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The Physician-Pharma Relationship Georgetown University Medical Center January 2008.

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Presentation on theme: "The Physician-Pharma Relationship Georgetown University Medical Center January 2008."— Presentation transcript:

1 The Physician-Pharma Relationship Georgetown University Medical Center January 2008

2 Is very old and very close But are the goals of pharmaceutical companies and medicine the same?

3 Promotion includes Detailing Meetings and events (dinner meetings, CME, rounds, symposia) Publications (symposia, monographs, supplements, throwaways) Advertising and reprints Direct mail, e-detailing

4 Top 10 products by US Sales, 2006 (IMS Health) Lipitor $8.6 billion Nexium $5.1 billion Advair diskus $3.9 billion Aranesp $3.9 billion Prevacid $3.5 billion Epogen $3.2 billion Zocor $3.1 billion Enbrel $3.0 billion Seroquel $3.0 billion Singulair $3.0 billion IMS national sales perspectives. IMS Health Mar. TableTable

5 The costs of promotion In 2004, total promotion cost for Rx drugs was almost $30 billion About $7 billion spent on detailing NIH budget FY 2008 is $29 billion* FDA budget FY 2008 is $2 billion** West D. Changing lanes. Pharm Exec May;25(5): Full textFull text *NIH summary of the FY 2008 presidents budget, 2007 Feb 5. SummarySummary **Summary of FDAs FY 2008 budget. SummarySummary

6 Promoting the profitable There are more than 10,000 drugs in the US pharmaceutical market More than half of promotional expenditures are concentrated on the top-selling 50 drugs* *Ma J et al. Clin Ther 2003;25(5): AbstractAbstract

7 New drugs are not necessarily better drugs Most new drugs are me-too drugs, or combinations of old drugs In general, generic drugs are safer than branded drugs simply because more information is available about them

8 Studies consistently show that promotion increases prescribing* Studies consistently show that physicians do not believe that promotion affects prescribing** *Chren MM and Landefeld CSl. JAMA 1994 Mar 2;271(9): *Chren MM and Landefeld CSl. JAMA 1994 Mar 2;271(9): AbstractAbstract Lurie N et al. J Gen Int Med 1990;5(3): Lurie N et al. J Gen Int Med 1990;5(3): AbstractAbstract Wazana A. JAMA 2000 Jan 19;283(3): Wazana A. JAMA 2000 Jan 19;283(3): AbstractAbstract **Sigworth SK et al. JAMA Sept 5;286(9): **Sigworth SK et al. JAMA Sept 5;286(9): AbstractAbstract McKinney WP et al. JAMA 1990 Oct 3;264(13): McKinney WP et al. JAMA 1990 Oct 3;264(13): AbstractAbstract Doctors are too smart to be bought by a slice of pizza

9 Detailing In 2005, there were about 600,000 doctors and about 100,000 drug reps in the US Actual ratio about 1 rep per 2.5 targeted docs* Targeted docs are high-prescribers, or docs who control market share *Goldberg M et. al. Pharm Exec Jan 1;24:40-5. *Goldberg M et. al. Pharm Exec Jan 1;24:40-5. AbstractAbstract

10 The AMA Physician Masterfile Contains demographic data that the AMA has sold to industry continuously since the 1940s* In 2005, licensing Masterfile information and other database product sales provided about 16% ($44 million) of the AMAs revenue** *Greene JA. Ann Int Med May 15;146: Full textFull text **Steinbrook R. NEJM Jun 29;354(26): AbstractAbstract

11 AMAs Prescription Data Restriction Plan (PDRP) Few physicians know about it < 1% of doctors have signed up "Just giving them an option [to opt-out] alleviates their concerns," explained the AMAs senior VP of publishing and business services to Pharmaceutical Executive Herskovits B. Pharm Exec Direct Jul 19. Full textFull text

12 AMAs Opt-out plan The restrictions do not apply to (a) deciles at the market or therapeutic class level (b) segmented data that are not likely to reveal the actual or estimated activity of an individual physician, or (c) data on products ordered by physicians from pharmaceutical companies. Musacchio RA and Hunkler RJ. Pharm Exec 2006 May 1. Musacchio RA and Hunkler RJ. Pharm Exec 2006 May 1. Full text Full text

13 What drug reps cost Average annual income for a drug rep is $81,700* Per rep per annum, pharma spends $150,000 ( primary care) $330,000 (specialty) Sales force costs are 5% - 8% of revenue** *Goldberg M and Davenport B. Pharm Exec Jan 1;25(1): 70. Full text Full text **Niles S. Med Ad News May;24(5):1-4.

