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United States of Pharma: Why Drug Marketing Rules American Healthcare

I often hear medical and pharmacy directors at public and private health plans express frustration over how physicians prescribe. These payers feel forced to use prior authorization to combat irrational prescribing. ”Why,” they ask, “do doctors ignore the evidence? Why don’t they follow guidelines?”

To me, the answer is obvious. When it comes to prescription medicines, there is the collective evidence point of view – represented by UpToDate, Dynamed and unbiased medical experts–and there is the pharmaceutical, biotech and medical device industry point of view. The problem arises because one side has so much more financial clout than the other. It is why, for example, any consumer watching television has heard about Crestor and Farixga, but has probably never heard of simvastatin or metformin.

Pharmaceutical companies touch virtually every aspect of healthcare delivery in America. Industry’s role in ADHD management, for example, stems back to the 1980s when companies began massive disease awareness programs targeted to school districts, parents, and pediatricians. These programs heightened awareness of ADHD, pointing out how certain behaviors were due to a biologically-based mental disorder best managed with prescription medications. While educating the public about how to diagnose and treat ADHD has proven to be profitable for pharmaceutical companies, having the pharmaceutical industry in charge of disease management in America may not always be good for our collective health.

Drug companies role in disease management extends beyond psych meds for kids. In the 1990s, pharmaceutical and biotech companies funded guideline development of erythropoietin-stimulating agents (ESAs) in patients with kidney disease. Around the same time, industry funded both diabetes guideline development and national PR initiatives that persuaded patients with Type 2 diabetes to get their HbA1c levels as low as possible, a practice shown by the ACCORD trial in 2008 to increase mortality in certain patients. Despite new updated ADA guidelines, many providers and patients strive to achieve the older lower A1c levels, numbers so  entrenched into our collective unconscious that overtreatment of type 2 diabetes in older adults remains a problem.

Of course, drug companies do fund educational initiatives that have social value. For example, in the late 1990s, the neuroscience division of Janssen, which at the time was headed up by Alex Gorsky, now CEO of Johnson & Johnson, generously funded educational programs designed to destigmatize schizophrenia.  At the time, I headed up the Risperdal account at an advertising agency in New York and got to work closely with Ken Steele, a person with schizophrenia who was one of the foremost mental health advocates of his time. Ken told me amazing stories about his life, mostly spent in mental institutions. One story involved his grandmother, who kept him locked up in a room because she thought he was possessed by the devil. What is worth noting is that while the newer antipsychotics contributed to Ken’s recovery, they also contributed to his morbid obesity and early death from a massive heart attack at 51 years of age.

One solution to the heavy influence of industry on health care in America is for medical schools to play a bigger role in consumer and provider healthcare education. America needs a new type of healthcare information, something that balances the impact of DTC and direct-to-professional advertising and delivers expert recommendations from unbiased medical experts a way in that resonate with people on an emotional, rational and subconscious level. If health care organizations divide and conquer — meaning that groups band together and share the costs of developing  content on different diseases and medications — the content could than be customized to suit the needs of individual stakeholders.

When the voice of medical experts is as loud as industry’s, we will see the reign of evidence over marketing in American healthcare. When that happens, we will have a system where each person gets the best possible treatment for their particular condition system, a system where patients — not profits— rules how drugs, devices and diagnostic tests are utilized.

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