The Two Sides of Drug Marketing
First, the direct-to-consumer side of things. A recent NEJM article raises a good point about the legal feasibility of congress banning direct-to-consumer ads; there’s the first amendment, after all, and there’s a history of the Supreme Court overturning federal bans on the advertising of a variety of substances in the interest of public health, including alcohol, tobacco, and so on.
I, for one, don’t believe that direct-to-consumer ads have any educational value whatsoever, but the preservation of the freedom to advertise in a public forum is very important. We want to make sure that there is enough freedom for things like political advertising, but we also want to make sure that advertising that lowers the overall societal welfare, such as direct-to-consumer ads, get regulated, or even banned. After all, the first amendment is primarily oriented towards politically motivated speech.
Another article, from a few weeks back, was “Following the Script”, from the April issue of PLoS Medicine. It reveals a window into the world of pharmaceutical drug representatives (Drug Reps), who market pharmaceuticals to doctors. Of course, drug marketing is very similar to other business-to-business marketing, in that there is endless networking, false smiles, gifts, hand-shaking, memorization of personal details, tailoring of the message to the target, and so on. Still, the article does show how these are applied specifically to doctors. I really enjoyed reading the table showing how the marketing is tailored to the doctor’s personality. Particularly interesting is the way they approach the “Aloof and skeptical” doctor:
I visit the office with journal articles that specifically counter the doctor’s perceptions of the shortcoming of my drug. Armed with the articles and having hopefully scheduled a 20 minute appointment (so the doc can’t escape), I play dumb and have the doc explain to me the significance of my article.
The intent of the marketing is not education, no matter what the drug companies might claim. Marketing is always about sales. After all, (as the article says) “If detailing were an educational service, it would be provided to all physicians, not just those who affect market share.” Still, one cannot deny that there is currently no good substitute for drug education by drug companies. Even though studies show that doctors still accept gifts from drug companies, drug reps do accomplish getting the name of obscure drugs out, and they do distribute scientific literature. Doctors are busy people; they don’t have time to trawl through the literature all day, as it takes time away from patients. A short blurb from a drug rep can be better than nothing.
In addition, the whole situation marketing situation is a giant prisoner’s dilemma; if a drug company decides to be “noble” and not market to doctors, it will lose sales pretty quickly to the drug companies that don’t have such idealism. There’s really no good incentive for drug companies to stop marketing. If one has to criticize anyone, perhaps one should criticize the doctors for being so easily swayed; but doctors are human, after all, and marketers are very, very good.
Perhaps the group the public should really criticize is the AMA, which for all its statements of ethical guidelines for gifts to physicians, still sells a demographic database to drug companies for more than $40 million a year that allows drug reps to figure out the prescription habits of each individual doctor.
