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Fight To the Finish – Why it Pays to Put on the Gloves

If you want to win the battle for doctors’ minds, stop complaining about – and start imitating– the pharmaceutical industry. Unless the healthcare and advertising industries suddenly collapse, you need to come to terms with the fact that drug companies are backed by an endless stream of resources, including marketing departments, advertising agencies, medical communication firms, public relation gurus and media firms.

Most drug companies spend 15% to 20% of sales on marketing. This adds up to a mindboggling amount of money. Lipitor sales were $7.8 billion dollars in 2008, so you do the math (IMS National Sales Perspectives™). You must accept that you do not have the same resources as the drug companies and never will. This doesn’t mean, however, that you have to take things lying down. Instead, I urge you to get in the ring and start fighting.

If you want to effectively deal with this formidable opponent (the pharmaceutical industry marketing machine), you may need to park your principles at the door. Your desire to inform, elucidate and educate physicians may be a valuable asset in the non-profit, academic and government worlds. Unfortunately, it will sink your ship when it comes to getting physicians to prescribe appropriately.

Most evidence-based technical reports and assessments start by asking key clinical questions. For example, a Drug Effectiveness Review Project (DERP) Report on drugs for schizophrenia might ask ‘do the atypical antipsychotic drugs differ in benefits (efficacy, effectiveness) or harms?’ If evidence based-medicine is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”(Cochrane Collaboration), drug marketing is the judicious use of rhetorical devices such as innuendo and inference in order to persuade physicians to prescribe brand name drugs.

In other words, while the Good Guys (you) are asking ‘how do I impart knowledge to physicians so that they prescribe according to best practices’, the Advertising Guys are asking ‘how do I get physicians to write more prescriptions so that we increase our market share?” While imparting knowledge may be a noble cause, there is substantial evidence that increasing a doctor’s knowledge does not lead to improved prescribing. This is evident to anyone who analyzes prescribing data, reads the academic literature or interacts with doctors.

Therefore, if you want to win the battle for the doctor’s mind and get physicians to prescribe drugs more appropriately, focus on what you want doctors to do, not on what you want them to know. Unfortunately, there is an entire industry fighting to do the opposite. Keeping this in mind will help you do a better job in communicating with your physicians.

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