Pa Advertising and Marketing Executive Assistance by hhs14854

VIEWS: 17 PAGES: 30

More Info
									         BINGO!
 Fun with drug advertising
and other teaching tools for evaluating
      pharmaceutical marketing

             Steven R. Brown, MD
Banner Good Samaritan Family Medicine Residency
                 Phoenix, AZ

     Society of Teachers of Family Medicine
                Spring Conference
                   May 2, 2008
 “If we put horse manure in a
capsule, we could sell it to 95%
       of these doctors.”

 -Harry Loynd, former president of Parke Davis
                                      Advertising
•       34% of the pages of JAMA and 44% of the pages of
        American Family Physician are advertisements.1
•       In 2004 the pharmaceutical industry spent $500 million
        on journal drug ads.
•       Journal drug ads increase sales and yield a return on
        investment for industry of $5 for every $1 spent.2
•       Printed ads and detailing from drug representatives
        are used synergistically in promoting new medicines.2



1   Lohiya S. Pharmaceutical advertisements in medical journals received in a medical clinic. JNMA
    2005;97(5):718.
2   Fugh-Berman A, Alladin K, Chow J. Advertising in medical journals: should current practice change? PLoS
    Medicine 2006;3(6):e130.
Promotional spending on prescription drugs, 2004
                         Journal Ads 2%
                         $500 million


         Detailing 26%
         $7.3 billion



                                                   Samples 57%
                                                   $15.9 billion



              DTC ads 14%
              $4 billion

 Source: IMS Health                 Total spending: $27.7 billion
            Interactions with industry
• 94% of physicians have some relationship with
  industry.1
• Family physicians meet with industry
  representatives an average of 16 times per
  month.
• 98% of residents and 97% of third-year medical
  students have eaten a meal sponsored by
  industry in the past year.2,3

1   Campbell EG, et al. A national survey of physician-industry relationships. NEJM 2007;356(17):1742.
2   Sierles FS, Brodkey AC, Cleary LM, et al. Medical students’ exposure to and attitudes about drug company interactions.
    JAMA 2005;294:1034-1042.
3   Sigworth SK, Cohen GM. Pharmaceutical branding of resident physicians. JAMA 2001;286(9):1024.
             Interactions with industry
• Information from drug reps is often false,1
  and recognized by most to be biased.
• Leads to non-rational prescribing.2



1   Ziegler MG, et al. The accuracy of drug information from pharmaceutical sales representatives. JAMA
    1995;273(16).
2   Wazana A. Physicians and the pharmaceutical industry: Is a gift ever just a gift? JAMA 2000:283:373.
  “Effective promotion, heavy
promotion, sustained promotion
   has carried the day. The
physicians have been sold. So
       has the country.”

     -Economist Seymour Harris, 1963
BINGO!
 (15 ads from the workshop were shown
 here and discussed but not uploaded to
 FMDRL. Educators are advised to find
and use their own recent advertisements.)
   “The best defense the physician can muster against
  (misleading) advertising is a healthy skepticism and a
 willingness…to do his homework. He must cultivate a
 flair for spotting the logical loophole, the invalid clinical
    trial, the unreliable or meaningless testimonial, the
unneeded improvement, and the unlikely claim. Above
all, he must develop greater resistance to the lure of the
                  fashionable and the new.”

    -Pierre Garai, pharmaceutical advertising executive, 1964
Rational vs. Non-rational reasons
    to prescribe a medication
Shaughnessy AF, Slawson DC, Bennett JM. Separating the wheat from the chaff:
Identifying fallacies in pharmaceutical promotion. JGIM 1994;9:543.
                      (cover of article shown during presentation)
“Advertising not only provides information but attempts
  to persuade us by appealing to our emotions, to the
vulnerable spots in our egos, and by applying pressure
          to the tender area of our psyches.”
Non-rational appeals – “fallacy
           of logic”
          Non-rational prescribing
            from the Drug Ads
•   Non-scientific graphs      •   Chart Junk
•   New disease or diagnosis   •   Appeal to authority
•   Relative risk reduction    •   Appeal to celebrity
•   Disease-oriented           •   DTC ad reference
    evidence                   •   Non-medical catchy
•   Statements supported by        slogan
    “data on file.”            •   Cutesy character
•   Bandwagon                  •   Appeal to fear
•   Brand name larger than     •   “New”,“first and only”,
    generic name                   “first”
•   Disease “education”        •   Red herring
           Non-rational prescribing
         from a pharmaceutical rep
•   Non-scientific graphs      •   Chart Junk
•   New disease or diagnosis   •   Appeal to authority
•   Relative risk reduction    •   Appeal to celebrity
•   Disease-oriented           •   DTC ad reference
    evidence                   •   Non-medical catchy
•   Statements supported by        slogan
    “data on file.”            •   Cutesy character
•   Bandwagon                  •   Appeal to fear
•   Brand name larger than     •   “New”,“first and only”,
    generic name                   “first”
•   Disease “education”        •   Red Herring
Anderson GM, Juurlink D, Detsky AS. Newly approved does not always
mean new and improved. JAMA 2008;299:1598
               (Cover of article shown during presentation)
        Non-rational prescribing
      from a pharmaceutical rep
•   Gifts, food, relationship building
•   Testimonial
•   Appeal to pity (“pity melts the mind”)
•   Ego gratification
•   Ad hominem attacks on competitor
•   Appeal to curiosity
Rational prescribing
          Rational reasons to prescribe a drug:
                        (“STEPS”)
•          Safety
•          Tolerability
•          Effectiveness
•          Price
•          Simplicity


