Physician Bailout: On Average, Pharma Pays Every US Physician Over $750 Per Year

The pharmaceutical industry has been very generous in making payments to physicians. Last year (2010), for example, a mere dozen pharmaceutical companies paid $760 million to physicians and other health care providers for consulting, speaking, research and expenses, according to ProPublica's "Dollars for Docs" project. ProPublica has taken "translucent" -- ie, difficult to analyze -- data reported by pharmaceutical companies and created a single database that makes comparisons simple (see here).

The database contains information about payments made to about 500,000 doctors. That's about half of ALL doctors in the US (including Peurto Rico). That works out to about $1,520 per doctor (or about $760 per EVERY doctor in the US), on average.

Of course, some doctors were paid MUCH more than this -- eg, pain specialist Gerald M. Sacks raked in $270,825 from Pfizer, Johnson & Johnson, Lilly and Cephalon in 2010, up from $225,575 in 2009. And some doctors received only $50 for lunch. At least 20 doctors, however, received "meals worth $2000 or more from Pfizer between July 2009 and March of this year," said ProPublica reporter Charles Ornstein.

According to the ProPublica database, Pfizer paid my doctor -- Catherine Spratt-Turner -- $388 for meals and $1,500 for speaking in 2010. This worries me because she wants me to come in and discuss my high cholesterol. Apparently, generic pravastatin is not doing the job and I suspect she wants to switch me to another anti-cholesterol medication. Will she suggest Pfizer's LIPITOR? I'll let you know when I see her. Previously, she was hot to get me on AstraZeneca's CRESTOR, which I resisted because of its published side effects. BTW, Spratt-Turner did NOT get any money from AZ last year.

This is exactly what worries some physicians who receive payments from pharmaceutical companies. As more and more searchable data becomes easily available to the public, they fear that patients will rebel and resist their advice if it appears that payments are influencing that advice. Oh, well! Welcome to the social media age!

The table above shows physician payments made by some pharma companies compared to sales. Surprisingly, Lilly spent about 2 times as much as did Pfizer despite having only about half Pfizer's sales volume. Perhaps Pfizer is more efficient than Lilly in targeting influential physicians? Nah! Viagra sales don't need much physician goosing to prescribe, whereas Lilly's Cialis needs as much help as money can buy. [I suspect, however, from the fees paid to pain docs like Dr Sacks, that Lilly is more concerned with promoting Cymbalta for pain.]

Overall, it appears that pharma companies tend to spread payments among physicians such that there is a more or less direct correlation between the number of physicians in a state and the amount of payments made to physicians in that state (see chart below).

Of course, $760 (or $1,520) per every physician is not going to improve a physician's lifestyle very much (although I am sure YOU and I would be happy to have an extra thou to spend every year!).

No, this money is central to what I call pharma's "prescribing recovery act" designed to grease the drug prescribing economy.

[This post originally appeared in Pharma Marketing Blog. 

Make sure you are reading the source to get the latest comments.]

How Sales Reps Can Use Tablets to Fool Their Sales Manager Overlords

While reading "How Pfizer Uses Tablet PCs and Click-Stream Data to Track Its Strategy" (see here), I was struck by two thoughts:

1. Pfizer's use of technology to collect sales analytics seems pretty basic; eg, David Kreutter, a Pfizer VP of US Commercial Operations, revealed a source of "predictive analytics" to be a simple Web log that shows what physicians click on and what they click through to when they visit a product website. But Pfizer doesn't have "any greater data on how those clicks translate into prescription writing."

and


2. The "real-time" data they get from sales reps using tablet PCs seems pretty easy to falsify. Here's how Kreutter describes it:
   
   "As they click the screens with their styluses to illustrate points, those clicks are recorded. That’s how we’re able to see things like the order of presentations, the messages within a presentation that were presented, if the physician found it engaging. Representatives synchronize their tablets on a daily basis, and we get a data stream back to our data warehouse. Our customer data master now has all of that click-stream data for each representative and each doctor."
   
   Maybe I'm being a cynic or not understanding the technology, but what's to prevent a sales rep from doing all the clicking while waiting in the physician's office hallway just to drop off samples?

This sort of thing is probably not new -- no doubt sales reps have falsified paper-based sales call reports as well. But now the amount of data coming in from 4,000 representatives, each seeing "about seven or eight physicians a day," and each detailing "about two to three products in each of those calls," provides a false sense of knowing in detail what's going on. As has been said ever since computers were invented, "garbage in, garbage out."

P.S. I also note that Kreutter only spoke about "tablet PCs" and NOT iPads. I guess Pfizer has not yet progressed to using that technology.

