DRUG company sales reps have only a small impact on what doctors prescribe, according to a large study of doctors鈥� drug choices. The claim is fuelling the debate over whether marketing tactics benefit or harm patients.
Drug marketing is a booming industry. Between 1995 and 2000 the number of people employed in marketing pharmaceuticals soared from 55,000 to 88,000 in the US, while the numbers researching new drugs has stayed constant (see Graph). By 2001, the industry in the US was spending $16 billion a year on direct marketing visits to doctors, dubbed 鈥渄etailing鈥�.
Critics of the system argue that it benefits no one but the companies because it persuades doctors to switch to more expensive brands, while the cost of marketing is inevitably passed on to the patient. Drug companies respond that reps offer a valuable service, keeping doctors up to date with new products and providing free samples.
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Now Natalie Mizik at Columbia University in New York and Robert Jacobson at the University of Washington in Seattle say rep visits have only a small effect on doctors. Over a two-year period, they analysed data on visits and prescriptions of three drugs for nearly 75,000 family and hospital doctors.
From the number of visits made promoting each drug, and the number of new prescriptions gained, the researchers calculate that the reps had to make 0.6, 3.1 and 6.5 extra visits respectively just to persuade doctors to write one extra prescription. They reported the result at a conference at the University of Maryland earlier this month. Sales reps are low on physicians鈥� list of trusted sources, Mizik concludes.
But other researchers think the findings tell the opposite story. Puneet Manchanda at the University of Chicago points out that each prescription will be followed by around three refills, each providing upwards of $50 profit. What鈥檚 more, a rep may promote two or three drugs with each visit. For the three drugs in the study, each visit increased their market share with the doctor by between six and 11 per cent. 鈥淚f I were a marketing executive, I would be ecstatic,鈥� says Manchanda.
His own research though suggests that companies spend too much on detailing, to the extent that doctors stop responding to repeated rep visits. Manchanda believes drug companies are afraid of cutting marketing if their competitors continue. If they pull back, somebody else could walk in and pick up their share, he says. 鈥淓verybody else is doing it, so you have to,鈥� agrees Mizik.
Bob Goodman, founder of an organisation of medical professionals call 鈥淣o Free Lunch鈥� which campaigns against drug marketing says that in the internet age there鈥檚 no reason for doctors to rely on reps for their information. 鈥淎 rep鈥檚 job is to sell drugs, not to educate doctors,鈥� he says.