This is a follow-up to a recent post on why I think direct-to-consumer advertising of prescription drugs is wrong. This post is going to look specifically at marketing by drug companies aimed at health care professionals. Primarily this relationship between Big Pharma and psychiatry involves targeting physicians, since they’re doing the majority of the prescribing.
There are multiple different forms this marketing can take. One example is the drug reps that go around to medical offices. They’ll schmooze with physicians and do things like provide written information about the drug, give samples, and hand out assorted merch like pens and notepads so that their product name is in front of the prescriber’s eyeballs more often. While drug reps receive training on their particular set of drugs, in most cases they don’t have health professional training.
Drug companies will also sponsor educational activities. They may sponsor a hospital’s departmental grand rounds, providing free lunch for an event that would have gone ahead with or without sponsorship. A drug rep would often be there, happy for the opportunity to schmooze.
A pharmaceutical company might also bring in a speaker, typically a psychiatrist, to give a talk about the company’s drug. This might be a local psychiatrist who the audience will already know and presumably trust, or someone who’s brought in from elsewhere and has strong credentials. Typically there is food involved, because who doesn’t love free food, right?
Another strategy is to sponsor continuing education activities that are geared at a broader audience, which may take the form of a free webinar. All health professionals have some form of continuing education requirements they have to meet every year, and the opportunity to get free continuing education hours can be attractive.
There are pros and cons to all of this. Health professionals do need to learn about new drugs that are on the market. Just because talk is being sponsored by a drug company does not necessarily mean that the speaker will be heavily biased. Sometimes the featured speakers at drug company-sponsored events are widely recognized as experts in their field.
Sometimes health care organizations will put restrictions on sponsored activities occurring onsite. I remember earlier in my career going to grand rounds at the hospital I worked at and munching on drug-company-funded lunch. A few years later the healthy authority I worked at put the kibosh on sponsored events at any of the health authority’s sites. I’ve been to a couple drug company-sponsored dinners, one with a speaker they’d brought in from elsewhere, and one with a local psychiatrist I really respected. I fairly regularly do continuing education webinars that are free because of drug company sponsorship. I like to think that I’m enough of an informed consumer of information to be able to evaluate what’s being given to me, and recognize that, sponsored or not, one particular talk is never going to give me the whole picture on the topic.
This is pure speculation, but I wonder if the most potential iffy part of what I’ve talked about so far is drug reps going into family doctors’ offices. Psychiatrists are only really keeping up to date about new psychiatry meds, and the same is true with other specialties. General practitioners often have little free time, and they have to learn about a much wider range of new drugs. Chances are, they’re going to be relying a little more on what they’re getting from drug reps. Still, a health professional should have the background information to put new info from drug reps into a proper context, something that’s just not possible when it comes to direct-to-consumer advertising.
All of this is small potatoes compared to the potential for corruption at higher levels. Drug companies’ primary objective is to generate profit for their shareholders. Yes, it would be nice if they were concerned about the wellbeing of the people taking their drugs, but that’s not the reality of capitalism. It may not be very nice, but it is what it is, and there’s no point pretending otherwise. The problem really comes if the drug companies are getting in bed with regulators or with major medical organizations. In an ideal world, the drug companies would be at not just arm’s length from regulators like the U.S. Food and Drug Administration (FDA), but more like football field length. Of course, we don’t live in an ideal world, and that kind of thing can be difficult to enforce. What if John Smith worked at the FDA for years, and decides he’s ready to make some big bucks and takes a position at a drug company. It’s pretty tough to regulate away that influence John Smith is still going to have with all his old buddies at the FDA. It’s the old boys’ club at its finest.
Concerns have been raised about the relationship between Big Pharma and psychiatry, and in particular with drug companies having undue influence with the American Psychiatric Association’s committee responsible for developing the most recent edition of the Diagnostic and Statistical Manual (DSM-5). The fact that the people on the committee have received either research funding or speaking fees from drug company doesn’t inherently mean they’re biased. Often, prominent figures within a specialty field are particularly sought after by drug companies for that kind of thing; it doesn’t mean they’re necessarily drug company flunkies. Yet the old boys’ club appearance is still there.
I think sometimes arguments in that area go a bit too far and throw the baby out with the bathwater, so to speak. Sometimes GlaxoSmithKline, the makes of Paxil, are accused of inventing social anxiety disorder as a way to sell more Paxil. Whatever role they did or did not play in the inclusion of social anxiety disorder in the DSM, there are many sufferers who would attest that social anxiety disorder is all too real and all too debilitating.
Of all of these areas, the relationships between drug companies and regulators like the FDA are most likely to cause damage, and that damage can occur on a very broad scale. If alarming research results are being hushed up because the drug companies are too cozy with the FDA and Big Pharma and psychiatry are getting buddy buddy, that’s dangerous. What is the answer, though? I wish I knew.
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