[refurb]

This may come as a shock to you, but marketing pharmaceuticals is really no different than marketing other products. It really comes down to educating consumers about your product.

Doctors as decision makers are not some monolithic block of individuals who are super educated about every product on the market and every piece of data. Just developing awareness of new drugs is a huge job. I'd say less than 5% of doctors are cutting edge enough that they require no additional education on new drugs.

The best story I can tell was from a friend who worked at a drug company that sold a hepatitis C drug. Once Gilead's drug came out, this company basically decided to discontinue their drug. Incredibly, there were doctors out there still ordering the old drug. The company had to send reps out to these doctors to tell them to stop ordering it. Continuing to use it made zero sense at all.

[mr_crankypants]

The problem here is that pharmaceutical companies' marketing departments have a deep conflict of interest. They're incentivized to encourage doctors to use the drug that makes their company the most profit, not the drug that is best for the patient.

And there is plenty of research demonstrating that this is exactly what they do, and that doctors are indeed swayed by it, because, as you say, they don't have the time to do keep up with it all on their own.

And yes, there is a fundamental difference to consider here: My doctor has a fiduciary responsibility to do what's best for my health, to the best of their ability, and drug marketing compromises that. By contrast, nobody has any fiduciary responsibilities related to which brand of toilet paper I use.

[nitrogen]

Maybe an alternative to drug marketing would be to have an independent national or international group (e.g. NIH or CDC) inform doctors about new drugs based on their prior prescriptions, and to present the preregistered clinical trials at medical conferences just like any other research result to reach the rest.

[pmart123]

At the same time, when a breakthrough happens like with Gilead’s hep c drug, a single governing body is far less likely to educate and inform doctors that a major disease can basically be cured even if all the evidence points this to be the case. Think about how long it took the food pyramid to be changed despite all the evidence that you should be eating six loafs of bread each day.

[Scoundreller]

A drug that good tends to sell itself.

There will be those that don’t change their practice ever once they graduate (seen a few).

Things get more complex when you have dozens of treatments for a condition with no clear winner.

[refurb]

I appreciate how you said “tends to sell itself”.

Before I got in the industry I thought “what the hell does marketing do?”. Then once I saw what they do, I realized, no, most drugs don’t sell themselves, there is too much inertia for doing the same old thing.

[Scoundreller]

The key word was good drugs tend to sell themselves.

If you develop yet another blood pressure drug or cholesterol drug and want GPs to prescribe it, you're going to have an uphill battle.

A blockbuster drug for HepC (where treatments before weren't particularly effective and had ugly side effects) will have a much easier time becoming well known amongst the specialists that treat the disease.

[Scoundreller]

Plenty of resources exist. But they’re boring/not flashy.

The government isn’t going to get away with hiring entire teams based on looks and then have a marketing line item for free fancy lunches for people that are definitely not starving.

Choosing Wisely is a broad approach that is somewhat like you described.

[refurb]

My counter to your comment, and my own personal experience, is that doctors are fully aware of the manufacturers conflict of interest. They know that the drug companies will present everything in the best possible light.

Other things that exist to counter this bias are competitors, who will provide a different perspective and most importantly, the FDA that regulates all pharmaceutical promotion for accuracy and will quite swiftly drop the hammer on a company that bends the rules.[1]

[1]https://www.fda.gov/drugs/warning-letters-and-notice-violati...

[theaustinseven]

Yeah, but this starts to break down when the pharmaceutical representatives can give laundered incentives(fancy "educational" dinners, "educational" yacht parties, etc.) to prescribe their product. In the US, pharma reps can see the prescription amounts of doctors to verify that they are actually prescribing their product(last I heard from a pharma CRM company in 2016). This seems deeply and fundamentally unethical.

Then you bundle all that up with the various studies that show that doctors(as with all professions) do a poor job with continuing education so that they are further inclined to take the recommendation from the pharma reps(which can be seen in the roots of the opioid crisis), I don't think we're in a very good place from a regulatory standpoint.

[refurb]

The practice of greasing the skids with lavish events ended a while back. Drug companies can't even give free pens to their doctors now.[1]

[1]http://phrma-docs.phrma.org/sites/default/files/pdf/phrma_ma...

[grahn]

Not to take a position in this debate as a whole, but I just want to interject that there is research suggesting that you actually are more likely to be affected if you are aware of the other person's conflict of interest. (Can't find a link right now...)

If memory serves me right, the theory is that it makes you overestimate your ability to stay objective and unaffected, so you're effectively lowering your guard, or something along those lines.

[m463]

You should read "the honest truth about dishonesty" by dan ariely where scientific studies of conflicts of interest found folks fall for this stuff unconsciously and repeatably.

[navigatesol]

>They're incentivized to encourage doctors to use the drug that makes their company the most profit, not the drug that is best for the patient.

