Big pharma's conflicts of interest

A couple recent stories highlighted the conflicts of interest inherent in the pharmaceutical industry's current approaches to marketing its wares. In the first case, Congress is starting to consider requiring increased disclosures of the payments that pharmaceutical companies make to doctors:

The drug industry spends an estimated $19 billion a year marketing its wares to physicians, in the form of gifts, speaking fees, classes, trips and meals, according to watchdog groups.

“You ought to know what the relationship is between your doctor and a medical supplier or pharmaceutical company,” said Sen. Chuck Grassley (R-Iowa), the ranking member of the Senate Finance Committee, who co-authored the bill with Sen. Herb Kohl (D-Wis.). Rep. Peter DeFazio (D-Ore.) introduced a similar bill in the House.

If the effect of the disclosures is to reduce industry marketing efforts, Grassley said, “pills will be cheaper.”

The purported problem extends beyond the case of direct marketing to physicians. Slate recently reported on a disturbing connection between the work published in peer-reviewed scientific journals and the amount of advertising and other revenue that drug companies were responsible for:

Just as pharmaceuticals fund studies and pay doctors to give lectures, so too do they buy journal ads and reprints of favorable articles—lots of them. Often a drug company may find one of its products featured in a scientific article while another of its products is dolled up in a high-gloss ad a few pages later. Yet the journals keep quiet about these financial arrangements. When an article is published that shows a specific drug at great advantage, the reader may learn plenty about the author while nothing—absolutely nothing—is disclosed about the medical journal itself.

The public deserves to know about the extent to which every medical journal relies on pharmaceutical advertising revenue to run its business. In 2003, drug companies spent almost half a billion dollars on advertising in medical journals. The two lead general medical journals in the United States—the New England Journal of Medicine and JAMA, the Journal of the American Medical Association—receive about $18 million and $27 million each year, respectively, for display advertisements (as opposed to classified ads placed by individuals seeking jobs or institutions seeking qualified candidates). The display ads represent 10 percent to 21 percent of the journals' overall revenue, according to one study.

The piece goes on to highlight anecdotal evidence of cases where editorials have been suppressed by the business side of a journal for fear or alienating a good customer. Of course, all of this regulation wouldn't necessarily make a dent in the actual direct to consumer marketing that drug companies engage in, which is already reaching such a fevered pitch that we're seeing stories like this one:

Erectile dysfunction has gone from something men were ashamed to admit to their doctors to something they sit around bars and sing about. At least that's what they do in the "Viva Viagra" commercial. Half a dozen 35- to 45-year-olds grinning like goons sing "Viva Viagra! Viva Viagra! Viva! Viva! Viagra!"

But in real life?

Zelda: "I'm so tired of the Viva Viagra commercials. It's ... causing conflict among couples. I suggest a class-action lawsuit of wives against the company that makes it."

Given the free speech implications of attempting to regulate actual direct to consumer marketing, it doesn't necessarily follow that forcing drug companies to disclose more about their marketing to physicians or their influence over journals will make pills cheaper and benefit consumers. It might simply mean consumers will find themselves increasingly deluged with marketing messages on other fronts. However, even if efforts to rein in Big Pharma's sprawling influence don't have the immediate tangible efforts that senators and consumer advocates might wish for, it still generally seems like a good idea from a generic sort of "information wants to be free" perspective; it's hard to get a clear take on the facts when so many millions of dollars are being spent to hype and promote selected facts.