Why Drug Marketing Rules American Healthcare and What We Can Do About it
have you ever been in a situation that
seems perfect
and then weeks months or years later you
discover it’s not as perfect as it seems
you find yourself fascinating between
putting on rose-colored glasses
and facing up to the facts and walking
away
i call this state of ambivalence sitting
on a fence
and let me tell you if you sit on a
fence
long enough it gets uncomfortable
my fence was my career i want to share
with you
my personal odyssey of enlightenment
as a pharmacist and former
pharmaceutical ad writer
from being a wizard of white lies to
being an
ardent advocate for honesty in
pharmaceutical
marketing and if there’s one lesson
i want to leave you with it’s this
just because something sounds like
science
doesn’t make it so
when i went to massachusetts college of
pharmacy
i worked part-time for the president ray
goslin was a pioneer
in pharmaceutical marketing he suggested
that i pursue a career in medical
advertising
because he thought it would leverage
both my creative writing skills
and my scientific training
pharmaceutical ad writers like me and
others take the science generated by
drug companies
and we weave it into powerful stories
that make people
clamor for the newest and latest drugs
medical devices and treatments
we do not work at pharmaceutical
companies
we work at advertising agencies medical
education companies
and pr firms retained by the
pharmaceutical industry
to help promote their brands
i learned about the meaning of science
to drug companies
my first week on the job i was a writer
at an ad agency in new york we were
meeting with a client who had a new drug
for hypertension we spent
the next two hours debating how to
describe
the drugs mechanism of action should we
describe it as being
potassium conserving or sodium depleting
would it seem more impressive if we
spelled out the word potassium
or used the symbol k plus from the
periodic table
i was so bored however
i internalized the first lesson of
medical marketing
wrap everything in science in order to
sell drugs
the science drug companies use is not
fake it’s real
however it is misleading because it is
incomplete drug companies
cherry-pick scientific facts
which then are spun in a positive
direction
as they flow through an information
pipeline
the dissemination of this science may
seem spontaneous
however it is anything but
it is planned organized and coordinated
by an army of science and marketing
communicators
all to the tune of 30 billion
dollars a year i believe drug companies
have the right to market their products
i believe drug companies have the right
to earn profits
however drug companies in america do
much
more than market their medicines they
actually
shape health care americans are less
than five percent of the world
population
yet we consume one third of the world’s
1.4 trillion dollar
marketplace in prescription medicines
but more disturbing than these costs
is the suffering that our culture of
over prescribing causes
we put kids as young as five on
antipsychotic medications
we inflict cholesterol-reducing agents
on people who don’t need them
and we over prescribe diabetes
medications
to older americans who then wind up in
the hospital
due to drug induced falls and fractures
at the end of the day a pharmaceutical
company’s objective
is to maximize their profits as an
executive
at a pharmaceutical company told me
drug companies say they want their drugs
used appropriately
however drug companies just want their
drugs used
will they ever admit that publicly hell
no
let me show you how easy it is to skew
science to sell
drugs there are three primary marketing
strategies that drug companies use
first you can exaggerate the drug’s
benefits
second you can expand the number of
patients
needing treatment and third you can
minimize
the drugs risks these strategies can be
hard to detect
because they’re based on lies of a
mission
not outright lies
the marketing of benefits actually
begins at the clinical
trial phase the drug company that is
designing the study
is the same company that at a future
date
hopes to profit off the sale of that
drug
the bar for fda approvals is actually
quite low the drug company only needs to
show
that their drug is more effective than
placebo
there are times where a company compares
their new
drug to an existing treatment called the
standard of care
these generally use a non-inferiority
trial design a non-inferiority
trial design is a tongue twister
even to a seasoned writer like me
what it means is that the new drug
only needs to be not worse
not inferior than the standard of care
let me repeat that what it means
is that the new drug needs to be
no worse not inferior
to the standard of care i had a client
who was trying to get approval
for a drug for advanced pancreatic
cancer
the initial trial results were on
promising
the drug only extended life by 30 days
the client however appeared unfazed he
believed
that we could get doctors to prescribe
the drug
despite its lack of efficacy i remember
looking at him
thinking how cold and calculated he
sounded
i did not however say anything because i
was there
to do a job not to deliver a lecture on
