How Big Pharma spends $20 billion a year on marketing their drugs to you

Pharmaceutical companies spend about twice as much on marketing their drugs every year as they do on research and development of new medications.  And it’s a pretty impressive marketing budget. The Wall Street Journal recently reported how marketing numbers broke down last year. The figures don’t include the value of free drug samples that companies distribute – the largest single marketing expense.

The other major categories include:

  • $12 billion for “detailing,” the industry term for sending sales reps to talk to doctors, nurses and other providers. Spending on detailing was highest for statins (such as Pfizer’s Lipitor), antidepressants (like Forest’s Lexapro) and antipsychotics (like Bristol-Myers Squibb’s Abilify). In each of those categories, branded drugs are competing against generics for a big market.
  • $4.7 billion for Direct-To-Consumer (“Ask your doctor”) advertising, and an additional $400 million on advertising in professional journals. TV ads accounted for almost 62% of drug company ad spending, print ads made up 35% and online ads 4%.
  • $3.4 billion for sponsoring professional meetings and events. This includes sponsoring courses and talks that doctors can attend (or watch online) in order to satisfy requirements for continuing medical education (known as CME). Industry-funding of CME has been getting some negative attention lately, with some physicians and academics calling for public disclosure of who pays for what.

And speaking of doctors, New Hampshire physician Dr. Kevin Pho writes in his always-enlightening blog KevinMD, about a type of pharmaceutical sales rep whose actions remain completely unregulated.

“These reps have unfettered access to the top academics of all fields of medicine, are invited by medical societies to give keynote addresses, routinely publish articles in the best journals, and offer advice about medications that is accepted as gospel by doctors everywhere. These reps have medical degrees, and some have become millionaires by taking fat payments from drug companies. The are “the hired guns of medicine”.

A revealing study presented at the American College of Preventive Medicine annual meeting by Dr. Mohammed Hassan Murad of Mayo Clinic reviewed 202 published medical journal articles that addressed the known association between heart attack risk and the GlaxoSmithKline diabetes drug, Avandia.  Among journal article authors who concluded Avandia does NOT increase the risk, 86% had financial relationships with GlaxoSmithKline. Among authors of articles offering unfavorable reviews, only 18% had relationships with GSK.

Read the entire Wall Street Journal article on drug marketing numbers.

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Warning: clinical trials funded by drug companies may appear more truthful than they actually are

gabapentinWell, here’s a shocker: apparently, there appears to be a difference between internal drug company documents about the research trials that they fund, and the articles reporting that research that end up in medical journals. The New England Journal of Medicine calls this ‘selective outcome reporting’, but for the sake of clarity, let’s just call it ‘lying’.

At first blush, the process of getting drug research results published seems straightforward enough. Since 2005, the International Committee of Medical Journal Editors has even required all research investigators to register their clinical trials prior to participant enrollment as a pre-condition for publishing the trial’s findings in member journals.

So in a nutshell, researchers set out to run clinical trials, as they are legally required to do, on a particular drug. They have some specific purpose in mind before undertaking this research.  Will this drug ease pain? Reduce inflammation? Lower blood pressure? Treat cancer? That’s the primary outcome of the clinical trial they have in mind, which must be registered before they even begin recruiting people to participate in this study if they want to later submit their findings to a medical journal. Which of course they do.

In a study published today in the NEJM, researchers examined practices for clinical trials of a drug called gabapentin, better known by its brand name Neurontin, an epilepsy drug which was approved in late 1993 for use as an adjunctive medication to control partial seizures (meaning that it’s considered effective when added to other anti-seizure drugs). The research trials for this drug were all funded by Pfizer and Warner-Lambert’s sudsidiary drug company, Parke-Davis.

Researchers looked at 20 clinical trials of gabapentin for which there were internal Pfizer or Parke-Davis documents, 12 of which were ultimately published in medical journals. For eight of these 12 reported trials, the primary outcome defined in the ultimately published journal article differed from that described in the internal documentation protocol. Quelle surprise…  Continue reading