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Pharmaceutical Influence Is Pervasive But Hard to Quantitate

Researchers attempting to determine exactly how much money moves from industry to individual physicians found the data to be elusive. Meanwhile, consumer marketing soars.

The methods used by pharmaceutical companies to market their wares have undergone increasing scrutiny in recent years. This year, several research groups attempted to provide quantitative data on these controversial tactics.

Legislation proposed or recently passed in 16 states mandates public disclosure of pharmaceutical company payments to physicians. However, researchers who examined records in two of these states found it virtually impossible to assemble a complete database of per-physician payments. Some companies routinely withheld information on the grounds that such information constituted a "trade secret," and others provided information only erratically. Overall, the researchers concluded that existing laws are not stringent enough to provide the public with the full disclosure intended, and, unless amended, will lead to substantial underestimates of the dollar amounts that are changing hands (Journal Watch Mar 20 2007).

Researchers also approached the question from the opposite direction: Of more than 3000 U.S. physicians who were asked to report gifts or payments from industry during a single year, 52% responded. Almost all responders reported accepting some gifts, most commonly food or trinkets (83%) and drug samples (78%) from drug reps. More than a third were subsidized to attend continuing medical education seminars or medical conferences, and 28% were paid for consulting, speaking, or enrolling patients in trials (Journal Watch Apr 25 2007).

Meanwhile, the marketing of drugs directly to patients has escalated. In a recap of such advertising, researchers found that, from 1996 to 2005 in the U.S., total spending rose from $1 billion to $4 billion, consuming as much as a third of the marketing budget for some well-known brand-name drugs. Direct-to-consumer advertising elicited a disproportionate fraction of the violations that the FDA found in overall drug promotion, with ads generally cited for minimizing drug risks or exaggerating effectiveness (Journal Watch Aug 15 2007).

Overall, the links between physicians and industry clearly are strong, but even our best data are likely to underestimate their extent. Industry also is reaching out to individual consumers with record amounts of advertising that is often rife with misinformation.

— Abigail Zuger, MD

Published in Journal Watch General Medicine December 28, 2007

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