Playing by Their Own Rules

03/28/2008

Executive Summary

Drug companies spend billions annually marketing their latest, most expensive drugs to doctors. These marketing efforts do not rely solely on scientific research and medical benefits, however; they employ a barrage of gifts, expensive meals, and wine-and-dine events to gain access to doctors. The result is that doctors looking for objective data about the efficacy and safety of pharmaceuticals are ensnared by this system, and find it increasingly easy to look to the drug companies for information.

The result of these drug company marketing practices is an over-prescribing of the newest drugs, those behind which the drug makers are throwing their marketing muscle. This over-prescribing causes three problems for consumers. First, these drugs are the most expensive for consumers – who end up paying twice, as they ultimately pay for the gifts given to doctors as well. Second, because the newest drugs have been on the market for a shorter time than the older ones, they are among the least-tested, with potentially unknown side effects. Finally, drug company marketing to doctors damages the exclusivity of the doctor-patient relationship, as drug marketers shoulder their way into the consulting room.

Currently, drug companies are allowed to set their own standards for their marketing to doctors. They are required by California’s Senate Bill 1765, however, to adopt a limit on the total value of the gifts they can give to a particular doctor in a given year, and post this information to their web sites.

This white paper examines the rules the drug companies have set for themselves, assesses whether they comply with the minimum requirements of SB 1765, and identifies aspects of the drug company rules that are deeply problematic. Among our findings:

• -Drug companies fail to count some meals and other payments as “gifts,” and therefore not subject to the limit;
• -Some companies reserve the right to exceed their limits if they so choose;
• -Others assert that they are following a limit, but do not disclose what that limit actually is, while a few fail even to post their policies at all.

It is clear that drug companies cannot be trusted to actually protect consumers through voluntary restrictions on their direct-to-doctor marketing. By playing by their own rules, the manufacturers have created limits that in many cases fail to constrain their actions at all. Fortunately, there are common-sense policies that will restrain direct-to-doctor marketing to an appropriate scope. These include:

• -Putting in place hard, enforceable limits on per-doctor gifts;
• -Publicly disclosing all gift and non-gift payments;
• -Encouraging access to disinterested, third-party informational resources on drug safety and efficacy.