Big Pharma needs to reevaluate their priorities

The Post and the Times have been covering the re-grouping of the big pharmaceutical companies' lobbying arm in Washington in reaction to the results of November's election. Big pharma is already alarmed that Democrats have promised to negotiate lower drug prices for Americans, which the Medicare Part D plan forbids. They are predicting a less friendly group of legislators while at the same time putting their energies in their big lobbying arms:

Many drug company lobbyists concede that the House is likely to pass a bill intended to drive down drug prices, but they are determined to block such legislation in the Senate. If that strategy fails, they are counting on President Bush to veto any bill that passes. With 49 Republicans in the Senate next year, the industry is confident that it can round up the 34 votes normally needed to uphold a veto.

While that showdown is a long way off, the drug companies are not wasting time. They began developing strategy last week at a meeting of the board of the Pharmaceutical Research and Manufacturers of America.

I have two thoughts after reading about such jockeying amongst the big pharma players and their allies in Congress. First, lobbying, at least in this industry (though I'm sure in others too), is not based so much on the merits of the interests that the lobbyist is representing but rather on the lobbyist's own ties with members of Congress and their staff. The Times and Post article both detail how the pharmaceutical lobbies are hiring people acquainted with members of the majority party. How much of policymaking is based on what and not who the legislator knows?

Second, lobbying sure costs a lot of money for big pharma. This is an industry that has two lobbying arms: the K street group whose targets are the Congress and the drug representatives whose targets are the physicians. Big pharma estimates that it spends 5.7 billion a year on marketing to doctors, another group estimates that 90% of the 21 billion in marketing that the companies have, or 18.9 billion is spent on marketing to physicians, a large part of that devoted to gifts large and small. The thought is of course that the physician will in turn prescribe their drug that they are hawking. Here's one physician's account of drug company "largesse":

It's gotten to the point that it's impossible not to partake of drug-company largesse when I attend a conference. Drug companies underwrite many of the talks, and even the buses that move us from lecture to lecture at no charge carry ads for popular drugs. Sure, I'll turn down the theater tickets and box seats at sporting events and the expensive tours, wine tastings, and meals, but it's impossible not to receive some form of freebie, however inadvertent.

Back at home, there's the community detailing with expensive luncheons and dinners, mostly with lectures attached, but not always. I receive invitations daily, and it's all free—not to mention the magazines and brochures that show up in my mail, without my having requested them. I can't tell who's been sending them; I wish they'd stop.

There's more too, for example, invitations to cruises, on which I could be paid as a consultant, to discuss "how I prescribe antidepressants." I was even gifted with a pricey, inscribed Mont Blanc pen when I became a medical director—I did not keep it—and<sup> the drug rep was upset, because who wants a pen with my name in gold?

Even if the physician makes an active effort to avoid submitting to the quid pro quo, studies have shown that gifts to physicians still have an impact on what the physician prescribes. Here's Dr. Charles Atkins' view:

Of course I'm influenced by them, I'm just not sure how much and in what ways. I have my suspicions, which are reflected in such questions as, Why are we so quick to abandon old medications when the new ones come out? If people spent the same amount of time, energy, and money extolling the virtues of off-patent medications, would we switch so quickly?

And Dr. Stephen Cha:

Like political contributions, these gifts are not necessarily improper, and some industry-physician collaborations can lead to important advances. But research shows that such largess affects physicians' prescribing practices and may compromise their objectivity.

Certainly if I knew that my doctor was getting $5,000 to $20,000 a year from the maker of Vioxx, I would wonder why the doctor was prescribing it.

It is often argued when a patent on a drug expires, allowing the sales of a generic counterpart, or when lawmakers express a desire to negotiate with the drug companies for lower prices, or when pharmaceutical companies are urged to sell expensive HIV/AIDS drugs to poor countries, that the research & development budget of that company will be negatively impacted to the point that it cannot possibly devote the same energies that it has in the past to develodevelopingrugs. However, companies like Merck, Pfizer, Bristol Myers Squibb, and so forth, need to take a look in the mirror when they can spend billions on lobbying to Congress and to doctors and still defend not losing some money by getting drugs to people who need them.