Business

The Most Marketed Drugs Have The Least Therapeutic Value

The pharmaceutical industry spends a lot of money on getting doctors and patients to buy their products. Americans are probably most familiar with those TV and radio commercials that end with the long list of side effects narrated in super-speed, but may not realize that their doctors are getting their own special brand of marketing, too. If that sounds suspect, it should. Two studies from the U.S. and Canada show that the drugs that pharma companies spend the most time promoting to doctors have the least therapeutic value.

All The Better To Sell You With, My Dear

Here's something that might feel a little weird: your doctor has probably gone to lunch with a pharmaceutical industry representative, and the rep probably picked up the check. Some hospitals and medical programs forbid the practice, but for those that don't, doctors routinely receive free meals, drinks, and small gifts from pharma reps hoping to increase their sales. Companies in the U.S. are required to report every payment to doctors of $10 or more. According to Open Payments, the online database of those reports, pharmaceutical companies spent $8.2 billion in 2016 promoting drugs to more than half a million physicians. (You can use the tool yourself to see what your own doctor has been paid.)

And this kind of promotion works. Studies show that doctors who are allowed to accept these gifts are more likely to prescribe brand-name drugs, even when cheaper generics are available. That's why two studies, an American one published in the British Medical Journal in May 2017 and a Canadian one published in the Canadian Medical Association Journal in September 2017, are so troubling. They found that the most-promoted drugs were the least likely to be therapeutically valuable — or, as the BMJ study defined it, "effective, safe, affordable, novel, and represent a genuine advance in treating a disease."

What kinds of drugs are we talking? In the U.S., the top three most heavily promoted drugs were Eliquis, an anticoagulant that can reduce stroke risk in some patients, and Bydureon and Invokana, two drugs for type II diabetes that are formulated to lower blood sugar. Invokana was also among Canada's most promoted drugs, along with the blood-pressure drug Coversyl and  medication Breo Ellipta. All of them were rated as having little therapeutic value, and not representing anything new in the pharmaceutical market.

The Greater Good

Of course, this does make sense. A revolutionary, must-have drug sells itself. "If a genuinely innovative drug becomes available that significantly advances patient care ... this information might be expected to spread rapidly among clinicians," the authors of the BMJ study write. "Conversely, a 'me-too' drug with minimal benefit over previous treatments in a class with generic alternatives ... might need robust promotion to facilitate its use."

This doesn't suggest that the relationship between doctors and pharmaceutical reps is a sign of corruption. After all, many drugs are useful, and doctors don't necessarily have time to constantly research every new drug out there. As a 2017 editorial in the Journal of the American Medical Association pointed out, "In the United States, there is no formal approach to educating physicians about new drugs. In the absence of such a system, physicians must either find information about new therapies from other sources, such as by reading or attending meetings, or accept information from pharmaceutical representatives."

It does mean, however, that patients should be vigilant and educated about their own care. Research what pharmaceutical companies your doctor and doctor's office have had contact with. When your doctor prescribes a drug, ask if there are effective generic alternatives. The more information you have, the better off you'll be.

Marketing to Doctors

Written by Ashley Hamer October 26, 2017