Not sure if this the right place to post this but i have become disgusted by pharmecutical companies lately. I shadowed a doc during winter break everyday for a month. every single day we had a catered lunch from pharm. reps, good food not cheap stuff. anyone feel this such a huge waste of money not to mention paying the reps salaries from 45-90k giving them cars etc. Why would they not just send out short and sweet pamphlets about the drugs with the samples and give docs a means by internet to request more samples etc. If the drug is good then it will be bought/perscribed, i hope any doctor does not make up their mind to prescribe a drug based upon anything a rep. with no medical training or generaly no scientific background outside of the 4 weeks of training about the drugs that can eaisly be read in 2 minutes by a phyisician. If they got rid of say 90% of drug reps the pharm companies would save money and maybe our drug prices would not be so unreasonable.
Pharmacetuical Companies
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Pharmaceutical companies want physicians to prescribe their drugs. Sure, it makes better sense for the pharmaceutical companies to give each physician a pamphlet of information along with $10,000 to read through it. But I guess conflict of interest would be much more noticeable.
C
Critical Mass
Just like other types of drug dealers, pharm reps give the first pills for free. Some physicians rely on the free samples for uninsured patients. On the other hand, I have also seen them give out the free samples to their own employees.
The drug reps are usually required to provide the free food, BTW, which is also alarming to some people because it seems to necessarily increase the price of the drugs.
Our government will begin to regulate marketing practices if/when government insurance starts to cover more prescription meds. They started doing this to the lab companies a few years back.
Something happens to physicians during their training that changes their mentality by and large. The reasons that they go into medicine change, and lifestyle considerations begin to trump altruism. Part of this is a sense of entitlement with respect to drug rep freebies.
The drug reps are usually required to provide the free food, BTW, which is also alarming to some people because it seems to necessarily increase the price of the drugs.
Our government will begin to regulate marketing practices if/when government insurance starts to cover more prescription meds. They started doing this to the lab companies a few years back.
Something happens to physicians during their training that changes their mentality by and large. The reasons that they go into medicine change, and lifestyle considerations begin to trump altruism. Part of this is a sense of entitlement with respect to drug rep freebies.
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This doesn't really belong in pre-allo., FWIW, for most ailments, there is more than one "good" drug, so companies need to really market to you to get you to prescribe theirs over their competitors. Many meds cost thousands of dollars a year, and for many drugs, their customers tend to be on the meds for as long as life. So drug companies need the opportunity to pitch their wares, and that means they sponsor lunch at a lunch meeting where they can present the evidence of their studies to willing and hungry physicians, and go around giving out pens, coffee mugs, cheap stethescopes, etc with their product's name. (Gifts used to be more substantial (i.e. vacations), but have long since been restricted by the profession). Virtually every company that sells anything has to do marketing to gain market share - there is nothing wrong with that, it is very much the American way. It is up to the consumer (here the physician), to not fall for every snake oil pitch where they get a free pen. When I was a lawyer, we got the same treatment from court reporters/process servers/appraisers/accountants -- there was no shortage of free lunches, pens or coffee mugs -- in the hopes I would utilize their service over their competitors. I was not in the least swayed by this, but certainly didn't begrudge letting these folks tell me why their service was the best over lunch.
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Drug companies have no ethical obligation to patients. Doctors do. That's why we, along with the patient, make decisions on their treatment.
The argument that pharm companies waste money on marketing is absolute nonsense. No company in any sector of the economy will spend money on marketing if it doesn't result in an increase in profits. That would be the dumbest financial move ever. If direct-to-patient marketing didn't work then they wouldn't do it. That's why you see them advertising for ED pills and sleep pills but not anti-neoplastic drugs. Advertising for anti-neoplastic drugs is largely useless.
Pharm companies' marketing practices help their profits and indirectly keep costs down by enabling them to make their profit off of volume and not large markups for a small number of scripts.
The argument that pharm companies waste money on marketing is absolute nonsense. No company in any sector of the economy will spend money on marketing if it doesn't result in an increase in profits. That would be the dumbest financial move ever. If direct-to-patient marketing didn't work then they wouldn't do it. That's why you see them advertising for ED pills and sleep pills but not anti-neoplastic drugs. Advertising for anti-neoplastic drugs is largely useless.
Pharm companies' marketing practices help their profits and indirectly keep costs down by enabling them to make their profit off of volume and not large markups for a small number of scripts.
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Therein lies the ethical dilemma. You may not be swayed (or you think you might not be, but you are because they just bought personal time of a physician...usually more time than a physician is willing to spend with an actual patient) but you still lead the drug rep on that you are interested and indirectly add to the cost of drugs. That $15 lunch, $2 pen, and $20 of the rep's time has to be paid by someone: the consumer, also known as your patient.
