One thing drug companies are really good at is sales and marketing; persuading doctors to prescribe and patients to want their medications, sometimes even when it isn’t in the patient’s best interest. One of most popular marketing techniques, aside from direct-to-consumer advertising to drive demand (and drive physicians crazy) is detailing, or having sales representatives do in-person meetings with prescribers and usually leave samples for dispersement to patients. (JAMA Article) A research letter in the Journal of the American Medical Association Internal Medicine elucidates trends in prescriber detailing. According to the article, drug companies spent $18.5 billion in 2016 on detailing and samples, the single biggest category of marketing expense. In recent years, some providers have limited or banned detailing. The authors conducted a survey of outpatient practices to determine the prevalence of detailing. Practices with over three physicians were included in the survey and they were categorized as independent, medical groups with more than one practice, a practice affiliated with more than one hospital, and practices associated with large multi-hospital systems. 41% of practices were independent and 34% were associated with large, complex health systems. About half of all practices had at-least weekly detailing visits and had samples on hand. Weekly detailing was more common in the independent practices, at 60%, compared to 39% in complex systems. 55% of practices with less than 10 physicians had weekly visits compared to 27% of those with over 20 doctors. Non-academic medical center physicians were much more likely to have visits as well. It appears likely that around half of physicians are still getting in-person visits by pharmaceutical sales representatives.
I have expressed my view before that both direct-to-consumer advertising and detailing should be banned. They both create potential unwarranted demand and banning them would create a lot of savings for drug companies that could (but given the behavior of most drug companies, probably won’t) be used for price reductions. HHS could create a large database of all products, accessible to consumers and prescribers, which would give all the information on use, indications, side effects, summarize research, etc. It could also support creation of material to be given patients on the use of the products. This would ensure that people get factual and balanced information that allows for good decision-making. And more providers should voluntarily aid this transition by refusing to allow any in-person marketing by drug manufacturers.