The Effects of Drug Promotion on the Health Care System

Introduction

There has been an increase in the use of drugs as the population ages (Lown, 2003).  In addition, drug companies have been driven in this economy to maximize their profitability which has resulted in an escalation of costs associated with the drugs (Lown, 2003; Relman, 2002).  Lown (2003) estimates that drug spending has risen from approximately $38 billion before the 1990s to approximately $220 billion in 2002.  This figure continues to rise with no end in sight (Lown, 2003; Relman, 2002).  Tansey (2005) reports via information provided by IMS Health, a pharmaceutical information and consulting company, that by the year 2003 pharmaceutical sales exceeded $5.3 billion.

The use of prescription drugs is the fastest growing component of the costs of personal health care and increases 15% annually (Lown, 2003).  This is 4 times faster than any other health component spending.  Lown (2003) points out that the average costs for a month’s supply of any of the top 20 selling brand names is $100.00.  With approximately 40% of the elderly population in the United States taking five or more medicines per week, most patients depend on several of these drugs (Relman, 2002).  Compounding this issue is the fact that approximately 10 million elderly in the United States do not have the prescription coverage for such expenditures, and even among those who do, the coverage just isn’t enough (Lown, 2003).

The impact the costs of health care in the United States has on the American public is profound.  It affects every American citizen either directly or indirectly.  One must question the necessity of the number of drugs being prescribed.  Lown (2003) states:

Promotion of drugs to the public drains health care dollars, and dramatically increases unnecessary prescribing and strain doctor patient relationships. Furthermore it seeds misinformation, medicalizes ordinary life and aging, and promotes hypochondriasis as it turns persons into patients. (p. 1)

An examination needs to be made into whether it is a result of pharmaceutical advertising to the public, physicians clouded by the benefits provided by the pharmaceutical industry, or whether these drugs are truly needed by the patients taking them.  This paper will address these issues in an effort to shed light into the costs associated with healthcare, as well as potential dangers of drug promotion to physicians and the general public.

The Effects of Drug Promotion on the Health Care System

Tansey (2005) reports that the pharmaceutical industry spends more than $1.5 billion annually in drug promotions through television, print ads, and solicitation to physicians.  $8000 to $13,000 per physician is spent annually in promotion (Lown, 2003).  Approximately 85,000 drug representatives are assigned to visit physicians weekly.

The primary targets for the drug representatives are medical residents (Lown, 2003). This may be due to the fact that these physicians can be influenced through attentiveness and respect that they are not given within their profession (Lown, 2003).  Moreover, Lown (2003) reports that in the United Kingdom, Time Concepts LLC has been hired by the pharmaceutical industry to initiate a program where physicians are offered $50.00 each time they listen to a drug sales pitch from a drug representative in their office.  $50.00 goes to Time Concepts LLC and $5.00 goes to a charity that the doctor chooses (Relman, 2002; Spurgeon, 2002).

In the United States, drug marketers compete to try to persuade doctors to prescribe their brand-named drugs over generics and other competitors’ brands (Ebeling, 2008).  Drug companies may retain a doctor to be their spokesperson or offer free events at a resort or hotel to “educate” doctors about their newest drug or new disease (Ebeling, 2008).

The inherent danger in this is the potential for doctors to prescribe based on loyalty to the pharmaceutical company rather than based on scientific needs.  For example, Lown (2003) emphasizes that numerous studies have provided strong evidence that there is a correlation between physicians who have regular interactions with sales and the likelihood of those physicians having non-scientific prescribing habits.  Moreover, Watkins et al. (2003) state:

A British research group found that doctors who have frequent contact with drug representatives are more willing to prescribe new drugs, do not like ending patient visits with advice only, and are more likely to prescribe drugs that are not clinically indicated. (p. 1178)

Not only has pharmaceutical promotion affected the way doctors prescribe medication, it has also affected the way the general public perceives medication.  An example of the impact that the pharmaceutical companies has on public and doctor perception can be exhibited in the case of Vioxx and Celebrex.  Tansey (2005) points out that Vioxx and Celebrex were promoted as the class of arthritis drugs that would play a major role in helping to prevent ulcers and digestive ailments that were linked to medications such as aspirin when they first entered the market in the late 1990s.  In 2003, Celebrex made $2.6 billion in sales to include $23.6 million for the number of prescriptions (Tansey, 2005).  The costs were $483 million for the cost of promotions aimed at doctors, and $87 million for the cost of direct-to-consumer advertising (Tansey, 2005).  Vioxx sales for 2003 were $1.8 billion to include 19.9 million for the number of prescriptions (Tansey, 2005).  The costs were $499.8 million for cost of promotions aimed at doctors and $78 million for the cost of direct-to-consumer advertising (Tansey, 2005).  In 2003 Bextra made $935 million in sales (Tansey, 2005).