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Um no. All companies have budgets for marketing. Some percentage of marketing is unsuccessful -- that is a fixed cost of doing business. This is budgeted into the price of the drug long before the first drug rep talks to a physician about a med. So the drug costs what it does and the lunch, pen and rep's time is a sunk cost from day one. (FWIW, in the quantities drug companies purchase, the pens cost less than 50 cents, not $2). If wining and dining physicians (a relatively cheap marketing mode) was not an option, drug companies would find other avenues in which to market their products, most of which would cost more than this. You would see more ads for drugs -- companies spend a ton on marketing because they need to, and if they don't spend it in one mode, they reallocate it to another. The drug is priced long before it hits the market. You are assuming that if drug rep goodies were forbidden drugs would get cheaper, which is a false assumption -- the drug will likely cost the same and there will be a few more print ads instead. And besides, unless I prescribe such drug to my patient, which I wouldn't do based on a lunch, that particular marketing effort won't cost the patient a dime.
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That still doesn't absolve physicians of the ethical situation where they are allowing drug companies access to physicians for the express purpose of increasing revenue off the backs of patients. If the strategy didn't sway physicians, they wouldn't waste the money.
Also, one cannot disconnect themselves from the overall cost associated with the cost of drugs (or any product for that matter). If you take that pen, eat that lunch, or let the reps have you valuable time, the cost ultimately ends up in the cost of the drugs. It's basic math. Companies want a certain amount of profit (and should make a profit). All other expenses of getting that product to the consumer is borne by the consumer. One can say that they are not part of the problem, but they are just not being honest with themselves.
Also, one cannot disconnect themselves from the overall cost associated with the cost of drugs (or any product for that matter). If you take that pen, eat that lunch, or let the reps have you valuable time, the cost ultimately ends up in the cost of the drugs. It's basic math. Companies want a certain amount of profit (and should make a profit). All other expenses of getting that product to the consumer is borne by the consumer. One can say that they are not part of the problem, but they are just not being honest with themselves.
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The amount of money that the drug companies spend on marketing pales in comparison to the amount they spend on trials simply to get the drug to the marketing stage. Cutting back on drug reps, marketing, free lunches, etc. won't make pharm prices any cheaper.
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I don't see how this is different than any other business. As I mentioned above, I got all these kinds of perqs in law, and my friends in business get them too. All companies in every industry that sell good or services use marketing. And marketing costs get passed on to consumers. That is simple business 101. Not sure why physicians are different than any other distributor. The same money gets spent on marketing to physicians whether they are an active beneficiary, or just a passive target audience of ads. So the cost of the drugs will be the same to the patient, regardless of the perqs, if the physician chooses to prescribe it. The responsibility of physicians is not necessarilly to dictate how they are are going to be marketed to, it is to keep their wits and not fall for something inferior because of the marketing. But not infrequently these meds are good ones, and the lunch meeting is the only chance the physician gets to ask questions. So in some ways it's better to prescribe a drug after sitting through a presentation and having asked questions of a rep than it is to write a prescription after seeing an ad in JAMA.
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on a more fundamental level, because drug companies are for-profit corporations, they "waste" money developing profitable drugs for lifestyle issues like baldness and "social anxiety disorder", and then marketing this crap directly to consumers (because the poor patients who manage to go through life with "restless leg syndrome" sometimes need to be reminded about their suffering 
). by "waste" i mean spend money on developing and marketing crap, that could otherwise be spent developing (and not marketing) drugs for more serious, but less profitable medical conditions. as with other aspects of medical care, there shouldn't be a for-profit motive for developing drugs. it doesn't result in what's best for the most patients (in terms of the pocketbook and medical care). no suprise, as it was never intended to serve them in the first place.
). by "waste" i mean spend money on developing and marketing crap, that could otherwise be spent developing (and not marketing) drugs for more serious, but less profitable medical conditions. as with other aspects of medical care, there shouldn't be a for-profit motive for developing drugs. it doesn't result in what's best for the most patients (in terms of the pocketbook and medical care). no suprise, as it was never intended to serve them in the first place.
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i agree with you, but the only reason there is a "need" for industry funding is because of the way drug development and distribution is currently structured. government could play a bigger role in funding, and academic (and other non-profit) centers could play a bigger role in r&d. the same scientists with attractive enough salaries would still be doing the important work, just not in for-profit corporations or with industry money. and the poor marketers/other businesspeople whose exorbitant salaries help keep drug costs high would have to find jobs outside this healthcare industry, now that the cash cow has been tipped. in this system, all taxpayers would share the burden of (lower) drug development costs, rather than the patients who need medication. i think this is more fair, but i know others won't.
