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Aggressive drug marketing and resultant prescribing causes harm to patients

Kathleen Blanchard's picture

Medical ethicists suggest aggressive drug marketing harms most patients.

Investigators from University of Texas Medical Branch at Galveston say drug companies that market the most aggressively to physicians and patients are risking patient safety from a phenomenon described as the "inverse benefit law".

Researchers explored drug marketing tactics related to "blockbuster" drugs withdrawn from the market, finding high rates of patient exposure that compromised safety and public health. Examples include prescribing bisphosphonates for osteopenia - bone loss that has not progressed to osteoporosis, relying on statins for reducing the incidence of heart disease in the absence of proven results, and encouraging off-label use of anti-psychotics such as gabapentin and olanzapine that can harm patients and remain unproven for the treatment promoted.

The finding, published in the American Journal of Public Health, "is not a random occurrence, but rather a repeating, planned scenario in which drugs, discovered with good science for a specific set of patients, are marketed to a larger population as necessary, beneficial and safer than other alternatives," said co-author Dr. Howard Brody, a professor and director of the Institute for the Medical Humanities at UTMB Health. "Marketers are just doing their jobs. However, the reality is that for most new drugs, safety and efficacy are scientifically proven for only a small subset of patients. It's time for physicians to take a stand and not prescribe them so readily."

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The researchers describe prescribing bisphosphonates as 'disease mongering", saying loss of bone density, osteopenia, that is not osteoporosis has become a disease, but once was not treated. Efforts from drug companies have resulted in prescribing practices and designed to convince patients and physicians that drugs can stop the alleged disease from becoming worse.

"While we looked only at marketing directed toward physicians, direct-to-consumer advertising plays a critical role in driving demand for a drug by patients who fall outside the group that might truly need it, and pressuring physicians to prescribe it more readily," said Brody. "European countries are now debating whether to join the U.S. and New Zealand in allowing DTC advertising and we hope that our work could help inform that discussion."

The consequences of aggressive drug marketing to consumers and physicians has public health implications that can lead to patient harm from exposure to drugs with surrogate end points, and contribute to driving health care costs upwards.

The study authors note aggressive marketing tactics from pharmaceutical companies can lead to harmful side effects for patients and competition for scarce resources. The term "inverse benefit law', coined by the researchers, and inspired by Hart’s inverse care law, refers to drug marketing techniques that encourage prescribing drugs when there is lack solid evidence that a medication will help the condition being treated - something the researchers say is a common practice.

Am J Public Health, Jan 2011; doi:10.2105/AJPH.2010.199844