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PHARMACEUTICAL MARKETING in PERSPECTIVE Its Value and Role As One of Many Factors Informing Prescribing

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PHARMACEUTICAL MARKETING in PERSPECTIVE Its Value and Role As One of Many Factors Informing Prescribing PHARMACEUTICAL MARKETING IN PERSPECTIVE Its Value and Role as One of Many Factors Informing Prescribing One role of pharmaceutical research companies is to provide information about their medicines to health care professionals. This interaction between pharmaceutical representatives and health care professionals is often referred to as “marketing and promotion.” Without it, health care professionals would be less likely to have the latest, accurate information available regarding pre- scription medicines, which play an increasing role in effective health care. Direct communication between health care professionals and pharmaceutical research companies is a part of the pharmaceutical products supports appropriate care deci- companies’ mission of developing medicines that patients sions and can lead to better health outcomes. use to live longer, healthier, and more productive lives. This communication enables pharmaceutical research Bringing information about new treatments into the health companies to inform health care professionals about the care system often is challenging and requires significant benefits and risks of their products, provide scientific and effort. Even many years after new types of medicines are educational information about their use, and obtain infor- introduced, a large share of patients who should be us- mation and advice about their medicines through consulta- ing them according to clinical practice guidelines go un- tion with medical experts. treated. In fact, these treatment gaps are often viewed as serious public health problems that lead to poor patient This brochure reviews the evidence about: outcomes and high health costs—both human and eco- Q The value of pharmaceutical marketing and promotion; nomic—that could have been avoided. Q How the patterns of prescribing among health care practitio- Pharmaceutical representatives also provide physicians ners relate to pharmaceutical marketing; and and other health care professionals with information about Q The role of pharmaceutical marketing among the full range of new studies and clinical data, new dosing information, influences on physician prescribing. and updates on safety and risk information. Timely access to this information helps support effective patient care, and pharmaceutical representatives disseminate it to health care providers. Value of Pharmaceutical Marketing and Promotion Prescription Marketing Helps Addresses Treatment Gaps. While pharmaceutical marketing often is viewed as lead- The FDA-regulated, scientifically-based information con- ing to overuse of medicines, data across scores of peer- veyed by pharmaceutical company representatives to phy- reviewed studies demonstrates that medicines used to treat sicians helps disseminate knowledge about medicines. many conditions are far more likely to be underused than Providing physicians with up-to-date information about overused.1 Pharmaceutical marketing can play a role in raising awareness of the need for treatment and helping patients get the treatment they need. Gaps in the Treatment of Disease: The Reality The problem of ongoing treatment gaps was discussed in a 2003 New England Journal of Medicine article RAND research on vulnerable elders published in the authored by Claude Lenfant, then the Director of the Annals of Internal Medicine found that when quality National Institutes of Health (NIH) National Heart, Lung of care standards for medication management were and Blood Institute. The article cited underuse of beta failed, 50 percent of the time it was because an indi- blockers, cholesterol screening and treatment, and as- cated medication was not prescribed, while only 3 per- pirin (along with other services) for heart attack and cent were failed because an inappropriate medication coronary artery disease patients to illustrate the “lack was prescribed.5 of success we have had in translating research findings into medical practice and personal behavior,” and con- A 2003 study in the Journal of Managed Care Phar- cluded that as a result of such gaps “we are not reach- macy examined data from three of the 10 largest health ing the full public health benefits of our investment in plans in California and concluded that effective medi- research.”2 cines appear to be underused for three of four condi- tions studied—asthma, congestive heart failure and de- The gap between necessary care and the care patients pression. The researchers concluded that “the results are actually obtain indicates that new medicines cannot be particularly surprising and disturbing when we take into expected to enter into appropriate use based solely on account the fact