Drug Companies and Health Care

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Introduction

The commoditization of health has made the pharmaceutical industry one of the most profitable in the world, with global 2006 sales topping 643 billion $US (IMS health).This success is due to a number of factors. Drugs have, in many ways, revolutionized medicine, allowing doctors to thwart life-threatening infections and significantly prolong life in the face of chronic diseases. Clearly, it makes sense to reward companies who help save lifes and reduce suffering. At the same time, however, it is important to consider the enormity of such expenditures, examine the forces that cause them to come into play, and evaluate their motivation.

Canada's expenditure on prescription drugs was over $20 billion in 2006, with per capita spending almost doubling between 1998 and 2004. This increase in spending was due to both an increase in volume of precriptions, and the selection of increasingly costly options from within drug categories (Rx Atlas).

 

US pharmaceutical companies spend almost twice as much on promotion and marketing drugs (US 57.5b) as on research and development (31.5b). As a result, most of the new drugs coming out have little or no new therapeutic value, but instead are very similar to what is already available. This works out to nearly 25 cents of every dollar spend on prescription drugs going to promotion - sales reps visits, drug samples, and drug ads. (Gagnon and Lexchin, 2008)

 

Pharmaceutical costs are between 10-20% of health care dollars.

Increased drug costs are related to:

• increased number of prescriptions
• higher costing drugs that are prescribed
• price increases

 

 

 

Gifts and Promotions

Majority goes to physician samples and to sales rep contacts.

 

Gifts of any size influence behaviour.

Wazana. Pharmaceutical Gifts. JAMA.

 

Faculty, staff, students, and trainees will not accept any gifts.

 

Health care providers have a fiduciary relationship with patients, covering specialized knowledge, trust, high standards of conduct, avoids conflict of interest, and accountable and obligated.

 

 

 

Impact on Learners

 

 

 

Examples of Pharmaceutical Strategies

disease mongering

if can get indication for a medication, can 'sell' disease to people and then feed up the treatment

 

 

 

 

Pharmaceutical Publications

The primary goal of pharmaceutical advertisements is to convince physicians to prescribe the product. In order to do this, claims, which may or may not be true, are made about the benefits of products. In our 'world' of evidence-based medicine, it is critical for readers to use cautious interpretation when evaluating these claims.

 

One study examining the source of information used in claims found that over one-quarter of ads contained no references. Unpublished references were used in nineteen percent of claims, with 80% of requests for this information going unanswered by the manufacturer (Cooper and Schriger, 2005). This behaviour disregarded the policy of the Canadian Pharmaceutical Advertising Advisory Board.

 

The majority of published references were funded by, or had author affiliation with, the product's maunfacturer (Cooper and Schriger, 2005). However, published references are not enough. A staff member at an unnamed journal that checks submitted ads for scientific accuracy before accepting them says he asks for changes to be made in one third of ads (Giles, 2005) In fact, in one study, nearly half of referenced statements were not supported by the reference. The most common reasons had to do with generalization of outcomes, with specific claims being made when the cited study was about intermediate outcomes, other patient populations, or in some cases even animals (Villaneuva et al, 2003). In another analysis of the accuracy of pharmaceutical advertisements, experts were asked to evaluate ads in their field. In the experts' opinions, 44% would lead to improper prescribing if physicians used this information alone, while 92% of ads were not in compliance of criteria of the FDA (Wilkes et al, 1992). This report led to the withdrawal of pharmaceutical ads from the publishing journal (Fletcher RH, 2003).

 

Pharmaceutical ads often refer to published work funded by the manufacturer of the drug used. Even within randomized trials, a significant association exists between source of funding and favourable conclusions of the trial. This appears likely due to biased interpretation of trial results (Als-Nielsen et al, JAMA, 2003). Superiority trials were more likely to favour newer, more expensive treatments over current standard of care when funded by for-profit organizations (Ridker and Torres, JAMA 2006).

 

 

Study after study have shown that claims used in advertising can be misleading, distort the reporting of scientific data, or fail to provide enough information to accurately interpret data. (Cooper and Schriger, 2005)

 

Talk a bit about how advertising affects medical trainees.

 

Index on Censorship

www.msmonographs.org/preprintable.asp?id=39302

one idea: perhaps the NY times should publish RCTs, as they'd insist on seeing the data much more than ie NEJM

BMJ 2006, Healy

 

 

 

 

Recources and References

IMS Health

Canadian Rx Atlas

Abramson J and Wright TM (2007) Are Lipid-lowering guidelines evidence-based? Lancet 369(9557):168-9.

Gagnon MA, Lexchin J (2008). The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States PLoS Medicine Vol. 5, No. 1, e1 doi:10.1371

Giles J (2005) Journals lack explicit policies for separating eds from ads. Nature 434, 549

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