The job of the marketing department isn't "best drug for patient". That's the doctor's duty. The marketing department is there to bring awareness of the product to both doctor and patient. There is no conflict of interest at all.

[AnimalMuppet]

Not all marketing is "educating consumers about your product". Some of it is manufacturing a desire for your product.

Look at car ads. Do they say "The new 2019 models are available"? A few do. Do they say "This car gets better gas mileage" or "This car is safer"? A few do. Most say "If you drive this car, you'll get the hot girl". That's not "educating consumers". That's trying to make consumers want your product on the basis of something completely unrelated to your product.

And yes, I fear that marketing pharmaceuticals may in fact not be different from marketing any other product.

[refurb]

A very interesting read for me was an FDA survey on direct to consumer TV ads for drugs.[1]

A few of the negative findings:

-Eight percent of physicians said they felt very pressured to prescribe the specific brand-name drug when asked.

-In addition, about 75 percent of physicians surveyed believed that DTC ads cause patients to think that the drug works better than it does, and many physicians felt some pressure to prescribe something when patients mentioned DTC ads.

And positive findings:

-Many physicians thought that DTC ads made their patients more involved in their health care.

-Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit.

-The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated.

[1]https://www.fda.gov/drugs/drug-information-consumers/impact-...

[mettamage]

I simply wondered if I could play devil's advocate by looking up some research about men spending money for cars in order to attract women. I mean, most psychologists are men right? Surely, someone had the bright idea to look into this (I wonder if anyone has done it regarding the other way around, I'm too lazy to look it up since I can't play devil's advocate with that). As it turns out, there is research on it!

The introduction is the most juicy bit as the particular article I found is about intra-sex competition but states a few interesting studies in their introduction about being desirable to women.

In short what I skimmed so far related to this idea is:

"And indeed, a man who was seated in a luxury car was perceived as more attractive by women compared to the same man seated in a nonluxury car (Dunn & Searle, 2010). Hence, men appear to use showy spending to attract women in intersexual competition contexts. Sundie et al. (2011) further revealed that men’s flaunting of luxury goods signals their desirability as a shortterm (rather than long-term) mate."

Personally, I don't car about any of this. However, academically (from an evolutionary psych. view, lol): yes, men are seen as a more desirable mate!

If this conclusion is also actually true (and not subject to whatever ails the field of psychology) then I'd chalk it up to most of humanity being vain and if you want to get vain people you need to be the vainest of them all and get the sports car, the fancy house, other desirable 'high value' women in pictures and all that jazz. Though, why not just immediately go for the private helipad and private jet with built-in Jacuzzi? Nothing attracts as much as offering young people in general a trip around the world in pure luxury! Or so I presume. So don't buy the sports car. Buy the helipad with helicopter on top.

Source

Title: What If the Rival Drives a Porsche? Luxury Car Spending as a Costly Signal in Male Intrasexual Competition

DOI: 10.1177/1474704916678217

URL: https://journals.sagepub.com/doi/pdf/10.1177/147470491667821...

[navigatesol]

>"And indeed, a man who was seated in a luxury car was perceived as more attractive by women compared to the same man seated in a nonluxury car (Dunn & Searle, 2010).

Surprised the PC Police haven't demolished you for pointing out that, on average, women are attracted to men who convey wealth (even though it's blatantly obvious).

[mettamage]

A couple of things:

I said:

> Personally, I don't car (sic! also no pun intended) about any of this. However, academically (from an evolutionary psych. view, lol): yes, men are seen as a more desirable mate!

So first, I see evolutionary psychology as a joke and I don't care about the research because I think it's all lies anyway. I'm a bitter man when it comes to the promises of psychology being truthful about how humans think (the field has too many issues).

Secondly, I simply quoted research. And remember from point 1, distanced myself from that opinion.

Thirdly, in my experience I never needed to flaunt my wealth in order to attract women. I think the same is true for most if not all of my friends (both sexes). Disclaimer: I'm Dutch (maybe culture is a thing).

[vonmoltke]

> Look at car ads. Do they say "The new 2019 models are available"? A few do. Do they say "This car gets better gas mileage" or "This car is safer"? A few do. Most say "If you drive this car, you'll get the hot girl". That's not "educating consumers". That's trying to make consumers want your product on the basis of something completely unrelated to your product.

You and I must be watching different commercials, because I see far more of the former.

[navigatesol]

>You and I must be watching different commercials, because I see far more of the former.

I think it's changed a lot since the 60s and 70s. Cars are seen as more utilitarian now, and younger people don't even care about getting their license, let alone being concerned with "what you drive".

[notfromhere]

Except it's not marketing products to doctors, who are the gatekeepers to access. It's marketing to consumers, who aren't informed, and are then used to badger doctors to make them prescribe medicines they heard about on TV.