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Since government is not in the business of selling products, it cannot recoup the expenses of funding the kind of research that is done by industry now. We are talking huge amounts of money. No one who pays taxes would agree to this.
And FWIW, the so-called "exhorbitant salaries" are such a minute component of drug costs that even if they were zero, it would have negligible impact.
take the red pill and you stay in Wonderland and I show you how deep the rabbit-hole goes....
Moffatt, Barton. Ghost Marketing: Pharmaceutical Companies and Ghostwritten Journal Articles. Perspectives in Biology and Medicine - Volume 50, Number 1, Winter 2007, pp. 18-31
Pharma Buys a Conscience - http://www.theprospect.com/print/V12/17/elliott-c.html
A Soft Sell for Hard Drugs - http://www.mediaed.org/news/articles/SoftSellHardDrugs
Moffatt, Barton. Ghost Marketing: Pharmaceutical Companies and Ghostwritten Journal Articles. Perspectives in Biology and Medicine - Volume 50, Number 1, Winter 2007, pp. 18-31
Pharma Buys a Conscience - http://www.theprospect.com/print/V12/17/elliott-c.html
A Soft Sell for Hard Drugs - http://www.mediaed.org/news/articles/SoftSellHardDrugs
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I also recommend Blaming the Brain by Valenstein - http://www.amazon.com/Blaming-Brain-Truth-Mental-Health/dp/068484964X
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As someone who works for a pharm company, I feel like I need to chime in here.
The high costs of drugs aren't because of marketing, but because of R&D costs. Most people don't realize that patents on drugs don't start when a drug get approved, patents on drugs start way way further back, at the very beginning. Companies start patents on general molecular structures, from there it might take another 4-5 years just to find a drug candidate. Next, comes all the clinical trials which might last another 4-5 years. After that the FDA still needs to review all the data and make a decision which could take another 4-5 years. Thus a drug company a lot of times only has about 5-6 years to make all the hundreds of millions of dollars (even billions) it spent on R&D and on top of that make a profit before the patent runs out. Do you know how many drugs the FDA approved last year? Only 11.
How much R&D goes into a drug? On average it takes 240 FTE's (full time employment years) JUST TO FIND A DRUG CANDIDATE (it still needs to go through all the clinical trials and the FDA). That's right it takes a team of 120 people working non-stop fulltime for 2 years on a single project just to come up with a candidate for a potential drug. And as you probably guessed right, 99.9% of companies don't have 120 scientists working on the same project, but more like anywhere from 10-30 scientists.
so what if drug companies advertise? how many billions of dollars per year do car companies, shoe companies, electronic manufacturers etc. spend per year on advertising? if they didn't advertise, the the prices of those good would be cheaper too.
drug prices are rediculous because of the amount of R&D not because of advertising
The high costs of drugs aren't because of marketing, but because of R&D costs. Most people don't realize that patents on drugs don't start when a drug get approved, patents on drugs start way way further back, at the very beginning. Companies start patents on general molecular structures, from there it might take another 4-5 years just to find a drug candidate. Next, comes all the clinical trials which might last another 4-5 years. After that the FDA still needs to review all the data and make a decision which could take another 4-5 years. Thus a drug company a lot of times only has about 5-6 years to make all the hundreds of millions of dollars (even billions) it spent on R&D and on top of that make a profit before the patent runs out. Do you know how many drugs the FDA approved last year? Only 11.
How much R&D goes into a drug? On average it takes 240 FTE's (full time employment years) JUST TO FIND A DRUG CANDIDATE (it still needs to go through all the clinical trials and the FDA). That's right it takes a team of 120 people working non-stop fulltime for 2 years on a single project just to come up with a candidate for a potential drug. And as you probably guessed right, 99.9% of companies don't have 120 scientists working on the same project, but more like anywhere from 10-30 scientists.
so what if drug companies advertise? how many billions of dollars per year do car companies, shoe companies, electronic manufacturers etc. spend per year on advertising? if they didn't advertise, the the prices of those good would be cheaper too.
drug prices are rediculous because of the amount of R&D not because of advertising
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Actually without advertising, you don't sell as many, and so the cost per item is more, and thus the cost to consumer is more. So effective marketing allows companies to sell in the volumes required to keep it relatively less expensive. This is part of the reason the government had to pass various Orphan Drug Acts -- to give tax breaks to make certain meds worth the endeavor, even though the consumer base was fairly limited.
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If the advertising is increasing sales, it's likely convincing patients and doctors that it's necessary beyond what is medically needed (eg. lifestyle drugs or treatments for relatively benign disorders.). If the drug was needed, no amount of advertising would here been necessary in the first place. Pharmaceutical reps are there to ensure doctors and patients believe that their product is necessary.