Boehringer Ingelheim and Ashoka Make More Health via Social Media

In preparation for my participation in the panel discussion entitled "Social Media and Professional Marketing…What’s Really Working?" on October 4, 2011, during the PharmaForce conference (see here), I am on the lookout for examples of "what's really working" in the pharma social media realm.

I did warn program director Kristin Paulick that I usually focus on what's NOT working. Kristin, however, noted that what’s not working is just as important as what is working!

Still, I feel compelled to start looking at the glass half full and come up with some examples of successful, useful pharma social media endeavors. The "Making More Health" partnership between Boehringer Ingelheim (BI) and Ashoka Changemakers is a good and timely example (see Ashoka and Boehringer Ingelheim Partner to Promote New Ways of "Making More Health").

“Making More Health brings together two organizations committed to finding innovative people and ideas to help shape the future of the health sector,” said Prof. Dr. Andreas Barner, chairman of the board of managing directors for Boehringer Ingelheim. “Through this partnership we will bring forth meaningful and sustainable solutions that can achieve individual and family well-being in communities around the globe.” 

Ashoka Changemakers "is a global online community that supports everyone’s ability to be a changemaker by inspiring, mentoring, and collaborating with other members of the community at every level of changemaking. Changemakers hosts collaborative online competitions to identify and connect the best social innovators and implementers. Participants compete to surface the most promising solutions, and then collaborate to refine, enrich, and implement them. Changemakers builds on Ashoka’s three-decade history of transforming the citizen sector by building the largest association of leading social entrepreneurs in the world."


Part of the "Making More Health" social media campaign is a competition whereby anyone can submit ideas to improve health. Eligible entries "may target a wide variety of populations throughout the world and include (but are not limited to) those that:

• Increase access to quality health services and treatment: Innovations may incorporate strategies such as addressing cultural and financial barriers, lack of transportation, decentralized medical resources, and gaps in education and knowledge.
  Solutions may include initiatives for disease prevention and diagnosis, developing healthy lifestyles, or advocacy and awareness programs relevant to any life stage.
• Empower individuals, families, and communities to address local health issues:Innovations may engage and inform individuals, families, and communities, and allow them to directly participate in the management of their own health. These span a range of solutions from communal patient care initiatives to programs that nurture a culture of health within communities.
• Target vulnerable and underserved populations: Entries may include those that address conflict and/or post-crisis environments, poverty and development as related to health, mental health, or rural health."

So far, 186 entries have been submitted -- a record number for Changemakers. It shows how a little pharma support in terms of money AND willingness to participate in social media can make a difference.

In fact, today between 3 and 5 PM Eastern US, BI and Changemakers will host #SocEntChat -- "a Twitter-based, real-time discussion about social entrepreneurship that focuses on specific issues, areas, or events. It is designed for current and aspiring social entrepreneurs, funders, media, and supporters to share their ideas, discuss the state of the field, identify the latest innovations, and pinpoint areas requiring more exploration. It is also an open forum for the global public to voice concerns and hopes, and propose ideas of their own!"

I plan to participate.

Of course, many of the innovative ideas submitted to "Making More Health" involve innovations for healthcare delivery in underdeveloped countries. Just yesterday, however, I was reminded that the US healthcare system also needs help. A @Pfizer_News Twitter post noted that "9 million Americans lost their healthcare in the last several years." What is Pfizer doing to help? They urge you to visit the "Pfizer Healthful Answers" website.

Pfizer, however, is not engaging in social media to discuss helpful ideas; they are just offering a "handout;" ie, free or discounted medicines for people who qualify for one of the programs they support.

IMHO, we need to find a way to PREVENT millions of Americans from "losing their healthcare" in the first place! Now, that would be an innovation!

[This post originally appeared in Pharma Marketing Blog. 

Make sure you are reading the source to get the latest comments.]

DDMAC's Bad Ad Program Catches Pfizer Using Google Style "bAdWords" on Lipitor Web Site

This is rich!

Recall that back in April, 2009, the FDA sent 14 "warning" -- actually notice of violation or NOV -- letters to major pharmaceutical companies citing as violative several short Google Adwords such as this Pfizer sponsored Adword for CADUET (find the screen shot of this as archived by FDA here and the letter FDA sent to Pfizer here):

I called such ads "bAdWords" way back in November, 2006 -- 3 and one-half years BEFORE FDA caught on (see "Lunesta, Google, and 'bAdWords'").

Last week (August 31, 2011), DDMAC sent ANOTHER letter to Pfizer about some Google-style violative "AdWords" it found in the “Online Resources” webpage of the Pfizer, Inc. (Pfizer) website for LIPITOR. One of the ads was for -- wait for it -- CADUET! THAT ad looked like this:

The CADUET link ad above is practically IDENTICAL to the sponsored Google ad, which FDA warned Pfizer about more than 2 years ago!