[ivraatiems]

Actually, big pharma does both. Marketing to doctors is sometimes even more sinister, because of (often implied) incentives for pushing more of a medication on the physician's patients.

Some resources:

[1] https://www.sciencedaily.com/releases/2018/05/180514132441.h...

[2] https://www.pewtrusts.org/en/research-and-analysis/fact-shee...

Plus, this classic Scrubs clip describing a particularly chauvinistic (but truth-in-television) take on the practice: https://www.youtube.com/watch?v=VMXa0U4WZyU

[markus92]

That's only in two countries in the world (NZ and USA).

[bspn]

And in reality, it's really only the US. Even though pharmaceutical ads are legal in NZ, they are pretty rare and most GPs won't just write a script because a patient asks for a particular drug unless there's a clear need for it. The role of Pharmac (NZ's central drug purchasing agency) also tempers the effectiveness of drug advertising so you just don't see it like you do in the mainstream US media.

[happytoexplain]

Medicine is absolutely different from other markets. The entire premise of the multi-catastrophic neverending train crash in the US is that it is treated as though it isn't different. Educating doctors is critical, but that doesn't necessitate treating pharmaceuticals like any other product.

As an aside, it's insulting to preface a rebuttal with, "this may come as a shock to you".

[mikeash]

Marketing comes down to educating consumers about your product? Have you ever seen marketing? Any education that occurs is either accidental or legally mandated.

I do agree with you that pharmaceutical marketing isn’t fundamentally different from marketing other products. Although my conclusion from that is not that pharmaceutical marketing is therefore good.

[1123581321]

Consumers who care enough about the medicine they’re taking to request certain prescriptions want to understand them. Mass media like TV ads drives searches and visits to more detailed official material (websites, pamphlets, etc.) Without providing useful information, the manufacturer would have trouble convincing more engaged patients to switch, and similarly to other product markets, engaged customer word of mouth is vital to growth. Word of mouth is bolstered by the more familiar mass media. It’s not perfect, but it’s far from axiomatic that the communications from the entire marketing campaign are valueless. It only appears that way to TV viewers with no medicinal motivation to research the drug.

[save_ferris]

Not to mention that much of the 1st world prohibits drug advertising. The US is somewhat of an odd case in this regard.

I often ask foreign expats in America about the strangest aspect of American culture in their opinion. Believe it or not, pharmaceutical advertising is one of the most common answers I get.

[mirimir]

> This may come as a shock to you, but marketing pharmaceuticals is really no different than marketing other products. It really comes down to educating consumers about your product.

That's how it is, in practice.

But some of us take that Hippocratic Oath thing seriously.

[dwaltrip]

This may come as a shock to you, but educating the consumer is not the primary purpose of advertising.

[refurb]

A huge part of it is education when it comes to drug advertising.

[the8472]

> It really comes down to educating consumers about your product.

A lot of marketing does not seem very educational and more manipulative.

[api]

> It really comes down to educating consumers about your product.

Most advertising is more about triggering emotions and using other cognitive dark patterns than educating anyone.

[raheemm]

You make a good point. I wonder how is drug marketing handled in places like EU. How do their doctors learn of new drugs and decide which meds to prescribe?

[refurb]

Talking to my European colleagues, it’s not that different from the US (although the specific rules can differ).

Personal and non-personal promotion is how it’s done in Europe.

[cwkoss]

If this system only educates doctors about the benefits of profitable patented effective drugs, they are overprescribing an arbitrary subset of effective drugs because they lack information about non-profitable treatment options.

[gaze]

Advertising can in general involve misleading. It’s not even close to education.

[enraged_camel]

>> This may come as a shock to you, but marketing pharmaceuticals is really no different than marketing other products.

Really? You don't see the difference between marketing, say, a car or a smartphone, and marketing a drug that treats a life-threatening condition?

Perhaps you should think about this subject a bit more deeply.

>> I'd say less than 5% of doctors are cutting edge enough that they require no additional education on new drugs.

What do you base this on? Do you have some citations to support it?

[dsfyu404ed]

I'm not a fan of drug advertising (I want it regulated, not banned) but I don't see how it's categorically different than other advertising.

Chronic pain (and a whole host of other issues) aren't life threatening. Until the mid 20th century people just lived with chronic pain and tons of other things. Look at the kinds of TV ads you see, they're for drugs that minimize the symptoms of some some negative, but not life threatening thing. These are not essential products. They're luxuries of modern life that we consider to be nearly essential. Depending on one's specific situation having a smartphone or car may actually be more "essential" to daily life than having one's condition treated.

As an aside, drugs that actually save lives don't seem to get marketed much.

[ciupicri]

On the other hand heroin and other drugs were available.