Passing off marketing as education

Big pharma spends billions each year on “education,” a program that comes out of their marketing budgets. The education is aimed at both doctors and the public, supposedly to inform them and you about drugs. Of course there’s an inherent conflict of interest between selling products and evaluating them. For example, it's highly unlikely that Pfizer would provide impartial information when comparing its anti-depression drug, Zoloft, with Paxil, which is manufactured by GlaxoSmithKline.

Plus, by “educating” doctors about off label uses for their drugs, the companies can get around the legal constraints prohibiting them from marketing drugs for unapproved uses, as required by the FDA. Doctors do not suffer the same restraints. If they can be convinced to use a drug for off-label purposes, they can prescribe whatever they want. Thus, to expand the use of their products, the companies simply construe marketing information as educational information.

What’s more, because in most states doctors are required to receive continuing medical education throughout their professional lives, most doctors earn the credits by attending meetings and lectures. In 2001, drug companies paid for over 60 percent of the costs for these events, an amount that has increased since then. To provide the education, the sponsoring drug company contracts with a private medical education and communication company, which in turn plans the meetings, prepares the teaching materials, and procures speakers. This conflict of interest was made clear in the pitch made by one of these communication companies to the sponsoring pharmaceutical company: “Medical education is a powerful tool that can deliver your message to key audiences, and get those audiences to take action that benefits your product.” Translation: hire us and we’ll get doctors to prescribe your drug. Research has shown that doctors prescribe more of the sponsors’ drugs after these meetings.

Another way companies “educate” doctors is to buy reprints of journal articles that reflect well on their drugs, then distribute those to doctors. Reprints are hugely profitable for the journals. An editor can often tell in advance which articles are likely to bring in big reprint fees, such as a large positive clinical trial of a new drug. For example, the New England Journal of Medicine sold 929,400 reprints of Merck’s VIGOR study, the notoriously misleading trial of Vioxx that Merck used as a major marketing tool. These reprints brought in between $697,000 and $836,000 for the NEJM. (The NEJM eventually repudiated the VIGOR study, but did not return the money.)

Next week: An example of drug sales gone amok

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.