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How to doctors find out about new drugs?
Primarily from pharmaceutical companies
Based on the Congressional
testimony of Michael Wilkes, M.D., Ph.D. Vice Dean, Medical Education
Professor of Medicine and Public Health, University of California,
Davis in front of the Committee on Government Reform with respect to
safety of Vioxx.
Pharmaceutical expenditures are the fastest growing part of health care costs increasing at
15% a year. Americans spend 8% of their health care dollars on drugs – much of this
coming out of their own pockets. A conservative estimate is that last year Pharma spent
$20 billion dollars on drug marketing and promotion or as Pharma prefers to call it
“educational outreach”. |
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During this same time period all the US medical schools spent
only $3.5 billion on medical education and residencies spent $3.9 billion on education
(calculations based on demographic data provided in personal communication
AAMC). This $20 billion is far more than is spent on research and development, and is more than
is spent on manufacturing and distribution. Promotional (marketing) money is divided
between promoting drug products to physicians and promoting the same products to the
public. Most of the following presentation will focus on
physician-Pharma interactions but DTC advertising is not to be overlooked as an enormous source of misleading
information that results in inappropriate medical care with a huge impact on medical
costs, patient expectations, and iatrogenic illness.
How do doctors learn about new drugs?
In an ideal world medical schools would teach students to make prescribing
decisions based on the best available evidence taking in to account benefits, risks, costs,
and mechanisms of action. In fact, medical schools spend shockingly little time teaching
doctors in training about rational prescribing. In four years of medical school, less than
5% of actual teaching time relates to the use of medications. Once a doctor completes
her training there is no formal, independent system to teach doctors about new drugs and
treatments. It is catch as catch can. This is where Pharma has stepped in. Not
surprisingly, the prescribing practices of most physicians and physicians in training are
heavily influenced by $20 billion spent on drug promotion.
The end result of Pharma’s major role in educating doctors about prescription
drugs is poor, dangerous, and overly expensive prescribing practices of American
physicians. There are example after example of where, despite sound evidence, doctors
write prescriptions for inferior but heavily marketed products (beta blockers, finasteride
or Propecia, diabetes drugs, fluoroquinolones, calcium channel blocking drugs, dementia drugs, TPA,
etc.) ignoring or being unaware of the scientific evidence.
Related articles:
Interaction
of drug firms and physicians
How
should I dispose unused pills
Vioxx
recall and direct to consumer advertising
Why
should drug promotion be different?
Vioxx
and Celebrex advertising to blame for personal injuries
Trasylol recall
Ethics of marketing new drugs to doctors
Direct
to consumer advertising unchanged despite Vioxx
controversy
Vioxx
patients misled by Merck advertising
Impact
of drug promotions on doctors' prescription decisions
FDA
warns Pfizer on misleading Celebrex and Bextra ads
Relationship
of pharmaceutical companies and doctors
Overall
impact of drug promotion and advertising on pharma
industry
Responsibility
for Vioxx related deaths lies with doctors too
Impact
on prescription behavior due to marketing by pharma
companies
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