as my primary physician. She is all for me trying to find the root of the problem before pushing a drug on me which I love.

  15. It seems like every time I see a TV commercial for prescription drugs, I think about life before drugs. Who am I to need drug marketing? And the posters in doctor's officers, etc. Isn't my doctor supposed to pick what's best for me? But nope, they're picking whatever is being marketed at them and what they are most set to profit from.