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e.Forum Posit
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e.Forum Posit

Should there be curbs on two common practices by firms promoting medical drugs and devices?

Two of the current Sierra Sacramento Valley Medicine online posits are closely related. One focuses on public marketing of drugs and medical procedures, and the other on direct physician marketing of drugs.

The posits make these points:

1. Prescription drugs are now advertised directly to the public like beer or cosmetics.

2. According to the FDA, the pharmaceutical industry invests three times as much on marketing as on research and development, $16 billion yearly, or $19,000 per physician per year.

3. The U.S. Government Accountability Office notes that prices for the most prescribed drugs have increased more than 20 percent over the past three years.

4. Therefore it is alleged that direct marketing to the public, and physician "detailing," are misleading and drive up costs significantly.

POSIT 1. Direct public marketing of medical procedures, technology and pharmaceuticals should be prohibited.

POSIT 2. Direct physician marketing ("detailing") of drugs and technology is unethical and should be prohibited.

There were more than 40 written comments from members. A majority of opinions and commentary disagreed with posit 2.

Commercial advertising should not be prohibited because patients have a right to know......and after all, isn't it "free speech" for the pharmaceutical industry to advertise....however, certain practices should be curtailed such as "ask your doctor for a free sample pack...serious consequences though rare should be disclosed CLEARLY and UP FRONT...the consumer ... realizes ( who) pays the bill for the advertising.
—Akshay J. Manek, MD

...advertising is not education, (it) is designed to "move product" ... I think that detailing should be replaced with good quality CME. If detailing is simply abolished without any other changes... I worry that busy physicians would not find the time to keep up with pharmaceutical developments. "Detailing" ... is simply the most expensive kind of advertising, it is designed to "move product" and is very effective ...
— Alfredo Czerwinski, MD

( While i agree with posit one), some ethical "detailpersons" have been helpful in answering questions when the answers are not in the insert, the PDR or are not easily accessible in our medical journals... When requested, ( detailers) have never failed to get me a response from the manufacture. Samples ...have been a definite help.
— Allan H Galbreath, MD

**(re detailing ) I recommend detailing with the request/approval of the physician... this often is the only way that we get the information we need on new medications/products.
—Barbara Livermore, MD

Direct public marketing does help to educate the public (so that) patients are often more receptive to treatment options... If the marketing is misleading... we must educate the public and our patients on what is safe and cost-effective ...Physician ( detailing) of safe and cost-effective treatments ...can elevate the overall health of the community. Marketing of unproven treatments such as colonic enemas is unethical. —Craighton Chin, MD

Marketing is one more form of information, slanted as it might be... It is still the role of the doctor to educate and guide out patients.... more (legislation leads to) restrictions on the things we would like to promote. —Jose A. Arevalo, MD

**(Re detailing of physicians ) I doubt that ethics have anything to do with this but it is expensive and creates extra work for physicians who need to educate patients who don't understand the action of the medications. — Byron Demorest, MD

... Direct public marketing was wrong from the day it started. The "ask your doctor" bit is misleading and nauseous. I never let patients leverage me into prescriptions they had seen on T.V. but referred them to the company phone number in the ad. It is blatantly misleading to advertise a drug showing happy healthy models accentuating the positives and downplaying the negatives... ( re detailing) ... I appreciate knowing what's new... I am trained and ethically bound to evaluate new therapies before prescribing them... Preventing drug reps from visiting the office and curtailing use of samples are deleterious to good practice.
—Cleve Baker, MD

...medications should be advertised. (it often IS misleading and should be heavily regulated by the FCC and FDA. (Re detailing ) ... Every detailing takes away from patient time and ( is) money out of my pocket. —Carlos Solis, MD

**(Direct patient marketing ) certainly should be constrained ... I have equal or more concern about so-called nutritional supplements and other OTC biologics ... I have not been detailed in 20+ years and instead rely on Medical Letter and like sources and that seems fine to me. —T. Warner Hudson,III, MD

I believe that direct marketing is unethical and should be outlawed! ... pharmaceutical companies should be able to communicate with physicians directly through the mail and the internet to market their products. That marketing should consist of the package insert for the drug, a flier indicating the approved uses of the drug and its major side effects, and any peer-reviewed articles on the drug that they wish to include... —Robert Griffin, MD

Direct marketing of pharmaceuticals certainly causes many problems and increases the cost of pharmaceutical products. However, the practice also has some benefits in increasing consumer awareness of important but underappreciated health problems, and empowering consumers to demand things that they would otherwise feel too ignorant or intimidated to request. (It) needs careful regulation, but (not) prohibition. — Patrick Romano, MD

...I do not consider current drug ads as an appropriate way to accomplish patient education.

