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7 Marketing Is Not Objective Education Every year, practicing physicians receive a free copy of the Physicians Desk Reference (PDR), the reference that most of them make use of as a source of drug information. “Overall, doctors refer to the PDR 265,000,000 times a year.”2 e information in the PDR is written by drug companies and the companies support financially the distribution of free copies to 500,000 physicians, hospitals, and libraries.3 e PDR is another of the gifts that the drug industry provides physicians. e PDR contains useful information, most of it being the information contained in the package inserts that are distributed with drugs. It is essential to note, however, that the information in the PDR does not come from independent sources and that the free distribution every year effectively prevents independent references from competing successfully for physician attention and use. An independent drug reference might be expected to make “recommendations for selecting the best drugs and dosages for each clinical problem.”4 Such a comparison of different medications is not the kind of information provided in the PDR. e pharmaceutical industry cannot be held responsible for the failure No one should rely on a business for impartial evaluation of a product it sells. . . . [T]here is an inherent conflict of interest between selling products and assessing them.1 94 Marketing to Healthcare Professionals of medicine to develop and distribute a better source of information on drug use, though its financial power and its influence might contribute to medicine’s failure to do its own education better. e key point here is that the industry is the most important source of physician information about drugs. e PDR is just one way in which the pharmaceutical industry provides information that practicing physicians have about the drugs they can prescribe. e industry also makes extensive use of clearly recognized marketing techniques: visits by sales representatives , exhibits at professional meetings, advertisements in medical journals, company-sponsored presentations. e industry usually describes these interactions with healthcare professionals as “educational.” According to the PhRMA Code, “Informational presentations and discussions by industry representatives and others speaking on behalf of a company provide valuable scientific and educational benefits” (section 2). Critics of the ways in which the pharmaceutical industry influences the practice of medicine see the relationship between marketing products and educating physicians in a quite different way: the nature and purpose of marketing and the nature and purpose of education are essentially different. “[I]t is not really possible for companies to promote their drugs, which means touting only their favorable effects, and to provide impartial information, some of which might be unfavorable .”5 John Abramson contends that, among the factors in the storm threatening American medicine, the most important, “the eye of the storm,” is this: “the transformation of medical knowledge from a public good, measured by its potential to improve our health, into a commodity, measured by its commercial value.”6 In marketing drugs, with the emphasis on sales, the temptation is always to present primarily the kind of information that presents the product in the best possible light. In more objective medical education on drugs, the commercial emphasis is radically limited, encouraging an emphasis on the health benefits and the risks of the medication, usually with reference to other drugs and other options. Even though companies have an interest in being honest about the risks of a drug so that they keep physicians’ trust, this does not remove the conflict between marketing and education. 95 Marketing Is Not Objective Education ere are other sources of information about medications available to physicians that are not ordinarily understood as marketing —such as articles in peer-reviewed medical journals, professional medical education programs (including Continuing Medical Education [CME] programs), and published clinical guidelines. ese informational sources are provided by professional organizations and are generally thought to be quite separate from marketing . Even in these professional situations, however, there is concern about the independence and objectivity of authors and speakers. Most of the studies of medications that are published in the journals are sponsored by drug companies; CMEs are often supported by these companies, at least in part; writers of clinical guidelines are often consultants to the drug companies whose products they are evaluating. ese concerns are addressed in other chapters. In this chapter the focus is on the responsibilities of the industry when it provides information on drugs to physicians in a marketing context. CAVEAT EMPTOR e PhRMA Code includes...

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