Is Drug Company Marketing Evil?

There's an active research industry ginning up studies that suggest that doctors are being unduly seduced by the blandishments of pharmaceutical company marketing. For example, one such "conflict of interest" study published in the Journal of the American Medical Association in 2006 worried that "conflicts occur when physicians have motives or are in situations for which reasonable observers could conclude that the moral requirements of the physician's roles are or will be compromised."

It is certainly true that drug companies spend billions marketing their drugs to physicians. Pharmaceutical sales reps take them to lunch, pay for conferences, and provide them with billions of dollars in free samples. Obviously, this marketing must work in the sense that it does persuade doctors to prescribe their medicines more frequently than if there were no such marketing. If it didn't work, the pharmaceutical companies wouldn't do it. Is that a bad thing? Some legislators in thrall to conflicts of interest activists think so and are proposing regulations to limit drug company marketing in various ways. Are such regulations really necessary to protect patients?

Emory University law professor Paul Rubin has an excellent column on this topic in the current issue of Forbes. To wit:

Drug company reps offer overworked doctors useful, lifesaving information in an efficient manner. The drug companies are of course motivated by profit, but economists have known since Adam Smith that the profit motive is the best way to induce someone to do something useful.

Marketing and research are both information activities; they work together to get effective drugs to patients. The two activities are not in competition for resources. The denouncers of drug companies don't understand this. One of the senators sponsoring the bill suggests that "the millions of dollars these companies spend on marketing … could be put into research." In fact, drug companies would not switch money from marketing to research. If they cannot market drugs in the best way, they will reduce spending on research. What's the point of inventing a new drug if doctors and patients don't know about it?

Academic physicians think that doctors should obtain information by reading medical journals. Practicing doctors do not have time to comb through the International Journal of Medical Sciences or the Annals of Internal Medicine. A meal with a pharmaceutical salesperson is a time-efficient way for a busy doctor to learn about new drugs, or perhaps a better therapeutic alternative, or a drug with easier dosing or fewer side effects than the old drug. Physicians interact with more than one drug rep, so they have competing sources of information. …

Finally, by leading consumers to purchase newer drugs, marketing increases investment in innovation and thus makes research more likely.

As Rubin notes on costs, a 2007 study by Columbia University health economist Frank Lichtenberg found:

…a reduction in the age of drugs utilized reduces non-drug expenditure 7.2 times as much as it increases drug expenditure. For example, reducing the mean age of drugs used to treat a condition from 15 years to 5.5 years is estimated to increase prescription drug spending by $18 but reduce other medical spending by $129, yielding a $111 net reduction in total health spending.

Since newer drugs lead to lower overall medical costs, marketing drugs to physicians is good for patients.

Do conflicts of interest studies actually show that patients have harmed by drug company marketing? As Rubin observes:

A widely cited 2000 article in the Journal of the American Medical Association summarized 29 published studies critiquing the interaction between doctors and drug reps. Notable feature of these articles, as quoted in the summary paper: "No study used patient outcome measures." (emphasis added) That is, in all of the medical literature on drug sales, there was no evidence of harm to patients caused by doctors and drug reps breaking bread. These articles were written by physicians who by their oaths put patient welfare at the top of the list, but they were critical of the industry based on analyses that totally ignore this measure.

Rubin concludes:

It is truly amazing that this society keeps coming up with ways to demonize and penalize an industry that has provided us with so many benefits.

Amen.

If you're interested in this topic, please see my articles "Is Industry-Funded Science Killing You?" and "Goddamn the Pusher Man."

Absurd Conflicts of Interest Disclosure: I have just completed a long peer-reviewed study of the conflicts of interest literature for the American Council on Science and Health which will be published later this year. And yes, ACSH paid me to do the research and the writing.

I am also an adjunct scholar at two Washington, DC-based libertarian public policy think tanks, the Cato Institute and the Competitive Enterprise Institute. It was explained to me that being an adjunct scholar means that I don't get paid anything, but that the institutes can use my name for media and fundraising purposes. I have worked on a contractual basis as an editor of three books on environmental policy for the Competitive Enterprise Institute, all of which were published by commercial publishers.

I regularly drum up grants from non-profits to pay for my reporting habits. This is not an exhaustive list, but I have received travel grants to cover United Nations Climate Change conferences and World Trade Organization conferences from the Altas Economic Research Foundation, the International Policy Network, and TCSDaily. In addition, I once went on a junket paid for the government of the Northern Marianas Islands. I generally disclose these grants because I'm grateful for their help. No grantor has ever exercised any editorial control over my reporting.

In addition, I have spoken at scores of universities, conferences and non-profit organizations around the world–mostly for just travel expenses (although on a few happy occasions I have received a small speaker's fee).

I am very happy to acknowledge (as I did in the book) that I received grants from the Richard Lounsbery Foundation, the Bruce and Giovanna Ames Foundation, and the Alliance for Aging Research to support my work on my latest book, Liberation Biology: The Scientific and Moral Case for the Biotech Revolution (Prometheus, 2005).

I also own shares in various biotech and pharmaceutical companies (no more than 1000 in any one company, alas). I purchased all of the shares with my own money and all are held in my retirement accounts. May your deity of choice have mercy on you if you even think about taking any investment advice from me.

Past and Current Charitable contributions and memberships (that I can remember):

American Civil Liberties Union
Society of Environmental Journalists
American Society of Bioethics and Humanities
Drug Policy Alliance
Center for Reproductive Rights
Committee to Protect Journalists
Equality Virginia
National Rifle Association
Marijuana Policy Project
Second Street Gallery
Whitman-Walker Clinic
Nature Conservancy
USO
CARE

In the past I have generally, but not always, voted Republican or Libertarian. In fact, I voted for Barack Obama in Virginia's Democratic primary earlier this month.

Finally, I strongly dislike fish and lamb.