...studies that suggest physician detailing ... influences prescribing in ways that move away from rather than towards more effective treatment. I have been fortunate to have spent most of my career in setting in which I can easily avoid pharmaceutical representatives but now am in a setting in which I can dispense samples ...much needed by some ...patients. However, ...I still minimize my contact with the drug reps and limit it to signing for the samples and asking that any articles be put in my mailbox. — Marlene M. Mirassou, MD

** I find direct marketing by pharmaceutical firms to patients to be obnoxious and objectionable, however the idea that government might find it appropriate to restrict their right to do it is even more objectionable. — Ken Meyer,MD

**The public needs to be educated but not from the folks who stand to make a profit from selling their product. If detailing is not available, some physicians may get no information at all. There needs to be a better way for information on new drugs and technology to be made widely available besides from proprietary interests. — Joanne Berkowitz, MD

Firms should be free to advertise and market their products. At the same time consumers should be free to exercise their judgment and buy from any source they wish whether American, Canadian, or British... Much greater pressure should be applied to advertisers for accuracy and candor in their presentations. There is nothing wrong with representatives of drug manufacturers providing information regarding their products. The ethics come into question when virtual bribes (trips, gifts,tickets, etc) are used to attempt to influence doctors to use the products. —Gerald Swafford, MD

It is important to keep physicians informed of new and old drugs... hopefully we (can) sort ... marketing (from) fact. However, we cannot expect the general public to know as much, so all this advertising just confuses people ... drives how they receive their care.
— Un Har, MD

**... the risks of violating free speech are greater than the risks of patients being harmed by that right. (Re detailing,) this hinges on what you mean by "direct" . it is ethical for companies to advertise. it is unethical for physicians to accept bribes. —William.Fenton, MD

**I would like to see organized medicine provide the media with public service announcements which state that medications advertised in this manner are potentially hazardous to one's health and that it is their physician's role in consultation with the patient to prescribe the medications that best address a person's illness or condition.
— Robert Bonar, MD

...I doubt that efforts to prohibit direct marketing to the public will succeed. Society is inundated by media hype through television, the press, and the internet.

(Re detailing,) It is imperative physicians ... be kept informed in order to educate patients... I believe that the vast majority of physicians will evaluate the efficacy of drugs and technology and dispel the myths associated with the hype. — Ralph Sett, MD

**I've heard arguments that restricting ...ability to... (advertise directly to the public) interferes with freedom of speech. MALARKY! If that is true, then the tobacco companies should have no restrictions on THEIR ads either. — Pat Hardy, MD

**Although doctors think they are immune to the ploys of the pharmaceutical industry, they aren't. if advertising to physicians didn't work to their favor, the pharmaceutical industry would stop the flow of dollars ... gifts, dinners, etc. — Craig Yamata, MD

As much as I deplore the deceptive marketing practices of the pharma manufacturers, I do not favor limiting free speech. We need to open the entire system to the consumer and put our faith in their ability to separate fact from fiction. — David Gibson, MD

... Educating the public to just ask about a product improves the(ir) knowledge of our patients, keeps us on our toes ... High costs of drugs have everything to do with onerous regulations, litigation and the increasing entitlement nature of healthcare delivery (progression to socialized medicine).

Direct physician marketing... is reasonable and very helpful... By the way, nice way the socialist propagandist in your editorial staff worded the questions. — Donald Hause, MD

Pharmaceutical representatives (provide) information regarding the treatment of certain medical conditions... At the same time, the representatives do spend a lot of time repeatedly selling their products. This practice, I think, is overuse of their resources and should be curtailed in order to reduce cost. —E. Mansour, MD

**The only benefit of detail people is the free samples that they provide. There is absolutely no objectivity in their pimping. — Gene Speicher, MD

**Generally, the public does not know enough to make a knowledgeable decision. An analogy would be the auto parts companies advertising parts for an eight cylinder car, when most people are driving four- and six. — George Chiu, MD

Physicians have the training and knowledge base to critically analyze the marketing claims--the public at large does not. Drug rep's provide the best case for the use of their medication... it is up to ...the doctor to (...form) a... balanced opinion. — John Gisla, MD

The vagaries of medicinal effects and side effects are little understood by the public and medical personnel; therefore, exposing many trade names to the lay public is misleading ...For practicing physicians new medicines need to be investigated and evaluated. Allowing MDs to gain an education and ask questions about side effects as well as contra-indications makes sense to me. — Forrest Junod, MD

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