[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.

[pmart123]

Do you think there could be a substantial time lag in that case though? Sure, some movies become hits with no marketing, but DiCaprio, Brad Pitt, Ana Margo Robbie have been everywhere to market a movie with stellar reviews and a top director. Maybe that is a poor analogy. I’m not in the pharma industry, but to me, I’d hold my doctor accountable for prescribing me something I saw in a tv commercial, or not doing the legwork to understand why it could be a beneficial drug.

[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.