Finally, an op-ed that gets it right

When discussing the drug industry, it's rare to see a voice in a major media outlet that isn't crying out against the supposed evils of "Big Pharma." That's why it was so refreshing to read Paul H. Rubin's essay, "A Free Lunch," in the current issue of Forbes magazine.

Mr. Rubin points out the flaws in the arguments of drug industry critics, who usually bemoan the fact that marketing dollars "could be spent on research." As Mr. Rubin points out, cutting marketing spending would not result in an increase in research spending -- because if nobody will know about or buy a drug, why spend the money to develop it?

He also argues that the expectation of academics and politicians is that doctors should learn about new products from supposedly unbiased sources such as medical journals, and not from drug reps, is unrealistic. What doctor has the time to read through all the relevant journals? While each drug rep would be expected to present information most favorable to his brand, no doctor deals with only one rep -- he or she would have access to presentations from competing companies, and would be able to use his or her own judgment in evaluating them. I would add to this observation of Mr. Rubin's that the drug rep's presentation is actually less likely to contain a great deal of favorable information than a journal article! Why? Because the FDA doesn't regulate journal articles, but it puts a tight muzzle on what can be said in presentations by industry representatives. I'm often responsible for writing such presentations in my job in pharmaceutical advertising, and I cannot count the number of times I've seen a piece of data in a journal article that would support the use of the product I'm working on, but that we cannot put in print because the FDA won't allow it.

In short, Mr. Rubin argues that drug companies should be allowed to market their drugs to doctors without being demonized. I agree, but would add that even marketing drugs to doctors is a result of improper government intervention in healthcare. As I argued last year in "Rx for largesse," the reason that pharmaceutical companies devote so much money to wining and dining doctors is that prescription drug law makes the doctor, rather than the patient (who, after all, is the one consuming the drug and who will benefit or be harmed by it in the end), the decision-maker in pharmaceutical questions. If prescription drug law (which violates the right of a patient to put whatever substance into his body he pleases) didn't exist, then the drug companies' marketing budgets would be used not to market to doctors, but to patients. Then, a greater share of that money would go, not to buying lavish dinners for doctors, but to rebate offers and other means of competing for the consumer's attention, not the prescriber's. One can already see this with existing over-the-counter drugs: for example, while Tylenol does advertise to doctors to persuade them to recommend it for the treatment of arthritis, a far greater share of Tylenol's budget goes to coupons and other offers targeted directly at the consumer.

The point is, government intervention in pharmaceutical companies' marketing efforts is not a good thing. Kudos to Paul Rubin for recognizing that -- and having the courage to say it.