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Huh? They are required to do nothing of the sort.
What happens to physicians is they grow up. And I don't know what sense of entitlement to which you are referring other than the reasonable expectation that all of our hard work and long hours as residents will have a tangible payoff. A couple of free sandwiches are not part of this picture. I can take them or leave them and if it means listening to some oily salesman I usually leave them.
Whether marketing works or not, most of us aren't running around salivating at the prospect of still more free pens. (We also eat for free at my hospital so the idea of a free lunch just doesn't have the power it used to.) If anything, the drug reps are viewed as a mild annoyance before conference (unless they are good looking female eye-candy) and something to sit through with a polite expression if that.
I'm probably the most altruistic person on SDN, just that my altruism is directed towards my wife and children and not some nebulous, poorly defined group know as "The Poor" who you could dump your time and money into until they screamed for mercy and it wouldn't improve their condition an iota.
C
Critical Mass
Per a Pfizer rep, they have a budget for things like physician meals that they are indeed expected to exhaust according to company policy. Same thing for their pens and samples.
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No -- you are sort of missing the whole point of this kind of advertising. In most cases the drugs ARE necessary, but there are multiple choices in the market, with slightly different pathways, side effects and the like. So the drug companies need to advertise to get their product used over the competitors. That is what all the reps are doing in most cases - they are there to sell you on why their cholesterol drug is the best, not trying to sell you on the need for a cholesterol drug in the first place. i.e. Not suggesting uses where none are needed, suggesting a certain drug for applications where drugs are already being used. Very few of these lunch presentations are non medically needed products, just not perhaps the optimal product for all patient's circumstances. But just because a company needs to advertise heavilly does not mean their product isn't extremely good or necessary.
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Sure they have a budget (which in real life is a use it or lose it for next year proposition) -- but the think the prior poster was suggesting that the hospital/doctors were making them buy them lunch, which is unlikely the case.
C
Critical Mass
I was misunderstood in that case. My bad. {L2D} {Panda}
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Oh, sorry. I thought you meant that we require them to provide food.
Seriously though and on a personal level, I detest eating that crappy drug-rep food while sitting on a crappy folding chair and balancing the plate on my knees. I'd rather go sit in the cafeteria and have a real sit-down lunch making small talk instead of looking at some boring powerpoint. This is why I skip noon conferences whenever and wherever I can. As if it's not bad enough I have to spend 13 hours at the hospital every day on off-service rotations. Sitting in a close, uncomfortable, and usually too small room listening to the droning is amost too much.
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I would like to clarify one point:
The field of medicine is NOT like other business fields. You cannot treat this field the same, sure it may have been ok for you as a lawyer to recieve perks from a company, but it should not be ok for doctors to recieve this type of perk. The cost of medication is unbelievable for those without insurance as is. It drives medication costs up. Pharmaceutical companies and doctors should not be buddy-buddy at all, there needs to be more regulation on this, just like there are in govt contracts.
This isnt a crazy idea by the way Law2Doc. When i worked for govt defense, we were not allowed to accept more than 20 dollars of anything, whether it be a lunch or a pen, just for the cause that we should not be influenced to buy parts from a company because we were influenced by little trinkets and gifts.
I have a fairly heated view of this. I just recently went to a doctor i dont have insurance, and the doctor immediately prescribed me the expensive version of the drug. All around her office were pens, pads, squeezy balls all with the pharmaceutical companies name on it. WHen i called back to ask if she could prescribe me the generic version instead, she told me that "this office only prescribes drug X".
The field of medicine is NOT like other business fields. You cannot treat this field the same, sure it may have been ok for you as a lawyer to recieve perks from a company, but it should not be ok for doctors to recieve this type of perk. The cost of medication is unbelievable for those without insurance as is. It drives medication costs up. Pharmaceutical companies and doctors should not be buddy-buddy at all, there needs to be more regulation on this, just like there are in govt contracts.
This isnt a crazy idea by the way Law2Doc. When i worked for govt defense, we were not allowed to accept more than 20 dollars of anything, whether it be a lunch or a pen, just for the cause that we should not be influenced to buy parts from a company because we were influenced by little trinkets and gifts.
I have a fairly heated view of this. I just recently went to a doctor i dont have insurance, and the doctor immediately prescribed me the expensive version of the drug. All around her office were pens, pads, squeezy balls all with the pharmaceutical companies name on it. WHen i called back to ask if she could prescribe me the generic version instead, she told me that "this office only prescribes drug X".