that [asthma, congestive heart failure, the clinical evidence supporting them. In the absence of and depression] are known to produce high costs to the active dissemination of information about medicines to health care system.”6 both physicians and consumers, the gap would likely be even larger. A 2002 study published in Arthritis & Rheumatism exam- ined whether patients at high risk for additional fractures For example, a study by Harvard economist David Cut- were being evaluated and treated effectively for osteopo- ler and then-Stanford researcher Mark McClellan points rosis. The study found that only 2–10 percent of patients out that through promotional activities, “Manufacturers received treatment.7 of SSRIs [then a new type of antidepressant medicine] encouraged doctors to watch for depression and the re- A 2005 Stanford Medical School study published in duced stigma afforded by the new medications induced Public Library of Science-Medicine found that among patients to seek help.”3 Nonetheless, of the 19 million patients at high risk for heart attack who had high cho- Americans with depression, over half of these individuals lesterol, fewer than half of patient visits resulted in a remain untreated.4 statin being prescribed.8 Similarly, marketing and promotion efforts have helped in the American Journal of Managed Care, “[c]oncurrent raise physician awareness of the most recent clinical public and private efforts aimed at physicians and con- practice guidelines. In the case of high cholesterol, the sumers were related to increased diagnosis and treatment. NIH updated their National Cholesterol Education Pro- Physician-directed initiatives have included pharmaceuti- gram [NCEP] guidelines in May 2001. These guidelines cal industry marketing, continuing medical education pro- called for greater numbers of individuals to be treated for grams, and promotion of NCEP guidelines.”9 According high cholesterol. According to an October 2002 article to a Journal of the American Medical Association article, 2 overcoming barriers to use of treatment guidelines—such Chronic conditions are extremely costly. According to the as lack of awareness and familiarity— “should improve CDC, people with chronic conditions now account for quality of care by decreasing inappropriate variation and 75 percent of total health care spending.12 For example, expediting the application of effective advances to every- Harvard and MIT researchers estimate that if all patients day practice.”10 with high blood pressure were treated optimally with anti- hypertensive medicines, an additional 89,000 premature Pharmaceutical Marketing Helps Raise Awareness deaths and 420,000 hospitalizations would be avoided About Treatments for Chronic Diseases, the Leading annually (Figure 1), saving annually $10.7 billion in total Driver of Health Care Spending. Chronic conditions direct medical costs from fewer strokes and $5.8 billion such as diabetes, depression, hyptertension and asthma from fewer heart attacks.13 are increasingly prevalent. Many patients with these con- ditions are not treated at all or are not treated accord- Pharmaceutical marketing can help narrow these treat- ing to recommended guidelines. Analysis of Center for ment gaps. For example, in 2003, Francine Kaufman, Disease Control an Prevention (CDC) data from 2003- M.D., then-President of the American Diabetes Associa- 2004 shows that approximately 29 million Americans tion (ADA), credited patient advocacy organizations like with hypertension, 9 million with diabetes, and 50 mil- ADA, along with pharmaceutical companies, with helping lion with hyperlipidemia are undiagnosed or diagnosed narrow the gap between the standard of care for diabe- but untreated.11 tes, which had become increasingly complex with the Figure 1 EFFECT I V E USE OF ANT IHYP E RTENSIV E M E D ICINES COULD AV OID AN ADDI T IONAL 89,000 D EAT HS AND 420,000 UNNECESSAR Y HOSP I TALIZAT IONS P E R YEAR 2 Deaths and Hospitalizations Prevented2 1500 Potential Additional Prevention if All Untreated Patients Used Medication 1200 Actual Prevention Based on Patients Treated with Medication 420 900 600 “...achieving effective blood pressure control would be approximately equivalent 833 to eliminating all deaths from accidents, or Number of lives (in thousands) 1 300 from influenca and pneumonia combined,” 89 – David Cutler, Health Affairs 86 0 Premature Deaths (2001) Hospitalizations for Stroke/Heart Attack (2002) Source: 1D. Cutler, et al., “The Value of Antihypertensive Drugs: A Perspective on Medical Innovation, “ Health Affairs, Vol.26, No. 1, 2007: 97-100; 2Centers for Disease Control and Prevention (2006), Health, United States, 2006, with Chartbook on Trends in Health of Americans, National Center for Health Statistics, p 559. 3 introduction of new agents, and actual practice.14 More- system. Debate about pharmaceutical marketing and over, pharmaceutical
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