Introduction

Reviews

How Drug Marketing Leads to Inappropriate Prescribing

Timothy B. McCall, M.D.

The marketing of drugs promotes unnecessary prescribing. Drug companies spend billions of dollars to influence the prescribing habits of physicians and these efforts are remarkably successful. They want doctors to prescribe new drugs when they've got no advantage over old ones, to prescribe name-brands when there are good generic equivalents, to prescribe drugs when no drug is really necessary.

Many doctors consider themselves immune to the power of drug advertising. They are scientists, not influenced by marketing techniques (or so they believe). Yet again and again, a new drug—often presenting little advantage over previously available drugs and with a whopping price tag—comes on the market accompanied by a advertising blitz and within months becomes one of the top selling drugs.

Pharmaceutical manufacturers are shrewd at their business. Their profit margins are three times those of other companies on the Fortune 500. Drug companies spend the money they do promoting drugs to doctors and increasingly of late, directly to patients, for one reason—it works. You, however, shouldn't take a drug because it has a slick advertising campaign or because the manufacturer gives nice gifts to doctors. When you need a drug at all, you want the best and safest drug for your condition.

Drug companies will do just about anything to influence which drugs a doctor prescribes. They give doctors books and videotapes, free dinners, tickets to Chicago Bulls games, trips to the Caribbean. Some of the gifts are ostensibly educational, others little more than bribes. One drug company, Ayerst Laboratories, offered a “frequent flyer” program that awarded doctors free airline tickets if they started more than 50 patients on the blood pressure medicine Inderal LA (propranolol).

Just remember: Drug promotions are akin to political ads. They hype their product and are one-sided. They point out their product's advantages and minimize any disadvantages. Price is seldom mentioned. Drug company representatives must not lie to doctors but they aren't required to tell the whole truth.

Doctors who rely on drug companies for information do their patients a disservice. My advice is if the drug the doctor prescribes is the same as the one on the posters, pens and note pads in the office, to be concerned that the doctor is overly influenced by the ads.

Consumer demand plays a role in unnecessary drug prescribing, too. In many patients' minds, a prescription shows them the doctor is both competent and concerned. Doctors want to satisfy their patients for altruistic and business reasons. Making a patient happy sometimes means prescribing a drug that has the potential to do more harm than good.

Drug companies are learning how to manipulate consumer demand by aiming promotional efforts directly at patients. Prominent ads in magazines and on TV urge you to “Ask your doctor.” Like the ones directed at doctors, these ads invariably promote new and highly-profitable drugs. The drug companies hope you'll request the drugs from your doctor. Consumer advertising also an indirect method to influence doctors who may not have paid attention to the ads for the same drugs in medical journals.

I am still waiting for the ad that says, “Ask your doctor about generic ibuprofen.” After all it is the brand prescribed by more doctors…

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