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This, my friends, is complete BUNK! Here's why:
1. Billions to produce a single drug? A 2001 report by Public Citizen, a consumer advocacy group, determined that the actual cost of R&D for a drug is < $100 million after taxes. Dont forget, the government allows Big Pharma to deduct R&D costs. http://www.citizen.org/documents/rdmyths.pdf
2. Most of the new drugs approved each year are variations on already approved drugs. Drug companies simply arent taking risks to develop new, lifesaving treatments. The FDA keeps track of drug approvals. Check it out. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Reports.ReportsMenu You can search and see how many new drugs are approved by month in any given year. How many are new, as in New Molecular Entities, as opposed to reformulations? The average is about 20% per year.
3. In MOST cases the early stage R&D (identifying drug candidates, etc.) is done by university research scientists using GOVERNMENT grants. Once these scientists ID new drugs and do basic safety testing, they license them to drug companies. For example, AZT, the first HIV/AIDS drug was developed by the NIH & researchers at Duke University and then licensed GlaxoSmithKline. I believe Taxol was developed in this way as well. Most of the time, all Big Pharma funds are clinical trials. Expensive? Yes. But not THAT expensive. Truth is, the federal government (read: tax payers) funds a large portion of the R&D costs.
4. R&D is often disguised as marketing. Big Pharma isn't required to disclose how much they spend each year on marketing and R&D and for the most part, they don't. Because there is no requirement regarding how companies classify their expenses, many who monitor/analyze this industry feel that a big hunk of reported R&D costs actually qualify as marketing. Most of this is in the form of phase IV studies, which Big Pharma runs after a drug is approved (supposedly to monitor for long term side effects, etc.) Phase IV studies, many argue, are a form of marketing in which the companies introduce their drugs to physicians by paying them to prescribe a drug and report minimally useful information back to the company.
Theres more, but I wont continue. When the drug companies attribute high drug costs to R&D theyre flat-out lying. They use this claim as a scare tactic to keep consumers paying the highest possible prices.
This is not to say that the drug companies arent useful; they do serve a purpose. It is important, however, to recognize them for what they are: for-profit corporations out to make as much $$$ as possible. Big Pharma certainly isnt an altruistic organization pouring billions into testing and developing drugs strictly for the benefit of mankind.
If you want more on how the drug companies really operate and why prices are so high, Id recommend The Truth About Drug Companies, by Marcia Angell, M.D. (the former editor-in-chief of the NEJM).
If you managed to read my entire post congratulations & thanks for bearing with me.
//end rant//
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on a more fundamental level, because drug companies are for-profit corporations, they "waste" money developing profitable drugs for lifestyle issues like baldness and "social anxiety disorder", and then marketing this crap directly to consumers (because the poor patients who manage to go through life with "restless leg syndrome" sometimes need to be reminded about their suffering
There shouldn't be a profit made for drug development? And there shouldn't be a profit made in medical care? If so then I'm quitting med school tomorrow, and so will most of my colleagues leaving Americans with no future doctos. What world do you live in?
This is idealistic bull crap that doesn't work. If you want to start up a non-profit drug company that develops drugs and then sells them at no loss and no profit, then GO FOR IT. But I'll tell you it won't work and you'll be bankrupt within months. You know all those people that actually do the work in the lab? Yeah, they want to get paid well for their work. You know those doctors that are taking up hours of their time every week to run drug trials? They want to get paid well for that. All the lawyers to make sure you aren't going to get lawsuits on your door? Yep, gotta pay 'em. Medical care is, at its heart, taking care of people in a time of need. However, that fact doesn't mean that healthcare providers (docs, nurses, radiology techs, pharm companies, hospitals, etc) shouldn't make money. In fact, I contend that for such a high calling those individuals should make very good money in order to attract the best and brightest.
Taking the financial benefits out of anything leads to a collapse of that industry. You can ignore that fact and gripe and moan about it, or you can embrace that fact and lead society to greater advances. Fortunately, our society has embraced the fact that money drives all of us leading the American economy to greater heights than anything ever before.
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Basic science research isn't all that expensive. It's the clinical trials that are. I've never seen an estimate as low as $100 millions. Most I've seen are in the $800 million-$1 billion range. The $100 million difference is probably the cost of taking a single successful drug from lab to pharmacy shelf. However, the vast majority of drugs never make it to the shelf for countless reasons, but those costs of development up to that point don't vanish. So the $800-1 billion range is probably taking into account all of the successes with all of the failures. Add up all R&D costs and divide by the number of fully developed drugs.
It's all moot anyway. These are private companies and the US government has no right to tell them how to run their companies. If so then they also have a right to tell docs how to run their practices. These companies can develop remedies to cure acne and varicose veins or they can try to cure cancer. It's their money and they can do with it as they like. The obvious extension of your argument is that the government control what they research (thereby cutting into their profits) at which time you will see them leave the country. There's nothing that says companies must research in the US. I'm sure China (or India or Japan or Mexico) would accept with open arms any pharmaceutical company that wanted to relocate there produce drugs that they want.