empathy i created an ad campaign
that depicted patients desperately
trying to hang on for 30 days more
so they could attend their daughter’s
wedding or their son’s
law school graduation the client was
overjoyed with the campaign which
featured the headline
i want to live cancer drug marketing
is an example of how advertising
plays on our hopes and fears and shapes
our core attitudes about sickness
and health imagine if drug companies
promoted
cancer prevention instead of cancer
treatment
sometimes i ask my colleagues if they
thought we were
using science to full doctors
i was met with blank stares and looks of
total miscomprehension
i realized that my colleagues felt that
i was insulting
their integrity so i remained on my
fence
not wanting to make waves
let me explain another marketing
strategy
that helps expand the number of
treatable patients
i like to call this strategy supersizing
today 45 percent of americans take drugs
for cholesterol
we spend so much money on diabetes care
that congress formed a commission to
investigate
why when you have 25 drugs
to reduce high blood sugar or 10 drugs
to reduce cholesterol there comes a time
where there are not enough treatable
patients drug companies can only earn a
profit
if they supersize the patient pool
imagine a pizza if 10 companies
share a pizza of patience each company
gets a small slice of the pie
however if you supersize the pizza
each company walks away with a generous
slice of the profits
super supersizing is more sophisticated
than traditional marketing
pharmaceutical companies
hire doctors so-called thought leaders
who represent their interests at medical
conferences
in scientific publishing and with the
medical associations
who determine how drugs are used
the centers for medicare and medicaid
reported
that these doctors were paid
2.3 billion dollars
in 2019 as recently as 25 or 30 years
ago
cholesterol was not an issue with the
medical
community today most americans believe
that every adult with high cholesterol
should be on a cholesterol-reducing
agent
i helped perpetuate this myth i wrote
one of the first
thought leader presentations on this
topic
i had to convince doctors that high
cholesterol
was as great a risk factor as high blood
pressure
or smoking for heart disease despite the
fact that there was little evidence to
that effect
today the myth persists that high
cholesterol
is bad for everyone even though that is
not
true i finally
did fall off the fence it was a night
to remember i was working on a new drug
for schizophrenia
this drug was more effective and safer
than existing treatments at least that’s
what we said
in our marketing materials as the drug
was used in more and more patients
reports started to emerge that the drug
caused
three serious side effects morbid
obesity
diabetes and enlarged breasts in men
the client became very concerned that
these side effects
would interfere with cells they
approached us
and asked if we could help them prove
that the side effects were unrelated to
the drug
unfortunately the side effects were
actually a byproduct
of the drug’s mechanism of action
the client was not happy to hear this
they asked
us to keep looking i reached out to
medical school
faculty who confirmed my findings
the client was still not satisfied
one night my ad agency manager
came to my office in tears begging me
for help
she was afraid that the client was going
to pull the account from the agency
and in one moment i was enlightened
no more rose-colored glasses
no more ambivalence no more
fence the next day i resigned
i did get a good laugh several years
later
because that company was fined 2.2
billion dollars
for making false and misleading claims
about that drug
we can learn a lot from the
pharmaceutical industry
one thing i learned is that no obstacle
is insurmountable
instead of demonizing the industry we
need to start imitating it
we need to form our own army of science
and marketing communicators
our army of communicators will build
a pipeline of drug and disease
information
that is a trusted alternative to the
pharmaceutical industry
we will amplify the voices of doctors
without ties to industry
this consortium should consist of
medical and pharmacy schools
physician experts and former
pharmaceutical ad writers
we will fund this alliance with a small
fee
on payments made by drug and device
companies
to doctors my nonprofit
rxbalance was part of a national
institute of health study
that showed that doctors and ad writers
could collaborate successfully on
medical content
we identified gaps in physician and
patient
knowledge and then we close those gaps
with ad style messaging using
workflows and editorial processes
from pharmaceutical advertising this
year
i am proud to say that rx balance worked
with government
physicians on a campaign to make
prescribing safer for older patients
with diabetes countering the influence
of pharmaceutical
marketing on american health care is a
herculean task
however every journey starts with the
first step
what we cannot do alone we can do
together
i commend you to the words of the first
century
jewish scholar hillel
if not you who
if not now when
it took me 30 years to get off my fence
may you get off your sooner thank you