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