How can I make sure I am getting a drug that is effective, safe and affordable? How can I help my doctor get unbiased information?

Generics are Powerful Medicine is pleased to offer visitors to our website a new resource, Ask Pharmie. Ask Pharmie is an occasional "advice column" put out by another project at Generics are Powerful Medicine's parent organization Community Catalyst, Prescription Access Litigation. Ask Pharmie aims to answer common consumer questions about prescription drugs and the pharmaceutical industry.

There’s been a lot in the news lately about prescription drugs that end up harming people.  If these drugs were dangerous, why did doctors prescribe them in the first place?  Shouldn’t doctors know about dangerous side effects?

Doctors in general want what’s best for their patients and wouldn’t prescribe drugs they knew to be dangerous.  Unfortunately, many doctors do not know as much as we’d want them to about the risks and side effects of new medications.  Partly, this is because doctors today have barely enough time to treat their patients and do the mountain of paperwork they have to do, let alone time to research every new drug that hits the market. 

Today, it’s very difficult for doctors to find reliable and unbiased information about a drug’s benefits and side effects. This makes the problem worse.  Traditionally, doctors have learned about new drugs from studies published in professional medical journals that are “peer reviewed.” This means that other doctors not involved in the study have examined it to make sure that it was accurate and unbiased.  Unfortunately, more and more of these studies are sponsored by the drug companies themselves.  A survey showed that drug studies sponsored by the drug industry were four times as likely to be favorable to a drug as studies sponsored by the National Institutes of Health.  More and more, even when doctors rely on medical journals, they are not getting the full story.

However, even more troubling is that doctors are relying more and more on drug companies to tell them about new drugs.  

Why should I be worried that Doctors are getting their information from drug companies?  Don’t they know best the risks and benefits of their own drugs?

Yes, pharmaceutical companies generally know more about their own drugs than any other source.  The problem is that they have a strong incentive to be less than truthful about what they know.  Like any other business, drug company profits are directly related to how many people buy their product (i.e. fill a prescription). Therefore, it is not necessarily in their best interests to provide impartial information. 

In order to sell their products, these companies use sales techniques that paint as rosy a picture of their drug as possible. Too often, this means exaggerating how good a drug is and downplaying its side effects.  For example, think about drug commercials you’ve seen on TV.  They show people frolicking through fields of flowers and create the impression that prescription drugs are “cure-alls” with no side effects.

But won’t my Doctor make the right choice, even if I can’t? Don’t doctors see through the advertising pitch?

Not necessarily.  Doctors are also affected by advertising. Although most doctors deny being influenced by industry sales pitches, studies show that visits from drug salespeople do actually increase the number of prescriptions a doctor writes for a particular company’s drug.  Drug companies know this and spend $5.5 billion per year marketing to doctors, which is more than what they spend advertising to consumers. Drug companies employ nearly 80,000 salespeople, called detailers, who travel to doctor’s offices pitching new drugs and offering perks like free samples and free lunches. As Kathleen Slattery-Moschkau, director of the drug salesperson comedy Side Effects, explained in an interview:

There is no educating going on. It is all about manipulation and spinning things in a way that is going to drive market share. It is never about what is in the patient's best interest. It is always about "what are the ways that we can get to this doctor to write more prescriptions for our drug?”

 The goal of detailers is to create brand loyalty. When it comes to most consumer products – say, laundry detergent or soda -- this is relatively harmless.  But drugs are not like other “products” – they’re medical treatment. Drug companies promote the newest, most expensive brand-name drugs.  Often, those newer drugs are no more effective than older generic or over-the-counter drugs, and have less of an established record of safety than older drugs. Promoting the newest and most expensive drugs drives up costs for both patients and the health care system, without necessarily improving health.  Many “new” drugs today are what are called “me too” drugs. “Me too” drugs are minor variations of drugs that are already available, with no major breakthroughs. Their only purpose is to help the company capture a share of the market for that drug. If a drug truly is a breakthrough, it doesn’t need salespeople to promote it.  

How can I make sure I am getting a drug that is effective, safe and affordable? How can I help my doctor get unbiased information?

It is always a good idea to be cautious when it comes to medication. Even the best physicians can be seduced by manipulative drug company marketing from time to time.  Don’t be afraid to ask questions.  Here are some questions to ask your doctor about any drugs you’re prescribed:

• How did you learn about this drug? Are you relying on information from drug company salespeople?
• Is this a free sample? If so, is there a generic or over-the-counter drug that I can use that is cheaper when the free samples run out?
• How long has this drug been on the market?  Are there any safety concerns with it?
• Are the benefits worth the side effects, the expense and the risk of interactions with other drugs I take?
• Do you have any financial ties with the company that makes this drug?

You can also encourage your doctor to take a pledge not to see drug salespeople and to use independent unbiased sources to learn about drugs. Refer them to No Free Lunch, www.nofreelunch.org.  Finally, be an informed consumer and learn as much about your medications as you can.  One good source is Consumer Reports’ Best Buy Drugs – www.crbestbuydrugs.org.

Ask Pharmie answers readers’ questions about the pharmaceutical industry, drug marketing, drug pricing, and the like. He does not answer medical or treatment questions, or render medical advice. We encourage readers to send their questions to Pharmie.