There is a HUGE economics aspect to this entire debate that 1) extends past what the vast majority of physicians would take the time to understand and 2) extends past the US alone and to other world markets. My theory is if you have a problem with the way pharmaceutical companies are operating, go forth and start your own and see where you get. It's not easy to operate a giant corporation especially in a business where your current growth is majorly dependent on innovations. And note that this is regardless of whether most of the money goes into R&D or advertising. The bottom line is that 1) this company needs to make drugs to sell, 2) this company needs to sell these drugs, and 3) this company has a responsibility to its shareholders and employees to maintain such growth so that they may continue to have jobs and prosper. You may not realize this but there is a huge partnership that occurs between public research and private industry. Do you really think that the research that is done by some public dude using a government grant magically ends up as a patent with a specific pharmaceutical company? There are deals that are made, sales that are coordinated, support that is granted, etc. I dare say that pharmaceutical companies have a responsibility to advertise their products. Either that, or we physicians should be forced to go through some amount of detail about the choice of every drug we use over other similar drugs or regimens that are similarly available on healthcare formularies at similar costs to the patient. Otherwise, aren't we being irresponsible just automatically giving our patients Protonix all the time when we don't know if in that particular patient's case the "other drug" may have been just as good, better, or worse?
I've stayed out of this debate because most of what's been written here are just numbers taken out of context.
But - your point is absolutely correct! This is a huge economic issue which is a global one & one which most folks don't know much about. We might get offended because of marketing on TV - but those are often life-style drugs which are soon to come to the otc market or drugs marketed directly to patients because studies have shown they've not been used enough in a particular pt population which could benefit (ie Plavix).
Are you even aware that many generic drug houses are actually owned by large pharmaceutical companies? Pfizer owns Greenstone, Schering owns Warrick, Novartis owns Sandoz. Additionally, brand companies enter into distribution agreements for authorized generics, often to settle patent disputes due to premature entry. Thats why it doesn't matter if you order Paxil or paroxetine - it all comes from the same place. The whole pricing structure of drugs is tremendously complicated & involves changing from the average wholesale price to the average manufacturers price all the while using spread pricing to get the best benefit possible. Then throw in the PBM's - some of which are drug company owned (Merck-Medco) - now you have huge economic complications.
The complications of whats involved in bringing a drug to market - when 9 out of 10 fail bring huge costs & little involves marketing. Most of it is R&D, drug trials & compliance issues within countries it is being studied in. Currently there are more than 3000 chemicals or biologicals at some point in their NDA in the US only. In 2006 - 18 significant new drugs were approved by the FDA, 9 significant new biologicals were approved, 24 significant new dosage forms were approved & 1 approved drug was withdrawn after marketing.
The projected pharmaceutical sales in the US for new drug entities is 321 billion dollars which lags significantly behind the $800 million-$1 billion dollars it is estimated to actually bring a completely new entity to market.
Fortunately, the costs & reimbursements are not all borne by the US since drug development is world wide. That is why, although the lunches, pens & pads seem to be significant to your world - it is very, very small when it comes to what these companies are actually spending worldwide to not just bring this drug to the point of approval, but to go thru the approval process of multiple countries - each with its own study requirements, labeling requirements, distribution requirements & post-marketing survelliance requirements.
That $1 pen or $3 sandwich or even the $50 dinner is very, very small change. One small error or glitch & I can take thousands of dollars of a drug off my shelf due to a recall which would make your "perks" seem miniscule - and I'm just one pharmacy!
As a prescriber - set your own standards. If you don't want their perks - don't take them. If you don't want their samples - don't take them. If you don't want their study reprints don't take them. Get your own information & make your own judgements. But...if you do take their perks, samples or reprints - all of us expect you to indeed make your own judgement since that is how you were trained - to use objective data.
For the poor individual whose physician would not consider changing to a less expensive medication - you might want to look for another physician. Recent studies of prescribing habits in 2005-2006 have shown that 88% of physicians made a drug change based on pts ability to pay for the medication. Your doctor is swimming against the tide. Since, he's more willing to use subjective data....I might question other recommendations or judgements he makes as well.
And just in case you think US pharmaceutical research companies are all villanous - I'll give you this link which might help some of your patients (or you).
www.pparx.org is the Partnership for Prescription Assistance (PPA) & is the only program that provides a single point of access to more than 475 patient assistance programs available nationwide. It is sponsored by US Pharmaceutical research companies & it connects low-income, uninsured or under-insured patients to prescription assistance programs, many of which provide medications for free or nearly free. The website quickly locates patient assistance programs based on a few simple eligibility questions then links them to an application form.
These companies are not all bad! They are not without fault nor greed, but they are truly not all bad.