It's all moot anyway. These are private companies and the US government has no right to tell them how to run their companies. If so then they also have a right to tell docs how to run their practices. These companies can develop remedies to cure acne and varicose veins or they can try to cure cancer. It's their money and they can do with it as they like. The obvious extension of your argument is that the government control what they research (thereby cutting into their profits) at which time you will see them leave the country. There's nothing that says companies must research in the US. I'm sure China (or India or Japan or Mexico) would accept with open arms any pharmaceutical company that wanted to relocate there produce drugs that they want.
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This, my friends, is complete BUNK! Here's why:
1. Billions to produce a single drug? A 2001 report by Public Citizen, a consumer advocacy group, determined that the actual cost of R&D for a drug is < $100 million after taxes. Don't forget, the government allows Big Pharma to deduct R&D costs. http://www.citizen.org/documents/rdmyths.pdf
2. Most of the "new" drugs approved each year are variations on already approved drugs. Drug companies simply aren't taking risks to develop new, lifesaving treatments. The FDA keeps track of drug approvals. Check it out. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Reports.ReportsMenu You can search and see how many new drugs are approved by month in any given year. How many are new, as in "New Molecular Entities," as opposed to reformulations? The average is about 20% per year.
3. In MOST cases the early stage R&D (identifying drug candidates, etc.) is done by university research scientists using GOVERNMENT grants. Once these scientists ID new drugs and do basic safety testing, they license them to drug companies. For example, AZT, the first HIV/AIDS drug was developed by the NIH & researchers at Duke University and then licensed GlaxoSmithKline. I believe Taxol was developed in this way as well. Most of the time, all Big Pharma funds are clinical trials. Expensive? Yes. But not THAT expensive. Truth is, the federal government (read: tax payers) funds a large portion of the R&D costs.
4. R&D is often disguised as marketing. Big Pharma isn't required to disclose how much they spend each year on marketing and R&D and for the most part, they don't. Because there is no requirement regarding how companies classify their expenses, many who monitor/analyze this industry feel that a big hunk of reported R&D costs actually qualify as marketing. Most of this is in the form of phase IV studies, which Big Pharma runs after a drug is approved (supposedly to monitor for long term side effects, etc.) Phase IV studies, many argue, are a form of marketing in which the companies introduce their drugs to physicians by paying them to prescribe a drug and report minimally useful information back to the company.
There's more, but I won't continue. When the drug companies attribute high drug costs to R&D they're flat-out lying. They use this claim as a scare tactic to keep consumers paying the highest possible prices.
This is not to say that the drug companies aren't useful; they do serve a purpose. It is important, however, to recognize them for what they are: for-profit corporations out to make as much $$$ as possible. Big Pharma certainly isn't an altruistic organization pouring billions into testing and developing drugs strictly for the benefit of mankind.
If you want more on how the drug companies really operate and why prices are so high, I'd recommend The Truth About Drug Companies, by Marcia Angell, M.D. (the former editor-in-chief of the NEJM).
If you managed to read my entire post…congratulations & thanks for bearing with me.
//end rant//
Do you have any idea what you are talking about? Do you know how much Pfizer spent on R&D and clincal trials for torcetrapib? It was close to $1billion dollars, and guess what Pfizer had to throw it away in the garbage over complications in phase III clincal trials.
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And my heart sank when the clinic I work for handed everyone a memo about drug reps no longer being welcome, to eliminate the perception of bribery and "being bought" by them. I will certainly miss the free pens, food, magnetic locker mirrors, staplers, etc. Oh well...
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Agreed. Folks who try to downplay R&D costs tend to omit the fact that for each drug that is successful and costs X, there are another couple dozen that each cost the same X and do not make it to market. Thus while the cost of a single drug may be less than $100 mill, in most cases, it's profits need to subsidize the other dozen drugs that each cost 100 mill but never made it to market. That's how the industry works -- you fund a bunch of things in the pipeline and hope something works out. So sure if you just pick the successful drug and say what did this one cost, the number is not going to be as dramatic as if you factor in all the non-successful things in the pipeline the company ate in that given year while trying to develop the one good drug. Also, bear in mind that the interest group cited in the prior thread has its own anti-pharmaceutical agenda and its data needs to be viewed in that light (much as you need to view pro-pharma statements as similarly agenda driven). There is a lot of spin out there, and a google search on such hot button issues often provides you with less accurate info than one would like.