Either Pfizer's legal/regulatory team has NO organizational memory, or it tried to pull a fast one on FDA.

It should be noted that FDA itself did not catch this. It was submitted to FDA's "Bad Ad" program; a name no doubt inspired by my "bAdword" blog post mentioned above. And it was probably one of those other 14 companies that received letters from the FDA in 2009 that ratted on Pfizer (see "Majority of Bad Ad Complaints Submitted by Pharma 'Representatives' Deemed Worthy of 'Comprehensive Review' by FDA").

[This post originally appeared in Pharma Marketing Blog. 

Make sure you are reading the source to get the latest comments.]

Communication from Chairperson & CEO Office

Dear Panelists,

Greetings,

This note to all of you is to refute some reports in the media on the fate of the company’s petition in the Supreme Court of India. The Honorable court has not dismissed our petition nor has made any adverse remarks against the company. The petition filed was withdrawn with no consequence by the company on the advice from very senior legal counsels.

On their advice we have and are taking various steps to protect your immediate interests such execution of the exit policy, business as usual and the long-term interest of your company. Our legal team, which incidentally is one of the best in the country, has been working relentlessly in this direction. The opinion of all these eminent lawyers is that we have not done anything illegal or have contravened the law in any manner whatsoever. They have assured us that we should expect some respite by the 10^th September 2011.

I personally request each one of you to stand by the company in this hour of need and help us resole the crises. We will only emerge stronger and greater from all this.

I will keep you posted of all developments as and when it happens.

With warm regards

Harendar Kaur

Chairperson & CEO

Pharma Walks, Devices Balk When It Comes to FDA User Fees

While brand name drug manufacturers pay about 62% of FDA's $930 million drug review budget, medical device companies only pay about 20% of FDA's $292 million budget allocated to reviewing devices (see "Pharma Pays 62% of FDA's Drug Review Budget").

Are device manufacturers cheap skates?

I don't think so. My guess is that they don't have as many sympathetic people inside FDA as does Big Pharma. Why else would the device industry and its allies have been "especially vocal this year in denouncing what they perceive as the relative length and unpredictability of the FDA's device-approval process"?

Big Pharma on the other hand is suspected to have close ties to DDMAC. Of course, it cannot be proved that FDA plays favorites depending on how much of the bill is paid by the companies it regulates. However, I am keeping tract of two trends:

1. the rise in PDUFA (the 1992 Prescription Drug User Fee Act) fees (ie, user fees) and 
2. the number of warning letters FDA sends each year to pharma companies. 

I get the former data straight from the FDA (here) and the latter from EyeOnFDA blog, which monitors warning letters (here, for example). The following chart shows the trends:

It appears that 2010 saw a slight decrease in user fees received by FDA, but this is an early estimate that is sure to be higher in the next report. In fact, the WSJ article cited above indicates that "the Food and Drug Administration has reached an agreement with the brand-name drug industry on a five-year plan that will increase industry fees paid to the agency by about 6%." I'm pretty sure they are talking about a 6% increase EVERY year for the next 5 years. The average yearly increase over the past 12 years has been 16.7%. Hmmm... I guess the FDA expects to be reviewing fewer new drug applications in the coming years than in the past.

P.S. In 1997, only 36% of FDA's drug review budget was paid for by pharma user fees.

Brand(o) Pharma Makes Offer Generic Companies Can't Refuse!

According to the  Federal Trade Commission (FTC), some brand pharmaceutical companies are imitating Marlon Brando's portrayal of the Godfather: They are making offers to potential competitors that they hope can't be refused.

 As reported today in the New York Times (see here) "some drug makers are using an indirect method to delay competition from low-cost generic products by promising not to introduce their own generic versions if a potential competitor delays its entry into the market.

“Instead of saying, ‘Here’s $200 million, go away,’ they’re saying they could penalize them $200 million, but they won’t, so go away,” said Jon Leibowitz, chairman of the FTC.

The FTC issued a final report (attached to this post) on authorized generic drugs that concludes when pharmaceutical companies introduce an authorized generic version of their brand-name drug, it can reduce both retail and wholesale drug prices. The report also found that authorized generics have a substantial effect on the revenues of competing generic firms. Over the longer term, by lowering expected profits for generic competitors, the introduction of an authorized generic could affect a generic drug company’s decision to challenge patents on branded drug products with low sales. However, the report concludes that in spite of this, patent challenges by generic competitors remain robust.

Finally, the report finds that some brand companies may have used agreements not to launch an authorized generic as a way to compensate would-be generic competitors for delaying entry into the market.