However, these drugs have subsequently been correlated with an increased risk of strokes and heart attacks (Tansey, 2005).  Many critics now posit that millions of people were exposed to needless dangers as a result of the aggressive advertising by the pharmaceutical industry.  In its heyday these drugs were some of the most widely prescribed painkillers in the United States (Tansey, 2005).  Not only were the drugs expensive, studies show that many of the patients that took the painkillers were never at risk for ulcers or digestive problems (Tansey, 2005).

In addition to the potential for the needless prescribing of drugs, there is also a huge potential for misleading the public through the use of celebrity endorsements.  In January of 2008, the U.S. House Committee on Energy and Commerce began an investigation into the use of celebrities for the endorsement of brand-name drugs (Ebeling, 2008).  This came about as a result of Pfizer’s commercials for Lipitor which featured Dr. Robert Jarvik who played a key role in the development of the artificial heart.  These direct to consumer (DTC) ads did not inform the viewers that Jarvik is not a licensed Medical Doctor, and is not a cardiologist (Ebeling, 2008).

The Food and Drug Administration (FDA) became more tolerant governing pharmaceutical marketing in 1997, and ever since DTC have become controversial (Ebeling, 2008).  Previous to Lipitor there was Viagra, which encouraged recreational use of the erectile dysfunction drug by suggesting that Viagra be used to “celebrate” events like the Super Bowl or New Year’s Eve (Ebeling, 2008).

Patients are being turned into consumers, which carries with it a high potential for the prescribing of drugs unnecessarily.  One way this is accomplished is through “rebranding” (Ebeling, 2008).   Prozac illustrates this process.  Eli Lilly, the manufacturer of Prozac, rebranded the top-selling antidepressant and sells it under the name of Sarafem.  Both Sarafem and Prozac are identical chemically.  They only differ in their branding and what they are prescribed for.   Sarafem is pink and purple while Prozac is yellow and green.  Prozac is used to treat depression and associated symptoms, while Sarafem is used to treat premenstrual dysphoric disorder (PMDD), which is little recognized, highly controversial and a highly contested condition (Ebeling, 2008).

Eli Lilly went back to the FDA and got approval to use Sarafem to treat PMDD just months before the patent ran out on Prozac, which in effect extended the patent on Prozac (Ebeling, 2008).  Not only did Eli Lilly extend its market, by extending the patent on Prozac Eli Lilly stopped any potential generic competitors from having a share in the market (Ebeling, 2008).

In essence, rebranding serves to allow the drug manufacturer to advertise DTC under a new name without having to mention that there is no chemical difference between the two drugs (Ebeling, 2008).  Moreover, in getting the FDA to approve Sarafem for use in the ill-defined medical condition, the pharmaceutical company can in effect decide who might benefit from the product (Ebeling, 2008).  The company’s definition of symptom treatment for certain conditions are quite wide to even include what would be considered normal experiences (Ebeling, 2008). Eli Lilly has included irritability, mood swings, tension, breast tenderness, and bloating in the symptoms for PMDD that Sarafem treats (Ebeling, 2008).

Another potential danger in pharmaceutical drug promotion is providing the public misleading information concerning the cause of disorders.  For example, Moncrieff (2006) argues that in spite of the fact that studies have shown that there is an overall improvement in health, there has been a huge increase in the taking of prescription drugs in the Western world.  Moncrieff (2006) points out that a large portion of these are for mental disorders.  In the decade leading up to 2002, the use of antidepressants increased by 234% in the UK (Moncrieff, 2006).  According to Moncrieff (2006) 11% of women and 5% of men take antidepressants in the United States.

Pharmaceutical companies often claim chemical imbalances as the main underlying cause of mental disorders (Moncrieff, 2006).  Moncrieff (2006) points out that this stems from the psychiatric model of mental disorder that posits these disorders are caused by “potentially identifiable deviations from normal biological functioning.”  Although this model has limited application to severe mental disorders, the pharmaceutical industry has promoted this theory greatly (Moncrieff, 2006).

