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Research from the Pew Charitable Trusts shows that in 2012 alone 27 Billion dollars was spent by US Pharmaceutical companies to promote their drugs to doctors a

Research from the Pew Charitable Trusts shows that in 2012 alone 27 Billion dollars was spent by US Pharmaceutical companies to promote their drugs to doctors and patients. http://www.pewtrusts.org/en/research-and-analysis/fact-sheets/2013/11/11/persuading-the-prescribers-pharmaceutical-industry-marketing-and-its-influence-on-physicians-and-patients http://www.pewtrusts.org/en/research-and-analysis/fact-sheet... This is money that could have been spent on R&D instead of advertising if we moved to a non-profit pharmaceuticals model.

jonlucc 9y ago
Pharma researcher here (on the early science side, not market research or that kind of thing) I think people vastly overestimate their physicians' ability to stay on top of newly published research, and that includes new drugs' safety and efficacy profiles. If I want the stuff I work on to reach patients (and I do), then I want doctors to know about it. In the absence of pharma marketing dollars aimed at doctors and patients, I would like if there were some way to bring doctors the new information. Maybe that should be handled by a third party that doesn't have the interests of pharma companies in mind, funded by all of the drug companies at the time of a new drug approval.
- pmyteh 9y ago
  In Britain, we rely more on guidance from the National Institute for Health and Care Excellence (NICE). It does comparative reviews to make recommendations on the most suitable drugs to use. Motivation is primarily to restrict crazy-expensive drugs to those situations where they're actually going to represent value for (the public's) money, but also to point clinicians towards new approaches which can improve the quality of treatment. So hugely expensive advertising towards physicians is not the only way to do it.
  - jonlucc 9y ago
    That sounds like a fantastic resource that I can not imagine passing in the United States any time soon. Is it funded along with the rest of the NHS?
    - pmyteh 9y ago
      Yes. In fact, its major remit is to improve value for money by targeting NHS treatments better. All of its meta-analyses and treatment guidance are available at http://www.nice.org.uk http://www.nice.org.uk, if you want to explore.
      - jonlucc 9y ago
        This is really great; thank you for pointing me to it.
  - GeekyBear 9y ago
    In the United States, policy debates about implementing this sort of body led to them being referred to as a "death panel". There is no logical reason why we shouldn't prefer an older generic medication if it treats the symptoms of a condition just as effectively and with fewer side effects than a newer option that is no more effective and has more side effects, but doing what is best for patients has to compete against the profit motive of our pharmaceutical companies.
    - jonlucc 9y ago
      > There is no logical reason why we shouldn't prefer an older generic medication if it treats the symptoms of a condition just as effectively and with fewer side effects than a newer option that is no more effective and has more side effects There are checks on this, and I'm not sure if you are thinking of a particular case, but I can't really see how this would happen. In order to get approval, a new drug almost always has to demonstrate that it is at least "non-inferior" to the standard of care. Additionally, there is a lot of pressure in the United States from payers. Insurance companies just won't pay for a drug that is in no way better than the previous standard of care with more detrimental side effects. There are definitely cases where the FDA made a mistake for one reason or another (allowed an entity to move through the wrong approval mechanism, were duped by fraudulent AE reports and didn't catch it, failed to require the appropriate screens for AEs, etc), but the system has some checks on drug companies.
      - GeekyBear 9y ago
        >I'm not sure if you are thinking of a particular case, but I can't really see how this would happen. Does Purdue Pharma's decision to push opioids as a safe treatment for everyday pain ring a bell? https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain https://www.newyorker.com/magazine/2017/10/30/the-family-tha... Oxycontin was certainly profitable, but it was not good for patients with chronic pain. This is a case where a Pharma company deliberately misled doctors, patients and regulators because doing so was exceptionally profitable. >The company that makes the narcotic painkiller OxyContin and three current and former executives pleaded guilty today in federal court here to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused. http://www.nytimes.com/2007/05/10/business/11drug-web.html http://www.nytimes.com/2007/05/10/business/11drug-web.html
