Physician Pharma Relationship Web

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The Physician-Pharma RelationshipPharmedOut.org

Georgetown University Medical CenterJanuary 2008


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The Physician-Pharma Relationship

Is very old and very close But are the goals of pharmaceutical companies

and medicine the same?


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Promotion includesPromotion includes

Detailing

Meetings and events (dinner meetings,CME, rounds, symposia)

Publications (symposia, monographs,supplements, throwaways)

Advertising and reprints

Direct mail, e-detailing


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Top 10 products by US Sales, 2006 (IMS Health)Top 10 products by US Sales, 2006 (IMS Health)

Lipitor $8.6 billion

Nexium $5.1 billion

Advair diskus $3.9 billion

Aranesp $3.9 billion Prevacid $3.5 billion

Epogen $3.2 billion

Zocor $3.1 billion

Enbrel $3.0 billion

Seroquel $3.0 billion

Singulair $3.0 billion

IMS national sales perspectives. IMS Health. 2007 Mar. Table


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The costs of promotionThe costs of promotion

In 2004, total promotion cost for Rx drugs wasalmost $30 billion

About $7 billion spent on detailing NIH budget FY 2008 is $29 billion* FDA budget FY 2008 is $2 billion**

WestD. Changing lanes. Pharm Exec. 2005 May;25(5):154-162. Full text*NIH summary of the FY 2008 presidents budget, 2007 Feb 5. Summary

**Summary of FDAs FY 2008 budget. Summary


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Promoting the profitablePromoting the profitable

There are more than 10,000 drugs in the USpharmaceutical market

More than half of promotional expenditures areconcentrated on the top-selling 50 drugs*

*Ma J et al. Clin Ther 2003;25(5):1503-17. Abstract


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New drugs are notNew drugs are not

necessarily better drugsnecessarily better drugs

Most new drugs are me-too drugs, or combinationsof old drugs

In general, generic drugs are safer than brandeddrugs simply because more information is availableabout them


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Studies consistently show that promotion

increases prescribing* Studies consistently show that physicians do

not believe that promotion affectsprescribing**

*Chren MM and Landefeld CSl. JAMA 1994 Mar 2;271(9):684*Chren MM and Landefeld CSl. JAMA 1994 Mar 2;271(9):684--9.9. AbstractLurie N et al. J Gen Int Med 1990;5(3):240Lurie N et al. J Gen Int Med 1990;5(3):240--243.243. AbstractWazana A. JAMA 2000 Jan 19;283(3):373Wazana A. JAMA 2000 Jan 19;283(3):373--80.80. Abstract

**Sigworth SK et al. JAMA. 2001 Sept 5;286(9):1024**Sigworth SK et al. JAMA. 2001 Sept 5;286(9):1024--5.5. AbstractMcKinney WP et al. JAMA 1990 Oct 3;264(13):1693McKinney WP et al. JAMA 1990 Oct 3;264(13):1693--7.7. Abstract

Doctors are too smart to bebought by a slice of pizza


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DetailingDetailing

In 2005, there were about 600,000 doctors andabout 100,000 drug reps in the US

Actual ratio about 1 rep per 2.5 targeted docs*

Targeted docs are high-prescribers, or docs whocontrol market share

*Goldberg M et. al. Pharm Exec. 2004 Jan 1;24:40*Goldberg M et. al. Pharm Exec. 2004 Jan 1;24:40--5.5. Abstract


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The AMA Physician MasterfileThe AMA Physician Masterfile

Contains demographic data that the AMAhas sold to industry continuously since the1940s*

In 2005, licensing Masterfile information and

other database product sales providedabout 16% ($44 million) of the AMAsrevenue**

*Greene JA. Ann Int Med. 2007 May 15;146:742-8. Full text**Steinbrook R. NEJM. 2006 Jun 29;354(26):2745-7. Abstract


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AMAs PrescriptionD

ataAMAs PrescriptionD

ataRestriction Plan (PDRP)Restriction Plan (PDRP)

Few physicians know about it

< 1% of doctors have signed up

"Just giving them an option [to opt-out]alleviates their concerns," explained the AMAssenior VP of publishing and business services to

Pharmaceutical Executive

Herskovits B. Pharm Exec Direct. 2006 Jul 19. Full text


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AMAs OptAMAs Opt--out planout plan

The restrictions do not apply to

(a) deciles at the market or therapeutic classlevel

(b) segmented data that are not likely to revealthe actual or estimated activity of an individualphysician, or

(c) data on products ordered by physicians frompharmaceutical companies.