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you and others with that attitude quitting med school sounds awesome to me! with only 50% of applicants getting into med school now, that should open the doors to the most altruistic of qualified applicants, and the people who see $ in medicine wouldn't bother applying. i look forward to having those people as colleagues, and hopefully we'll start to restore public trust in medicine. awesome!
i don't think you understand what a nonprofit organization is about. they are allowed to have income in excess of costs, they are just required to re-invest them in the organization.
i, or others with reasonable positions like mine, never said that people in health care shouldn't make money. i will say that scientists and medical researchers will get by fine doing their work without pharma being their big cash cow. people will be around to do the work because of its inherent value, the same way college-educated social workers make due with under 30k per year and college professors put many years into their education to start at a lot less than six figures in a tough job market.
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The $100 million reported by public citizen might be full of spin, but so is the $800 million figure commonly cited by the drug companies. This figure was first reported in 2001 in a study conducted by the Tufts Center for the Study of Drug Development. The problem? No one knows exactly how this study was done. The data was given to the Tufts center by the drug companies and hasnt been released for external review (also, the center that conducted this receives pharma funding). Also, this study considered only self-originated NMEs. The drugs in question were identified and developed by the drug companies and the companies paid for ALL the testing. This is not how the majority of drugs are developed.
An average of $100 million/drug might be low, but $800 million is greatly inflated.
I never claimed that R&D wasnt costly. However, the MAJORITY of the drugs approved by the FDA each year (~80% based on the FDAs own reports) are variants of currently approved drugs the R&D costs for such drugs are minimal (Id guess less than $100 million). The argument by the drug companies that prices are high b/c R&D costs are astronomical is complete BS. Most of what they do is modify their proven money-makers and apply for patent extensions.
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If you read my post I said to take both those figures with a grain of salt. But again, the question isn't the cost of specific drugs the FDA ultimately approves, it is the cost of the entire pipeline allocated across those drugs that actually get approved. The winners have to pay for all the losers.
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FWIW, whenever anyone titles a book or article "the truth about" or uses the phrase "myth", you have to be equally critical about their allegations. More spin and falsities can be found in supposed "truths" than from data released by people with more obvious motivations. Question the source.
If you do searches about hot topics such as injuries caused by vaccines, you can find all sorts of "truths" that, after subsequent years of study, simply do not appear to be true.
I would say its not so much during the training as afterwards. Dealing with Medicaid, Medicare, insurance, no-pay patients, malpractice suits, huge premiums, insurance companies, insurance companies insurance companies, huge overheads, huge debt, oh and then the regular cost of life - childcare, education, rent, food, vacation, car, heat, electric, tax, tax, tax, insurance, etc. In short, I think that most people go into medical school for the right reasons but they are naive about real life being that most students havent had to deal much with real life ( and college or summer jobs do not count ) but then when the graduate and have to live in the real world, reality forces altruism to take a back seat.
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I agree completely. What I am arguing is that there really aren't that many "losers."
I dont believe big pharmas claim that they are continually searching out and investing in new drugs, many of which never make it to market. This isnt a profitable business model.
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i have had no qualm accepting freebies from drug companies. why? because i'm too savvy to be swayed by a stupid sales pitch. if i were going into primary care, my patients would get generics and generics alone. and when the pharm companies realize i'm not prescribing their drugs, there's another pharm rep from another company who will pay for every meal i eat.
the problem with medicine is that doctors have no clue what expenses patients have. when 90% of doctors grow up on long island, there's no business savvy, no understanding of what a dollar is worth.... and that a $40 copay is different from a $10 copay.
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By accepting drug company meals, do you worry that you're increasing what patients who need name brand drugs (drugs for which no generics are available) must shell for their Rx?
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and although it's not affecting your behavior, it's giving the appearance that you're receptive to having your behavior changed. i.e., it's sustaining demand for these freebies. if nobody took the freebies, pharma would stop budgeting for them.
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This is the one argument I think has no merit because drug companies are going to spend X on marketing, whether they do it by wining and dining physicians or whether they do it reaching them in more ads. To think that fewer physician lunches translates to cheaper drugs simply does not take into account the reality of marketing budgets. The amount a company is going to spend to back a drug tends to be a fixed cost, regardless of how it is spent.
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No, they would still budget for marketing -- they just would move the funds to different forms of marketing. They still have to reach the physicians somehow, or they cannot compete with their competitors. You close one avenue you just force them into another.
