Heavily Lobbied Bill to Protect Patients from Drug Company Direct-to-Doctor Marketing Up Today in California Assembly Health Committee

AB 2821 (Feuer) opposed by pharmaceutical industry

By Michael Russo
Health Care Advocate and Staff Attorney
California Public Interest Research Group (CalPIRG)

Anybody who’s watched any TV in the past few years knows that flashy ads praising the benefits of exciting new drugs are ubiquitous. Beyond breezing past the list of potential side effects with quick, monotone narration, these ads too often mislead consumers into asking for medicines that aren’t right for them, either because they’re not effective or because they’re too expensive.

But these ads are only half the picture – in fact, drug companies spend more money hawking their wares to doctors than they do on direct-to-consumer marketing. They’ve got the same end in mind – namely, getting doctors to prescribe more of the newest, most expensive drugs. And rather than relying solely on scientific research and medical knowledge to sell their products, the companies employ brigades of marketing representatives called “detailers,” who lavish gifts and free meals on the doctors they woo. They also sponsor expense-paid trips to continuing medical education programs that tout the benefits of company-produced drugs, and pay for a web of speaker honoraria and consulting fees that reward doctors for extolling a drug’s virtues to their fellow practitioners.

The scope of this effort is breathtaking. In 2004, drug companies employed over 100,000 detailers (their office-based physician targets numbered only 500,000). They spent some 7 billion dollars on direct-to-doctor marketing. And that year the average primary care doctor had 28 interactions with a drug company detailer every week.

Patients pay for these practices in three ways. First, the $27 billion the drug industry annually spends on marketing is ultimately passed on to consumers in the form of increased drug prices. Second, the new drugs doctors are urged to prescribe are universally more expensive than older, established treatments, but may be no more effective or have worse side effects – as was the case with the new cholesterol medication Vytorin. Finally, the appearance of quid-pro-quo exchanges of gifts for the writing of prescriptions undermines the doctor-patient relationship.

Currently, drug companies are allowed to set their own standards for their marketing to doctors. They are required by California law, however, to adopt a policy that sets 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.

When we looked at these policies, however, we found that industry’s self-set standards failed to protect patients. Most basically, the limits are frighteningly large – up to $3,500 per doctor! But that’s only the tip of the iceberg. Drug companies fail to count some meals and other payments as “gifts,” which opens up loopholes to allow the companies to spend as much as they want without worrying about the limit on gifts. Other companies take a more direct tack, and simply reserve the right to exceed their limits if they so choose. Then there are those who assert that they are following a limit, but do not disclose what that limit actually is. And a few fail even to post their policies at all.

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