  - mft_ 9y ago
    To support the commenter you're replying to, I have seen --first hand-- examples of patients receiving better treatment with very cost-effective drugs (which sailed through NICE) due to the efforts of staff from pharmaceutical companies. Don't assume that all doctors are committed to making the latest advances (or even older advances) available to patients. They are human, just like all of us, and you'll find stubborn doctors on the conservative (or laggard) end of the spectrum just as much as within any other group or career.
thousandautumns 9y ago
That's an incredibly naive take and one that completely fails to understand the realities of the economics of drug development. Considering that in 2010, Forbes estimated that the cost of bringing a single drug to market, was between $4-11 billion dollars, you are buying between 2-6 extra drugs per year. (https://www.forbes.com/sites/matthewherper/2012/02/10/the-truly-staggering-cost-of-inventing-new-drugs/ https://www.forbes.com/sites/matthewherper/2012/02/10/the-tr...) But that fails to account for the fact that the number of drugs doctors and patients have to choose from currently is staggering, and both groups have proven hesitant to switch to new therapies, and so by not advertising new drugs, the amount of money that can be made dramatically decreases, which further impacts the ability for pharma companies to invest in R&D. No one thinks it is ludicrous for Google or Apple to throw as much money as they do at marketing. Its capitalism, and if you have a problem with it fine, but it isn't evil for pharma companies to work under the same model that every other industry on the planet has and which has been the driving force of the planet for the last several centuries.
- GeekyBear 9y ago
  We don't need 20 additional drugs that sort of treat one condition (albeit with serious side effects) that the pharmaceutical company prefers we use because the profit margin is higher on new formulations with no generic equivalent. We need one additional drug that treats said condition better than the existing options, but with less side effects. The profit motive distorts what is best for patients.
  - mft_ 9y ago
    You've got an overly negative and simplistic view of the Pharma industry. For sure, there are plenty of examples (do we need that many statins? do we need so many beta blockers?) to suit your narrative, but you're also missing the huge sums spent and strides taken in other areas, such as oncology. If you don't show a meaningful benefit here, your drug is a failure - it's that simple.
mft_ 9y ago
As much as I understand your underlying horror that so much money is spent on promotion, I think you're missing a major point. Let's assume, for a moment, that the people running these Pharma companies aren't stupid. We can therefore assume that they will mostly make sensible decisions on how to spend money. It therefore follows that a company calculates that by spending $X on promotion, they'll recoup $X+$Y, where Y is the additional revenue thanks to their promotion, over and above what they'd have made without promotion - i.e, their promotional spend is a worthwhile investment for them. For each company individually, therefore, promotional spend can be reasonably assumed to generate greater revenue and profit, some of which will be used to fund research into new medicines. Now, like you, I'd much rather live in a world where there was no promotional spend, and correspondingly lower drug prices... but that's not the current world. And pointing a finger --'but, marketing, sales reps'-- at promotion is not the full story.
- GeekyBear 9y ago
  You seem to be ignoring the larger problem. Having the pharmaceutical industry arrange everything around the notion of "what is more profitable to us" leads them to ignore the notion of "what is best for patients with this condition". If unbiased studies show that their treatment is more effective and has less side effects than existing options, then it should become the usual treatment for that condition. Otherwise, no amount of advertising and promotional activity on their part makes sense when approached from the notion of what is best for patients. In the case of promoting Oxycontin to treat chronic pain, real harm has been done.

