Drugs, Doctors and Doritos

Pharmaceutical Marketing Shouldn’t Be Held to a Different Standard than Other Products


Post By Jenn Tontini

In an article published in the Journal of the American Medical Association (JAMA), six authors came to the conclusion that the “receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship” (Colette DeJong, et al., 2016). This conclusion was reached through a cross-sectional analysis of pharmaceutical industry payment data from the Open Payments Program.

Let me share the subtext to the conclusion that the JAMA article makes: a poorly-designed cross-sectional analysis of incomplete data is the professional publication version of internet click bait. Researchers have positioned themselves as whistle blowers bringing attention to the unjust, unfair practice of promoting products to increase sales.

Dear pharma: you don’t need to duck your heads or apologize. Educational programs, advertisements and promotions are meant to do exactly that: educate, advertise and promote. The shaky suggestion that a modest meal being served while educational or promotional programs are being conducted is an insult to hard-working healthcare practitioners. They are spending their brief lunch or evenings off-duty learning about medications and disease states to continue their accumulation of knowledge.

At the end of the day, what we’re reading in this article is that education, promotion and advertisements work. We as a society believe in the power of education, hence, the proliferation of educational institutions and programs. We also know that promotions and advertisements work, right? It’s why companies pay millions of dollars for a spot during the Super Bowl, and how newspapers, magazines, and television maintain their entertainment mediums.

So why should pharma be any different than any other for-profit industry?

Imagine you’re the creators of Xarelto. You spent many years and millions of dollars in research and development to create the right drug. The marketing materials borne of years of market shaping and research. How do you tell the world how amazing Xarelto is?

Promotions. Advertising. You get Arnold Palmer (he of the iced tea/lemonade cocktail and golf hall of fame, among other distinctions), to tell people that “I went to my doctor and he perscribed XARELTO. It fits my lifestyle very well.” You provide samples of your product so people can see how wonderful it is. You build your market share one dose at a time, until you’re the market leader. You get new indications tested and approved, and increase your marketing budget with the expectation that increased marketing will translate into increased sales. It’s an investment in the growth of your product line.

But, pharmaceutical products reach a patent cliff, and soon generic competition looms. A generic manufacturing company recognizes your success and decides to launch a competitive generic product. They’ve copied your product in just a few months, as they’ve been able to piggyback on your R&D, and haven’t had the expense of having to duplicate your marketing efforts. They haven’t had to work to educate your customers about how wonderful their product is; you’ve already done all the work. Why bother with advertising and promotions? They’ve simply worked with the same distributors that you’re using to offer a comparable product at a lower price. It’s not 100 percent identical, but it has the same ingredients and is considered comparable. It’s a direct competitor for all of the customers you’ve worked to win over, and have been providing your product to without competition for all of these years.

Customers who are price-sensitive will immediately choose whichever option is comparable but less expensive. The customers with whom you’ve connected, that have become loyal to your brand, will continue to buy Xarelto. They might even try the generic, but discover that by either objective appraisal (the color is different,) or subjective assessment (it just doesn’t feel right,) that they prefer Xarelto.

Let’s pretend that instead of Xarelto being a blockbuster medication, it’s a delicious nacho-cheese dusted tortilla chip.

Let’s call it a “Dorito.” (My apologies to Frito-Lay for dragging you into this argument.) You have a company that makes these “Doritos,” and spends many years and millions and millions of dollars in research and development to create just the right product. The size. The shape. The color. The packaging. The marketing materials borne of years of market shaping and research. Millions and millions of dollars invested in this product, and you’re banking on it being a success. But how do you tell the world how amazing “Doritos” are?

Promotions. Advertising. You get Jay Leno (he of the cleft chin and Tonight Show fame, among other notable rolesdistinctions,) to tell the world to, “Crunch all you want. We’ll make more.” You provide samples of your product so people can see how wonderful it is. You build your market share one chip at a time, until you’re the market leader. You get new indications flavors tested and approved, and increase your marketing budget with the expectation that increased marketing will translate into increased sales. It’s an investment in the growth of your product line.

But a big box retailer sees your success and decides to launch a competitive generic product called Good Value brand Coritos. They’ve copied your product in just a few months, as they’ve been able to piggyback on your R&D, and haven’t had the expense of having to duplicate your marketing efforts. They haven’t had to work to educate your customers about how wonderful their product is; you’ve already done all the work. Why bother with advertising and promotions? They’ve simply worked with the same distributors that you’re using to offer a comparable product at a lower price. And it’s not 100 percent identical, but it has the same ingredients and is considered comparable. It’s a direct competitor for all of the customers you’ve worked to win over, and have been providing your product to without competition for all of these years. (Seeing any similarities yet?)

Customers who are price-sensitive will immediately choose whichever option is comparable but less expensive. The customers with whom you’ve connected, that have become loyal to your brand, will continue to buy Doritos. They might even try Coritos, but discover that by either objective appraisal (the color is different,) or subjective assessment (it just doesn’t feel right,) that they prefer Doritos.

The difference between Doritos and Xarelto is that no one is giving Doritos the stink eye for out-promoting competitors. No one is crying foul that Doritos gives away samples and sponsor advertisements. No one is accusing Doritos of bribing customers by providing information and including a modest meal as a courtesy while customers were told about all the R&D and available information about Doritos, along with warnings that eating too many Doritos may lead to health issues. Wait, you weren’t given warnings about how excessive use of Doritos could lead to obesity? WHERE IS THE OVERSIGHT FOR THE LOOSELY REGULATED SNACK FOOD INDUSTRY?

It’s a ridiculous comparison, right? Almost as ridiculous as the article published in JAMA.

It’s a transparent, easily-diffused attack on the pharma industry. The easy conclusion of, “When doctors have the opportunity to learn about a product, and that product is part of their top-of-mind awareness, they’re more likely to prescribe that product,” was ignored in favor of lobbying for the agenda of the authors.

Where was the examination of the promotions without accompanying meals? Where within the analysis were citations of other exposures to branded and unbranded medications noted or tracked? Many different exposures contribute to the decision to write a prescription. If the authors can use the scientific method to positively identify the cause-and-effect relationship that one exposure to product education or marketing had on healthcare professionals’ prescribing habits, they’d better be prepared for a line out the door of Madison Avenue ad execs lusting after their secrets.

And here’s a CRAZY notion: Maybe educational information and the dissemination of ideas from a group of their peers had a greater effect on their opinions and prescribing habits than any other marketing tactic. Let’s not draw the radical conclusion that eating a sandwich suddenly turned Dr. Smith into a Xarelto advocate. Don’t do healthcare professionals the disservice of insinuating that their key decisions are based on Panera instead of education. If we’re going to do a study, let’s make sure that all variables are taken into account, and not cherry-pick the ends that justify the authors’ means. Let’s give more credit to the healthcare professionals who work hard to make choices for their patients’ best interests, day in and day out.

And my personal experience leads me to believe that Doritos are better than Coritos. Would you like to know why? It’s one of the tools in a marketer’s bag of tricks that they call “peer influence.” My brother swears by Doritos, so I gave them a try, and now, they’re my choice, too. Would you like to try a sample?

This article has been edited from its first publication on the MedPoint Digital website in July 2016.