    Preskorn SH. Advances in antidepressant therapy: the pharmacologic basis. San Antonio: Dannemiller
    Memorial Educational Foundation, 1994.
   Other resources and ideas
• Allen Shaughnessey and David Slawson’s
  2006 STFM presentation “Evaluating
  information from pharmaceutical
  representatives,” on FMDRL
• “Pharmaceutical Representative Feedback
  Form”
  – Google “Virginia information mastery”
• The “STEPS” conference for new
  medicines
Evaluation
               Discussion
• “Pharmaceutical representatives should be
  allowed to interact with physicians and
  trainees in our patient-centered medical
  homes.”
  – Pro vs. Con
  – The discussion may be as important as the
    outcome
  Pharmaceutical representatives should be allowed to interact with
   physicians and trainees in our patient-centered medical homes
        (list compiled from the “wisdom of the group” at STFM Baltimore 2008)


• Pro (yes reps)                                         • Con (no reps)
   –   Helps prepare learners to interact with reps in      –   Not in the best interest of our patients.
       future practice.                                     –   Not a good use of time in busy schedule of
   –   Money for education (e.g. food)                          practice or education.
   –   Samples.                                             –   Increases cost to patients.
   –   Food for staff.                                      –   Leads to inappropriate prescribing.
   –   Point of contact for further funding (e.g.           –   “Information” from reps is biased and often
       grants).                                                 wrong. Just the party line from industry.
   –   Social/collegial interaction (especially in          –   Professionalism, conflict of interest.
       isolated/solo practice settings).                    –   We lead by example. This “hidden
   –   Focus for discussion about new medicines.                curriculum” is more powerful than what we tell
   –   Prepare for patient requests from DTC                    learners.
       advertising.                                         –   Samples aren’t really beneficial to patients.
   –   Educational items (e.g. Inhalers, body               –   You can’t really teach how to avoid conflict of
       models, charts) to help patient care.                    interest/influence. Industry knows it can
   –   Guidance with patient assistance programs.               influence doctors despite training.
                                                            –   Learners are too “green” to know they are
                                                                being influenced inappropriately.
                                                            –   Gifts start “branding” process for learners and
                                                                creates a sense of entitlement.
      Pharma-Free Family Medicine Residencies

Questions
Q#1: Does the residency allow gifts from industry or industry supported
  food?
Q#2: Are drug samples accepted?
Q#3: Are industry representatives allowed access to medical students
  and/or residents at the primary educational site?
Q#4: Are any industry-sponsored residency activities allowed?


        A “Pharma-Free” residency answers “no” to all 4 questions.
     Pharma-Free Family Medicine Residencies

Great Plains FMR                                     Oklahoma City, OK
Trident/MUSC FMR                                     Charleston, SC
Smiley's FMR                                         Minneapolis, MN
Tuft's University FMR at Cambridge Health Alliance   Malden, MA
UCSF- San Francisco General Hospital FMR             San Francisco, CA
Mercy FMR                                            Toledo, OH
Valley FMR                                           Renton, WA
Maine-Dartmouth FMR                                  Augusta, ME
San Jose-O'Connor Hospital FMR                       San Jose, CA
UPMC Shadyside FMR                                   Pittsburgh, PA
Banner Good Samaritan FMR                            Phoenix, AZ
Pharma-Free Family Medicine Residencies
Discussion/questions

								
To top