The Power to Prescribe and the Power to Influence Prescribing

Sell when you can, you are not for all markets.

Shakespeare (1564-1616). As You Like It

September 8, 2011 - Perhaps the greatest power of being a physician is the power to prescribe. The Supreme Court diluted this power in 1997 when it ruled drug companies could directly advertise to consumers. Now, with the ubiquity of pharmaceutical marketing, physicians must cope with patient demands for drugs they saw on television.

You can scarcely spend an hour before the television tube without seeing a series of ads for drugs.`

Today while watching TV to assess the aftermath of the Republican debate at the Reagan Library. I saw ads for Pradaxa (atrial fibrillation), Lyrica (fibromyalia), Viagra and Cialis (erectile dysfunction), Embrel (rheumatoid arthritis), Bayer aspirin (coronary prevention), Boniva (osteoarthritis), Plavix (prevention of coronary thrombosis, and Freestyle and other diabetic supplies.

I do not object to these ads, but I as I witnessed them, I grew a little weary of the time they consumed away from the news. I’m aware television programming must be paid for, and drug advertising and promotions is one of the greatest sources of television advertising.

I know too that most drug companies are for-profit enterprises and require marketing to survive and to please investors.

Basically pharmaceutical companies have two audiences to whom to market_- physicians and consumers. To reach these markets they use the follow methods, which in 2005, were said to be 56% free samples, 25% detailing to physicians, 12.5% direct-to-consumers marketing, 4% hospital detailing, and 2% hospital detailing.

The United States and New Zealand, I am told, are the only two companies that allow direct-to-consumer marketing. This has its good aspects - informed consumers – and its bad – misinformed consumers and pressures on doctors to prescribe drugs that may not be needed, and the medicalization of the American public.

I cannot help but notice two things about direct-to-consumer advertising – one, the exclusive marketing of expensive brand name drugs to the exclusion of cheaper generic drugs, and two, the creation of diseases or syndromes that require drugs to treat. An example of the latter is Lyrica for fibromyalia, a “disease” that may or may not exist. I have doubts about the prevalence of erectile dysfunction, which from the volume and nature of its advertising, you would think runs amuck among handsome middle-aged males and their beautiful wives. As a doctor, I wonder how I would handle a male with a four hour erection.

Tweet: U.S. and New Zealand allow direct drug advertising to consumers. Drug firms may create diseases and overstate conditions to sell drugs.