Musacchio RA and Hunkler RJ. Pharm Exec 2006 May 1.Musacchio RA and Hunkler RJ. Pharm Exec 2006 May 1. Full text


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What drug reps costWhat drug reps cost

Average annual income for a drug rep is$81,700*

Per rep per annum, pharma spends $150,000 ( primary care)

$330,000 (specialty)

Sales force costs are 5% - 8% ofrevenue**

*Goldberg M and Davenport B. Pharm Exec. 2005 Jan 1;25(1): 70. Full text

**Niles S. Med Ad News. 2005 May;24(5):1-4.


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ExEx--reps speak outreps speak out

During training, I was told, when youre out todinner with a doctor, The physician is eating

with a friend. You are eating with a client.Shahram Ahari*

The essence of pharmaceutical giftingisbribes that arent considered bribes.

Michael Oldani You are absolutely buying love.

James Reidy

*Fugh-Berman A and Ahari S. PLoS Med. 2007 Apr 24;4(4):e150. Full text

Elliott C. Atlantic Monthly. 2006 Apr;297(3):82-93. Full text


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I dont listen to the reps


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I only see reps forthe samples


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Why docs like samples

Start treatment immediately

Test tolerance to a new drug Reduce the total cost of a Rx

Provide free medication to those who

cant afford it


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Why drug companieslike samples

Increases new starts on a new drug

Encourages switches from other drugs

Patients usually stay on the sampleddrug

Increases prescriptions of the mostexpensive, most promoted drugs


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Gain access to physicians

Habituate physicians to prescribing

targeted drugs

Increase goodwill by enabling doctorsto give gifts to patients

Serve as unacknowledged gifts tophysicians and staff

The real purpose of samples


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Samples are a marketing toolSamples are a marketing toolthe manufacturer needs to

figure out the right amount ofsamples the rep has to drop offin order to maximize the number

of paid prescriptions written.

Tsang J and Rudychev I. Medical Marketing & Media. 2006 Feb;41(2):52-8.


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Meetings and eventsMeetings and events

Nearly 30 percent of physicians

who attend association meetingsrefuse to see reps in theirofficea no-see strategy is criticalfor companies to overcomeRehal D. Successful Product Managers Handbook. Pharm Exec. 2007Mar 1;7:8-15. Full text


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Pharma controls CMEPharma controls CME

In 2006, over $2.3 billion dollars was spent on CME

More than half of this came from pharmaceutical

manufacturers Medical Education and Communication Companies

(MECs)

76% of income is from firms that manufacture FDA-regulated products

Medical schools

62% of CME income to medical schools comesfrom pharma (ACCME)

ACCME Annual ReportData 2006, Table 7. 2007 Jul 6. Report


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Advertising in medical journalsAdvertising in medical journals

More than 95% of JAMA ads are for Rx drugs

5 of 6 physician organizations raised at least

10% of annual revenue from ads in affiliatedmedical journals

Pharma companies also purchase sponsoredsubscriptions

And are the largest purchaser of reprints

Fugh-Berman A, Alladin K, Chow J. PLoS Med. 2006;3(6):e130. Full text


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I Never Read the Ads


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No promotion 14%

Detail only 21%

Detail and print [ads] 36%

Detail and sales aid 33%

Detail and print and sales aid 44%

Correct message retention by media mix

Paul CM. Medical Marketing & Media. 2006 Dec;41(12):60-2. Full text


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What about R&D costs?What about R&D costs?

Pharma spends 2-3 times as much on

marketing as it does on research

Edwards J. Brandweek. 2005 Feb 7; ;46(6):24-6.


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Is promotion worth it?Is promotion worth it?

In 2006, the ten best-selling global pharma

brands made $53.5 billion* In 2001, the average return on investment

per dollar spent on promotion was $12.70**

*Robins R. Successful Product Managers Handbook. Pharm Exec 2007Mar 1;7:38-41.

**Niles S. Med Ad News 2004 Mar;23(3):1


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Educational materials, news, resources, filmclips, slideshows, articles, book list

Links to reliable, free drug information

Links to 300 credits of pharma-free CME Soon, our own CME modules on

pharmaceutical promotion

Funded by the Attorney General Consumer and PrescriberEducation grant program, created as part of a 2004settlement between Warner-Lambert, a division of Pfizer,Inc., and the Attorneys General of 50 States and D.C., tosettle allegations that Warner-Lambert conducted an unlawfulmarketing campaign for the drug Neurontin (gabapentin).Contact us athttp://www.pharmedout.org or 202-687-1191.


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Thank you

References

Physician Pharma Relationship Web

Documents

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