jonlucc 9y ago

Pharma researcher here (on the early science side, not market research or that kind of thing) I think people vastly overestimate their physicians' ability to stay on top of newly published research, and that includes new drugs' safety and efficacy profiles. If I want the stuff I work on to reach patients (and I do), then I want doctors to know about it. In the absence of pharma marketing dollars aimed at doctors and patients, I would like if there were some way to bring doctors the new information. Maybe that should be handled by a third party that doesn't have the interests of pharma companies in mind, funded by all of the drug companies at the time of a new drug approval.

pmyteh 9y ago
In Britain, we rely more on guidance from the National Institute for Health and Care Excellence (NICE). It does comparative reviews to make recommendations on the most suitable drugs to use. Motivation is primarily to restrict crazy-expensive drugs to those situations where they're actually going to represent value for (the public's) money, but also to point clinicians towards new approaches which can improve the quality of treatment. So hugely expensive advertising towards physicians is not the only way to do it.
- jonlucc 9y ago
  That sounds like a fantastic resource that I can not imagine passing in the United States any time soon. Is it funded along with the rest of the NHS?
  - pmyteh 9y ago
    Yes. In fact, its major remit is to improve value for money by targeting NHS treatments better. All of its meta-analyses and treatment guidance are available at http://www.nice.org.uk http://www.nice.org.uk, if you want to explore.
    - jonlucc 9y ago
      This is really great; thank you for pointing me to it.
- GeekyBear 9y ago
  In the United States, policy debates about implementing this sort of body led to them being referred to as a "death panel". There is no logical reason why we shouldn't prefer an older generic medication if it treats the symptoms of a condition just as effectively and with fewer side effects than a newer option that is no more effective and has more side effects, but doing what is best for patients has to compete against the profit motive of our pharmaceutical companies.
  - jonlucc 9y ago
    > There is no logical reason why we shouldn't prefer an older generic medication if it treats the symptoms of a condition just as effectively and with fewer side effects than a newer option that is no more effective and has more side effects There are checks on this, and I'm not sure if you are thinking of a particular case, but I can't really see how this would happen. In order to get approval, a new drug almost always has to demonstrate that it is at least "non-inferior" to the standard of care. Additionally, there is a lot of pressure in the United States from payers. Insurance companies just won't pay for a drug that is in no way better than the previous standard of care with more detrimental side effects. There are definitely cases where the FDA made a mistake for one reason or another (allowed an entity to move through the wrong approval mechanism, were duped by fraudulent AE reports and didn't catch it, failed to require the appropriate screens for AEs, etc), but the system has some checks on drug companies.
    - GeekyBear 9y ago
      >I'm not sure if you are thinking of a particular case, but I can't really see how this would happen. Does Purdue Pharma's decision to push opioids as a safe treatment for everyday pain ring a bell? https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain https://www.newyorker.com/magazine/2017/10/30/the-family-tha... Oxycontin was certainly profitable, but it was not good for patients with chronic pain. This is a case where a Pharma company deliberately misled doctors, patients and regulators because doing so was exceptionally profitable. >The company that makes the narcotic painkiller OxyContin and three current and former executives pleaded guilty today in federal court here to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused. http://www.nytimes.com/2007/05/10/business/11drug-web.html http://www.nytimes.com/2007/05/10/business/11drug-web.html
- mft_ 9y ago
  To support the commenter you're replying to, I have seen --first hand-- examples of patients receiving better treatment with very cost-effective drugs (which sailed through NICE) due to the efforts of staff from pharmaceutical companies. Don't assume that all doctors are committed to making the latest advances (or even older advances) available to patients. They are human, just like all of us, and you'll find stubborn doctors on the conservative (or laggard) end of the spectrum just as much as within any other group or career.

thousandautumns 9y ago

That's an incredibly naive take and one that completely fails to understand the realities of the economics of drug development. Considering that in 2010, Forbes estimated that the cost of bringing a single drug to market, was between $4-11 billion dollars, you are buying between 2-6 extra drugs per year. (https://www.forbes.com/sites/matthewherper/2012/02/10/the-truly-staggering-cost-of-inventing-new-drugs/ https://www.forbes.com/sites/matthewherper/2012/02/10/the-tr...) But that fails to account for the fact that the number of drugs doctors and patients have to choose from currently is staggering, and both groups have proven hesitant to switch to new therapies, and so by not advertising new drugs, the amount of money that can be made dramatically decreases, which further impacts the ability for pharma companies to invest in R&D. No one thinks it is ludicrous for Google or Apple to throw as much money as they do at marketing. Its capitalism, and if you have a problem with it fine, but it isn't evil for pharma companies to work under the same model that every other industry on the planet has and which has been the driving force of the planet for the last several centuries.

GeekyBear 9y ago
We don't need 20 additional drugs that sort of treat one condition (albeit with serious side effects) that the pharmaceutical company prefers we use because the profit margin is higher on new formulations with no generic equivalent. We need one additional drug that treats said condition better than the existing options, but with less side effects. The profit motive distorts what is best for patients.
- mft_ 9y ago
  You've got an overly negative and simplistic view of the Pharma industry. For sure, there are plenty of examples (do we need that many statins? do we need so many beta blockers?) to suit your narrative, but you're also missing the huge sums spent and strides taken in other areas, such as oncology. If you don't show a meaningful benefit here, your drug is a failure - it's that simple.

mft_ 9y ago

As much as I understand your underlying horror that so much money is spent on promotion, I think you're missing a major point. Let's assume, for a moment, that the people running these Pharma companies aren't stupid. We can therefore assume that they will mostly make sensible decisions on how to spend money. It therefore follows that a company calculates that by spending $X on promotion, they'll recoup $X+$Y, where Y is the additional revenue thanks to their promotion, over and above what they'd have made without promotion - i.e, their promotional spend is a worthwhile investment for them. For each company individually, therefore, promotional spend can be reasonably assumed to generate greater revenue and profit, some of which will be used to fund research into new medicines. Now, like you, I'd much rather live in a world where there was no promotional spend, and correspondingly lower drug prices... but that's not the current world. And pointing a finger --'but, marketing, sales reps'-- at promotion is not the full story.

GeekyBear 9y ago
You seem to be ignoring the larger problem. Having the pharmaceutical industry arrange everything around the notion of "what is more profitable to us" leads them to ignore the notion of "what is best for patients with this condition". If unbiased studies show that their treatment is more effective and has less side effects than existing options, then it should become the usual treatment for that condition. Otherwise, no amount of advertising and promotional activity on their part makes sense when approached from the notion of what is best for patients. In the case of promoting Oxycontin to treat chronic pain, real harm has been done.