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so drug companies aren't required to state how much they spend on R&D, but then you claim to know roughly how much they spend on R&D? ??? Is that not contradictory or what? How about you read the 3rd Q financial report for the pharm company I work for:
http://phx.corporate-ir.net/phoenix.zhtml?c=120919&p=irol-newsArticle&t=Regular&id=923886&
Thats right, out the 18 million we lost in 3 months, 15 million of that was from R&D 10 million was from marketing+salaries+other administrative costs. My company hasn't made a profit in 10 years since we don't have any drugs on the market--yet. Thus, if we do get a drug on the market that drug will have to not only pay for the R&D costs over that 10 years, plus the revenue we receive from it will also have to pay for all the money lost from costs like salaries, pensions, administrative crap etc. THEN after all that is paid off, maybe we can finally make some profit. It has already been 10+ years that means we only have about 8-9 years to recover all those losses and then make some profit before our patent runs out. I work for a very small pharm company too, the big pharma companies spend way way much more on R&D than we do and also have way more salaries to pay.
How many drug companies do you know of? 5 or 6 like GSK, Pfizer, Wyeth, Merck, etc?? You do realize there are 100's of small biopharm companies out there that never make it and fold because the cost of developing drugs and getting them to the market is ridiculous. The big pharma companies represent probably <5% of all the pharm companies out there, the rest pretty much go out of business. The only reason so many pharm companies exist is because of the risk vs. reward factor. If there wasn't a big reward for finding a drug, you can be guaranteed that research into new cures for diseases would sharply decline.
http://phx.corporate-ir.net/phoenix.zhtml?c=120919&p=irol-newsArticle&t=Regular&id=923886&
Thats right, out the 18 million we lost in 3 months, 15 million of that was from R&D 10 million was from marketing+salaries+other administrative costs. My company hasn't made a profit in 10 years since we don't have any drugs on the market--yet. Thus, if we do get a drug on the market that drug will have to not only pay for the R&D costs over that 10 years, plus the revenue we receive from it will also have to pay for all the money lost from costs like salaries, pensions, administrative crap etc. THEN after all that is paid off, maybe we can finally make some profit. It has already been 10+ years that means we only have about 8-9 years to recover all those losses and then make some profit before our patent runs out. I work for a very small pharm company too, the big pharma companies spend way way much more on R&D than we do and also have way more salaries to pay.
How many drug companies do you know of? 5 or 6 like GSK, Pfizer, Wyeth, Merck, etc?? You do realize there are 100's of small biopharm companies out there that never make it and fold because the cost of developing drugs and getting them to the market is ridiculous. The big pharma companies represent probably <5% of all the pharm companies out there, the rest pretty much go out of business. The only reason so many pharm companies exist is because of the risk vs. reward factor. If there wasn't a big reward for finding a drug, you can be guaranteed that research into new cures for diseases would sharply decline.
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This is an important healthcare topic, but it's more appropriate for the Topics in Healthcare (TIH) forum. I'm moving this to TIH, but I encourage you guys to continue the discussion there.
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Umm... yes they do
Umm....actually, no, they don't. At least not in the same sense that physicians or lawyers or clergy have to their respective patients/clients/parishioners. Pharmaceutical companies don't recite any oath. They don't have to give the best option to the patient. They don't even have to present all options to a patient. They have a legal responsibility to not lie, but that doesn't come out of the goodness of their hearts. That's because it's the law and they'd be sued if they did lie. If you go into any major corporation and sit in on their board of directors talking, you won't hear any of them say "what's the ethical action to take?" You will hear them ask, "what's our legal responsibility?" or "how will this play in public relations?" or "how does this impact our profits?" Having a set of ethical guidelines also necessitates that there be some self-policing, which isn't happening in the big pharma or any industry. It does happen with physicians (AMA and state licensing boards) and lawyers (bar associations) and clergy (conventions) among a select few other professions, but not private corporations.
I'll agree that it would be nice if pharm companies (any company for that matter) has a self-imposed moral compass that would guide them in their practices, but it's no more an ethical duty than me telling a man that he must open the door for the lady coming behind him.
Physicians, however, do have an ethical duty to patients. We must put their care above all else. We have the responsibility to tell them what the best care is regardless of profit motives or outside influence. That's what separates a profession from an industry.
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You can't talk like that! Common sense and reality have no place in a conversation such as the one we find ourselves in now! Didn't anyone tell you that?
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Marcia Angell is a fairly credible source of information. She was one of the first to criticize the unwarranted public outcry against silicone breast implants. She was also the interim editor in chief for the New England Journal of Medicine, albeit for a relatively short period of time. The title of her book is a poor choice, sounding similar to garbage like "Natural Cures They Don't Want You to Know About" and other such hysterical nonsense. I enjoyed her book, though I didn't agree with all of it.
There does seem to be an unspoken left-leaning bias throughout Dr. Angell's whole book. I would find the information more credible if she just came right out and disclosed some of her political views, instead of acting as though ones politics exist in a vacuum and have no bearing on their opinions of the pharm industry.