14 Ex-reps speak out During training, I was told, when youre out to dinner with a doctor, The physician is eating with a friend. You are eating with a client. Shahram Ahari* The essence of pharmaceutical gifting…is bribes that arent considered bribes. Michael Oldani You are absolutely buying love. James Reidy *Fugh-Berman A and Ahari S. PLoS Med Apr 24;4(4):e150. Full textFull text Elliott C. Atlantic Monthly Apr;297(3): Full textFull text

15 I dont listen to the reps <1 minute of a sales reps interaction with a doctor results in a 16% prescribing change 3 minutes with a doctor results in a 52% prescribing change Prounis C. Best foot forward. Communique, vol 7. Full text (alsoFull text downloadable pdfdownloadable pdf)

16 I only see reps for the samples

17 Why docs like samples Start treatment immediately Test tolerance to a new drug Reduce the total cost of a Rx Provide free medication to those who cant afford it

18 Why drug companies like samples Increases new starts on a new drug Encourages switches from other drugs Patients usually stay on the sampled drug Increases prescriptions of the most expensive, most promoted drugs

19 Gain access to physicians Habituate physicians to prescribing targeted drugs Increase goodwill by enabling doctors to give gifts to patients Serve as unacknowledged gifts to physicians and staff The real purpose of samples

20 Samples are a marketing tool …the manufacturer needs to figure out the right amount of samples the rep has to drop off in order to maximize the number of paid prescriptions written. Tsang J and Rudychev I. Medical Marketing & Media Feb;41(2):52-8.

21 Meetings and events Nearly 30 percent of physicians who attend association meetings refuse to see reps in their office…a no-see strategy is critical for companies to overcome Rehal D. Successful Product Managers Handbook. Pharm Exec Mar 1;7:8-15. Full textFull text

22 Pharma controls CME In 2006, over $2.3 billion dollars was spent on CME More than half of this came from pharmaceutical manufacturers Medical Education and Communication Companies (MECs) 76% of income is from firms that manufacture FDA- regulated products Medical schools 62% of CME income to medical schools comes from pharma (ACCME) ACCME Annual Report Data 2006, Table Jul 6. ReportReport

23 Advertising in medical journals More than 95% of JAMA ads are for Rx drugs 5 of 6 physician organizations raised at least 10% of annual revenue from ads in affiliated medical journals Pharma companies also purchase sponsored subscriptions And are the largest purchaser of reprints Fugh-Berman A, Alladin K, Chow J. PLoS Med. 2006;3(6):e130. Full textFull text

24 I Never Read the Ads

25 No promotion 14% Detail only 21% Detail and print [ads] 36% Detail and sales aid 33% Detail and print and sales aid 44% Correct message retention by media mix Paul CM. Medical Marketing & Media Dec;41(12):60-2. Full textFull text

26 What about R&D costs? Pharma spends 2-3 times as much on marketing as it does on research Edwards J. Brandweek Feb 7; ;46(6):24-6.

27 Is promotion worth it? In 2006, the ten best-selling global pharma brands made $53.5 billion* In 2001, the average return on investment per dollar spent on promotion was $12.70** *Robins R. Successful Product Managers Handbook. Pharm Exec 2007 Mar 1;7: **Niles S. Med Ad News 2004 Mar;23(3):1

28 Educational materials, news, resources, film clips, slideshows, articles, book list Links to reliable, free drug information Links to 300 credits of pharma-free CME Soon, our own CME modules on pharmaceutical promotion Funded by the Attorney General Consumer and Prescriber Education grant program, created as part of a 2004 settlement between Warner-Lambert, a division of Pfizer, Inc., and the Attorneys General of 50 States and D.C., to settle allegations that Warner-Lambert conducted an unlawful marketing campaign for the drug Neurontin® (gabapentin). Contact us at or

29 Thank you References

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