By Patricia Barry
March 2002

	Chart: Average Retail Prescription Prices Have Doubled in the Last 10 Years Chart: How the Pharmaceutical Industry Promotes Prescription Drugs Take the Poll: Drug Advertising Take the Poll: Out-of-Pocket Drug Expenses Join the Discussion: Medicare Reform

The Kaiser results show that consumer advertising "helps inform patients about their medical care while leaving the physician in control of treatment decisions," Christopher Molineaux, head of public affairs at PhRMA, responded. He added: "The bottom line is that direct-to-consumer advertising is good for patients and good for the public health."

Another study, by the National Institute for Health Care Management (NIHCM), a nonprofit research group, suggests that ads do lead to more use of the costliest medicines.

Sales increases of the 50 most advertised drugs made up almost half of the $21 billion growth in retail spending on prescription drugs from 1999 to 2000, NIHCM found. The 9,850 other drugs on the market accounted for the rest of the 12-month rise. Prescriptions for these 50 drugs rose by 25 percent in the same period, compared with a 4.3 percent increase for all other drugs combined.

	How much money do you spend out-of-pocket each month on prescription drugs? A.$0 B.$1 - $50 C.$51 - $100 D.$101 - $250 E.$251 - $500 F.More than $500

The seven most heavily advertised drugs in 2000 included six that are among the drugs most prescribed to older Americans for chronic conditions: Vioxx and Celebrex (both for arthritis), Prilosec (ulcers), Claritin (allergies), Paxil (depression) and Zocor (cholesterol).

Aggressive promotion can pay off big time. Merck, maker of Vioxx, the most promoted drug, spent $161 million advertising it in 2000, and sales of Vioxx quadrupled to $1.5 billion.

In fact, Merck spent more advertising Vioxx, according to NIHCM, than the $125 million spent promoting Pepsi or the $146 million spent on Budweiser beer ads. It even came close to the $169 million spent promoting GM's Saturn, the nation's most advertised car.

The drug industry says its ads not only educate consumers but also prompt people who might otherwise go undiagnosed to see their doctors. Many doctors agree. [For these reasons, AARP publications accept such ads.]

Some economists, though, see the ads as a big driver of consumer demand, known as "utilization." "Drug prices are rising at more than twice the rate of inflation, and utilization is going up even faster," says Steven Schondelmeyer, head of the University of Minnesota's PRIME Institute, which tracks prescription drug trends. "And advertising is a major part of that growth in utilization."

	Can Drug Ads Lead to Unnecessary Spending? Robert Goodman, M.D., assistant professor of clinical medicine at Columbia University in New York, gives a doctor's view of two competing anti-arthritis drugs: Pharmacia Corp.'s Celebrex, the first drug to make $1 billion in 12 months on the market, and Merck's Vioxx, with sales of $1.5 billion in 2000. More Info>>

COURTING DOCTORS
Consumer advertising made up the smaller part, 16 percent, of the industry's entire $16 billion promotional bill in 2000. The rest included the $8 billion worth of drugs that companies give doctors as free samples and the $4.8 billion spent on "detailing"—that is, sending representatives to doctors' offices, hospitals, medical schools and conferences to talk up the drugs they're selling.

The industry employed more than 87,000 marketing reps in 2000, a jump of 59 percent from 1995, according to Boston University researchers.

Again, the industry argues that this kind of promotion provides a valuable educational service, this time to doctors. And indeed drug companies now sponsor so many conferences, meetings and seminars that it is hard to see where alternative funding might come from if this rich industry didn't foot the bills.

But the companies' generosity in this direction has generated bad publicity in the past year or so, as details have emerged in the press of the way reps woo doctors with free lunches, dinners, tickets to ballgames, skiing trips and fees for giving talks that promote specific drugs.

Within the medical profession, too, there is a growing backlash against such blandishments. Some doctors refuse to meet drug reps personally, and some medical teaching hospitals have banned free samples.

Three years ago Robert Goodman, M.D., an assistant professor of clinical medicine at Columbia University in New York, felt so strongly that doctors "should not allow themselves to be bought by the pharmaceutical industry," that he created a website called http://www.nofreelunch.org/. That has grown, he says, into a group of 200 like-minded medical professionals.

Goodman says he opposes all free gifts, samples and sponsorships by drugmakers. "But I fault the profession more than the industry," he says. "The industry is supposed to be making profits and increasing the value of stocks for their shareholders. Doctors have sworn to be committed to their patients. I'd like to change this whole culture of accepting gifts, which has really gone out of control."

Detailed documentation of questionable behavior is cited in a new report on physician-industry relations published this month by the American College of Physicians (ACP).

"Physicians frequently do not recognize that their decisions have been affected by commercial gifts and services and in fact deny industry's influence even when such enticements as all-expenses-paid trips to luxury resorts are provided," writes the report's author, Susan L. Coyle of the ACP's Ethics and Human Rights Committee. "Research, however, shows a strong correlation between receiving industry benefits and favoring their products."

Coyle is equally forthright about drug samples. "The sample mainly serves to encourage physicians to prescribe the new product," she writes. "Because few samples are for older or less expensive products, higher patient costs generally result."

Subsequent articles in this series will focus on drugmakers' efforts to keep cheaper generic drugs off the market longer and on lobbying and lawsuits.