Anyone who has experienced the assault of the
pharmaceutical industry''s marketing campaigns would appreciate Jennifer Berry''s
one-person play Big Pharma: The Rise of the Anti-Depressant Drug Industry and the Loss of a Generation. Since the mid-1990s, spending on drug promotion has grown steadily, reaching 21 billion in 2002. Berry explores the fallout of this expanded marketing blitz through the eyes of its masterminds, unwitting (and complicit) abettors, and victims through her portrayal of an
advertising executive, a physician, and women and children who are prescribed heavily marketed antidepressants.
A primary target of the
pharmaceutical industry, physicians receive not just advertising materials but office visits from drug representatives. Berry''s physician, depicted as a pawn of the pharmaceutical industry, gratefully accepts the free drug samples, the free lunches, and the pharmaceutical industrysponsored trips to tropical islands. In fact, the pharmaceutical industry woos physicians with educational dinners, honoraria for participating in conference calls, consulting fees for participating in speakers'' bureaus, research funding, and payments to write scientific publications. And physicians act as agents of the pharmaceutical industry in many ways, such as giving talks that favor a company''s product, participating in clinical trials that increase physicians'' exposure to a new drugs or new indications for old drugs, and publishing research articles that are financed and, in fact, written by pharmaceutical company employees .
In addition to reaching physicians directly, the industry promotes consumer familiarity with particular drugs. In 2002, almost 3 billion of the industry''s drug promotion budget was spent on direct-to-consumer advertising , with advertising venues spanning from print media to radio, television, and the Internet . In her play, Berry notes that direct-to-consumer drug advertising skyrocketed in the United States after a 1997 change in the Food and Drug Administration guidelines for advertising. She also gives a nod to the nearly incomprehensible patient information that must be provided with each ad: We tell them to buy it, then tell them why not to buy it. And, the why not is presented in an illegible font in print ads, or high-speed chatter for television and radio.
Less obvious marketing strategies include using opinion leaders, and sponsoring education programs, scientific research, publications, and professional meetings. The pharmaceutical industry has also extended its influence to clinical trial administration, research design, regulatory lobbying, physician and patient education, drug pricing, pharmacy distribution, and drug compliance .
There is a wide range of evidence suggesting that all of these marketing strategies influence physician prescribing and affect patient attitudes and behavior. Interactions with the pharmaceutical industry increase the likelihood of physicians prescribing inappropriately or making formulary requests for the company''s product . Yet health professionals at all levels of training tend to believe that they are not influenced by the drug industry . For instance, research suggests that most health-care professionals think information from drug companies is biased, but many think it is useful nonetheless. With regard to direct-to-consmer advertising, most doctors are opposed to it, primarily because it negatively impacts the doctorpatient relationship and pressures doctors to prescribe drugs they might not otherwise use ,.
Empirical evidence regarding direct-to-consumer advertising shows that it acts as promotion rather than education, often includes inaccurate, misleading, or unbalanced information, frequently includes emotional appeals to anxiety about illness, underplays risks, omits mention of costs, and tends to promote the medicalization of normal health and minor ailments . And consumers tend to have positive views of drug