[e-drug] Pharmaceutical marketing and prescribing behaviour

[Hilbrand Haak <haakh@chd-consultants.nl>]

E-drug: Pharmaceutical marketing and prescribing behaviour
----------------------------------------------------------------------

Dear E-druggers,

For those of us who continue to be uncertain about what influences
prescribing behaviour of medical doctors, the below document may be
interesting reading:

     How does pharmaceutical marketing influence doctors'
     prescribing behaviour?
     De Laat, E., Windmeijer, F., Douven, R. 
     CPB - Netherlands Bureau for Economic Policy Analysis
     The Hague, March 2002

A full pdf version can be downloaded from:
http://www.cpb.nl/nl/news/2002_11.html

Interesting is that this document comes from a less common
source: the Netherlands Bureau for Economic Policy Analysis (Centraal
Planbureau - CPB). Although part of the Dutch Ministry of Economic
Affairs, CPB is an independent agency, and prepares up-to-date policy
analyses for the Dutch Government, Parliament and other organizations
in society, ranging from political parties to employer organizations and
unions. 

The bottomline of the report is that medical doctors are heavily
influenced by marketing activities of pharmaceutical companies.
Pharmaceutical companies spent 20% or more of their revenues on
marketing, more than in any other industry. An increase of 10% in
pharmaceutical marketing efforts results in an increase in demand of
3%. Approximately 40% of this increase is at the expense of demand
for other products, the remainder comes from an overall increase in
demand for drugs. Findings were based on a study of Dutch
prescribing practices and marketing data of 11 common drugs in the
1994 - 1999 period. 

Medical doctors value drugs higher and prescribe them more frequently
the more marketing information they receive on them. According to the
study, pharmaceutical marketing activities reduce price elasticity in
prescribing behaviour of doctors, a reduction that was found to be
statistically significant. Marketing activities specifically focussed on
doctors, e.g. visits and direct promotional texts, reduce this price
elasticity to nearly zero. Based on these results, CPB proposes stricter
rules, include bans on "training" activities sponsored by the industry,
or banning pharmaceutical company grants for participation of
physicians in post-marketing research as a way to promote specific
drugs.

CPB argues that in a sub-market, e.g. that of anti-hypertensives,
antacids, and anti-depressives, where marketing activities increase,
prescribing behaviour of doctors becomes less cost-conscious. This is
unfavourable for welfare in a nation, as it provides pharmaceutical
companies with extra market power, a power that may manifest itself
in price increases or absence of price decreases.

Dutch Minister of Health Els Borst pressed doctors and pharmaceutical
manufacturers some years ago the into preparing a code of conduct,
but the Dutch Medical Association recently confessed that this code
needs to be updated. 

Nefarma, the Dutch pharmaceutical manufacturers association said
that it was "baffled". According to Nefarma, medical doctors choose
drugs on the basis of quality, not on the basis of their price. Nefarma 
feels that "CPB confuses marketing with promotion", and that "the
majority of our marketing activities consist of knowledge transfer
and information exchange".

Hilbrand Haak
Consultants for Health and Development
------------------------------------------------------------------------
Sleedoorntuin 7         tel: +31-71-523.2052
2317 MV  Leiden         fax: +31-71-523.3592
The Netherlands   e-mail: haakh@compuserve.com

Visit CHD's website at www.chd-consultants.nl

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