The pharmaceutical companies have engaged in extensive disease awareness campaigns for conditions such as depression, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, attention-deficit hyperactivity disorder and premenstrual dysphoric disorder (Moncrieff, 2006).  In addition, they have sponsored research into compulsive buying disorder and the so-called preventive treatment for psychosis (Moncrieff, 2006). The results of these campaigns have “increased the number of people who define themselves as psychiatrically ill and to create the impression that the biochemical basis of psychiatric disorders is well established” (Moncrieff, 2006).

Even among the well-informed public this perception seems to be the norm.  Many are shocked to discover that research has not established that serotonin abnormality is the cause of depression (Moncrieff, 2006). Moncrieff (2006) also points to recent papers that expose the gap  between the assertions found in drug promotional literature and the “inconsistent and tenuous nature of the findings of research into the links between serotonin and depression.”

Conclusion

The impact of drug promotion by the pharmaceutical companies have significantly affected the sale of prescription drugs through both the promotion to doctors as well as turning patients into consumers.  This has caused a spike in pharmaceutical sales and often unnecessary prescriptions to individuals who don’t need it.  Even among the therapists, most are often turning to psychopharmacological treatments rather than to therapy based treatments.  Breggin (2003) states:

In relying on medication, therapists often undermine the humanistic, existential view of human nature-the belief that each human being has the task of learning to live by principles and by higher values, such as liberty, personal responsibility, and love and that this effort is an essential part of the psychotherapeutic processes and life itself. Not only does the resort to medication tend to subvert these higher values, but the physical impact of all psychoactive medication on the brain also ultimately blunts or distorts the individual’s higher faculties. (p. 35)

There has been an emergence in the use of drugs including psychoactive drugs in the treatment of disorders (Breggin, 2003).  Many individuals are encouraged, pressured, or forced to take drugs for extended periods of time, and ostracized if they don’t (Breggin, 2003).   As Breggin (2003) points out, most of the time the doctors themselves do not have much direct knowledge concerning the research used to justify the use of psychiatric drugs and take the word of the pharmaceutical industry.  They either do not understand or look the other way in realizing that the pharmaceutical industry dominates the research (Breggin, 2003).

Additionally, most journals tend to reject articles that criticize biopsychiatry (Breggin, ND).  As Breggin (2003) emphasizes, most of the basis of biopsychiatry is circles around drug promotion and drug company money, excluding studies that are contradictory to this model.  Unfortunately, well-informed public and doctors have put their faith in medicine, psychiatry, and drugs rather than looking to the scientific basis of the research.  As long as this continues, as Breggin (2003) states the drug companies and biological psychiatry do more harm than good.

 

REFERENCES

Breggin, P. R.  (2003).  Psychopharmacology and human values.  Journal of Humanistic Psychology, 43(2), 34-49.

Ebeling, M.  (2008).  Beyond advertising: The pharmaceutical industry’s hidden marketing tactics.  In PR Watch.org: Center for Media and Democracy.  Retrieved October 31, 2010 from http://www.prwatch.org/node/7026.

Lown, B.  (2003).  Commentary: The drug crisis II—drug promotion.  In ProCor: Advocacy and Policy. Retrieved October 31, 2010 from http://www.procor.org/advocacy/advocacy_show.htm?doc_id=699110.

Moncreiff, J.  (2006).  Psychiatric drug promotion and the politics of neoliberalism.  British Journal of Psychiatry, 188, 301- 302.

Relman, A. S., Angel, M. (2002).  America’s other drug problem :How the drug industry distorts medicine and politics. New Republic, Dec 16, 27.

Spurgeon, D.  (2002).  Doctors accept $50 a time to listen to drug representatives.  British Medicine Journal, 324, 1113.

Tansey, B.  (2005).  Hard sell: How marketing drives the pharmaceutical company/The side effects of drug promotion/Aggressive ads for pain killers left more patients exposed to risks.    In SFGate.com: Article Collections.  February 27.

Watkins, C., Moore, L., Harvey, L. et al. (2003).  Characteristics of general practitioners, who frequently see drug industry representatives: National cross sectional survey. British Medicine Journal, 326, 1178-9.