The investigative journalism website ProPublica, in conjunction with the New York Times medical blog The Upshot, recently published an article analyzing drug companies’ spending over the past five months in order to ascertain what drugs and medical devices they were promoting most heavily. The answer, it turns out, are medications that are not particularly cutting edge, or cures for diseases, or even their best-selling products. Instead, they spend the largest sums promoting what the story’s authors call “me-too” drugs–pharmaceuticals that do what other existing drugs already do, and not always better or with fewer side effects.
The article singles out diabetes treatment Victoza as “the drug associated with the most payments to doctors, by dollar amount” over the past five months, with its manufacturer Novo Nordisk spending more than $9 million promoting it. Critics, however, have pointed out medications like Victoza “carry an increased risk of thyroid cancer and pancreatitis.” The second drug on the list, with about $8 million in spending, is Eliquis, one of four blood-thinning medications in the top twenty (another of which is number three–Brilinta).
One pharmaceutical consultant interviewed for the story points out that many of these drugs associated with high spending made the list because they perform similar functions to others on the list: “They’re fighting over the same doctors, I guarantee you.” It is in drug companies’ best interest to outspend competitors if it means their product is prescribed more frequently.
One consumer advocate claims that if drugs are “either the first to treat a disease or […] much better than existing drugs,” they will “‘sell themselves’ on the merits of their unique benefits.” This is why ProPublica’s list is crowded with three diabetes treatments, four anticoagulants, three schizophrenia medications, two COPD drugs, and two multiple sclerosis treatments.
The medical device associated with the highest payouts to doctors is the controversial da Vinci surgical robot system, which (as we have reported in the past) one prominent Johns Hopkins surgeon and professor has claimed is emblematic of our country’s health care system: “rapid widespread adoption with little to no evidence to support it and increased costs.”
Intuitive Surgical, the company that produces the da Vinci, spent nearly $13 million on promoting the device whose components have gone through several recalls and which faces numerous personal injury lawsuits. Speaking on this matter in early 2013, the president of the American Congress of Obstetricians and Gynecologists said, “Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. Nor is it the most cost efficient. It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.”
Though many pharmaceutical companies claim that their funds are directed toward continuing medical education as to proper applications of their products, the data also suggests that some money is going directly into the pockets of doctors, which appears to be something of a conflict of interest. For example, the article’s authors point out that one Detroit physician took home about $75,000 in the past five months for his “promotional talks about several of the most heavily marketed anticoagulants and blood thinners, particularly Brilinta […].”
While this step toward financial transparency is a welcome one, it raises a lot of concerns about doctors’ motivations to treat patients with a given device or drug, especially when it comes to cases in which such treatments may pose a danger to patient health.