[mandmandam]

I think the main difference there is that tech companies don't spend 67% of their marketing money schmoozing your doctor.

Of the $30 billion that Pharmas spends marketing in the US, $20bn is aimed at doctors.

There's about a million doctors in the US.

That's ~$20,000 per doctor, each of whom has a significant degree of implicit trust and authority.

Even if a doctor believes they are not swayed by marketing, studies have shown that these efforts can subconsciously affect their decisions.

And $20k/year/doctor just seems awfully high. There must be a more efficient way to help doctors make those sorts of decisions...

***

Responding by edit due to rate limit:

> Who else should they advertise to then?

No one. It's not a brand affiliation issue, it's a facts and awareness issue. Doctors can read journals and papers and peer reviews just fine!

There's no need for them to be told what to do on paid Hawaiian vacation weekends in 5 star hotels. You can see why they prefer things this way though.

> it is morally worse to advertise and influence people who don't know any better.

So don't.

[tomohelix]

Who else should they advertise to then? The consumers aren't knowledgeable enough to make the decision on which drug they should take. Doctors are the only one qualified.

In fact, it is morally worse to advertise and influence people who don't know any better. At least, doctors are educated and it is their duty, both ethically and professionally, to learn about new drugs that best treat their patients. That is the whole point of a Medical Science Liaison. They are the "advertisers" for a pharma to make sure doctors know about the drug their companies make.

Mind you, at this level, advertising is a bit different. These MSLs are legally required to disclose both the indicators and the side effects and have strict rules in what they are allowed to give and say to doctors. There are hundreds of laws in place to prevent corruption/bribery. Of course there are bad actors everywhere, but at least, it is more regulated than Congress's "lobbying" and Supreme Court's "gifts".

[FireBeyond]

The US and NZ are the only two countries in the world that allow direct-to-consumer advertising of prescription medications - and New Zealand is trying to get rid of it (and only allowed it following pressure from the US for a trade agreement).

[tomohelix]

You can't gift doctors a paid vacation, there are rules and laws already in place. Also, MSLs are not simply "salepeople". They often require a PhD so their job description is more about "spreading knowledge" than "advertising" a drug.

Like it or not, having an expert in the hospital who know everything there is about a specific drug is a lot more effective than requiring every doctor to read about every new drugs. By your argument, this type of job should be removed and doctors are responsible for finding out about new drug themselves.

Maybe that is better, maybe not. But the first thing that would happen is adoption rate of new treatment would drop and people who would otherwise recover may die because their doctors were too busy trying to treat people instead of reading journals.

[mandmandam]

> You can't gift doctors a paid vacation

They don't call it a vacation, they call it a conference.

An hour or two of "information sessions", with a big goody bag, and 2 or 3 days of fine dining, tours, and golf; all held in a plush 5 star hotel at $500 / night or more with all travel included.

> there are rules and laws already in place

What rules there are are not enforced. The regulatory office is flooded [0]:

"With the risks clear, Schwartz and Woloshin took a look at regulatory activity by the Food and Drug Administration and Federal Trade Commission and state attorneys general. They found a lackluster response to the skyrocketing medical marketing across the board. In fact, the FDA’s Office of Prescription Drug Promotion, which regulates consumer and professional promotional material, actually saw a decrease in regulatory activity. Though submissions increased from 34,182 in 1997 to *97,252* in 2016, violation letters dropped from 156 to *11* in those respective years. The finding “suggests the possibility of less oversight,” the authors conclude, possibly because FDA reviewers may be “overwhelmed by the massive increase in promotional submissions.”

Emphasis added.

> Like it or not, having an expert in the hospital who know everything there is about a specific drug is a lot more effective than requiring every doctor to read about every new drugs.

Do you think unbiased third party sources can't perform this role? And having an expert in every hospital is not what we're talking about [0].

If you think these companies are spending twenty thousand dollars per doctor per year just to better educate them and get better outcomes, I don't know what to tell you. That's a lil naive bud.

To take just one example of many: Remember Purdue? Remember how they told doctors that their new form of opiates (Oxycontin) was non-addictive and so much safer? ... Remember how few doctors made noise about this, compared to the massive number who swallowed it whole and prescribes the shit like candy? Remember how those brave doctors were ruthlessly and relentlessly smeared, and how Purdue got away with all this despite there being mountains of evidence for so, so long?

> the first thing that would happen is adoption rate of new treatment would drop and people who would otherwise recover may die

To me that just sounds like scare mongering and an imagination deficit. There's better ways of doing this, and no excuse for the current system.

0 - https://arstechnica.com/science/2019/01/healthcare-industry-...

[HeatrayEnjoyer]

At that price they might have teams dedicated to groups of a few dozen doctors, perfecting the company's manipulation to each of the doctors' personality. Somehow for-profit pharma always finds a way to be even more horrifying...

[mandmandam]

They are already doing this, without doubt.

They identify thought leaders, analyze their data (who knows what data and how they analyze it?) to identify the best approaches, and have salesfolk and MSLs assigned to specific doctors, all to build relationships with tailored approaches and proven strategies. This is coupled with gifts disguised in various ways.

It bears repeating: submissions to the FDA’s Office of Prescription Drug Promotion, which regulates consumer and professional promotional material, hit 97,252 in 2016. This resulted in 11 violation letters.

Ninety-seven thousand submissions. Eleven violation letters. No typo.

$20k/doc/yr.

There may be more recent stats; I'm not finding them right now.