Fake News Mustn't Drive the Healthcare Debate
By Peter J. Pitts
There's a dangerous disease spreading amongst political and media elites -- "soundbite-itis." It causes policymakers to advocate ill-informed policies that hurt the very people they want to help.
Exhibit A: The Washington Post, John Oliver, and state legislators are all alarmed that the pharmaceutical industry "spends more on sales and marketing than on [research and development]." They want to impose new restrictions on drug companies' advertising to stop this seemingly wasteful spending.
Let's set the record straight. When pundits and politicians speak about "sales and marketing," the picture they paint is of direct-to-consumer pharmaceutical advertising -- the public face of Big Pharma.
In 2016, drug companies spent $5.6 billion on DTC ads. In recent years, they spent roughly $60 billion on R&D. Commercials featuring amorous middle-aged couples in claw foot bathtubs are a lot sexier than lab equipment and research teams, but they're not nearly as expensive.
Admittedly, total marketing budgets exceed R&D budgets at most big drug manufacturers. But the category of "marketing and sales" is extremely broad -- it includes product sampling and communications to tens of thousands of physicians, legal and accounting fees, salaries, rent and utilities, and all post-licensure programs deemed necessary by the FDA. These nuts and bolts aren't cheap. For the ten largest drug companies, marketing expenses totaled nearly $100 billion in 2013.
Additionally, R&D reported investment is only for pre-approval investment and doesn't take into consideration post-approval R&D expenditures, which totaled $20 billion in 2011 and have likely grown since.
In other words, companies spend roughly the same amount to create breakthrough drugs as they do to market them. That's a more balanced ratio than every other industry. Pharmaceutical firms spend a higher proportion of their total budgets on R&D than companies in any other sector.
But let's address the elephant in the room -- DTC advertising. Yes -- it's good for business (otherwise it wouldn't exist) but it's also good for the public health. And, no, it doesn't make medicines more expensive.
In fact, there's little or no correlation between a brand-name drug's DTC advertising budget and its cost. Heavily-advertised brands do not necessarily cost more than their less-advertised competitors.
DTC advertising helps patients get the treatments they need faster --- so that they can avoid long-term health care costs. Properly done, pharmaceutical advertising de-stigmatizes certain diseases and encourages people to talk with their doctors about problems previously considered taboo -- like depression.
Additionally, DTC advertising actually helps patients receive proper treatment. The FDA found that 87 percent of patients who requested a prescription drug by name because of an ad, actually had the condition that the drug treats. In six percent of those visits, doctors even discovered a previously undiagnosed condition in the patient.
This isn't to say that doctors prescribe medicines based on patients' whims. Only seven percent of doctors reported feeling "very pressured to prescribe" a particular advertised drug, according to an FDA study. And that "pressure" was more time pressure -- patients came into the offices armed with more questions.
According to an FDA study, a majority of doctors feel that DTC advertising increases patient awareness and involvement, improves compliance, and enhances the overall doctor-patient relationship.
Pundits and policymakers need a dose of facts -- not the alternative kind -- to cure their soundbite-itis. Drug ads help sell products, but also advance public health without affecting prices. There's no reason to restrict them.
Peter J. Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest.
