COHEN: Let's turn to ethics in the context of marketing. How can ethics assist in the decisions about the propriety of marketing
strategies?
SODEN: A lot of physicians hate direct-to-consumer advertising because it creates a dynamic that's very uncomfortable for them.
A patient walks in and says, "I saw this advertisement about such and such drug, and I really want it." We know that 40 percent
of physicians will prescribe based upon that scenario, even though there may be a cheaper medicine in the same class and the
new one is no more efficacious. And now, because of managed care and different market forces, the physician is sort of saying,
"I don't want the patient to leave."
CAPALDI: If you confine marketing just to physicians, one problem marketing people have is getting doctors' attention. In the past
that meant golf junkets to Maui, and people would say, "That's unethical. You're bribing the doctors." That puts the pharma
industry in an awkward position. If they concentrate just on physicians, rather than on potential patients, it raises ethical
issues about whether they're unduly influencing the choice of physicians. It's a damned-if-you-do, damned-if-you-don't situation.
PEREA-HENZE: If you talk to leaders in some of the medical associations, they tell you that sometimes the problem is to convince their
members not to expect giveaways anymore. We built a system in which, for an investigator meeting, you brought in not only
the investigator but the spouse and their children to Aspen for a week with first-class tickets. Now when you tell the investigators,
"No, we're not covering spouses," they actually get annoyed.
Then there is the other factor. Physicians' time spent with patients is also decreasing. It's much easier for a physician
to say, "Okay. Let me write a prescription," instead of spending 30 minutes explaining why something else may be better.
COHEN: What changes would you impose if you were running a hypothetical drug company's marketing department to make sure there
are evaluations of the right and the wrong thing from an ethical standpoint?
CAPALDI: I don't think that's where the problem is. I mean, as long as you're not misrepresenting what the product is doing.
COHEN: Well, there are two forms of misrepresentation. There's one in which there's a false statement made about a product,
and there's one in which there is not full disclosure of material information about a product. Would you make any changes
in the disclosure of information?
CAPALDI: No, I wouldn't. It seems the way to get full disclosure is in a competitive market situation. In other words, not only do
you make the case on behalf of your own product, but you make the case in terms of what you take to be its superiority over
the competition. And part of the sales pitch has to be, "These are our strengths, and here are the weaknesses on the other
side." I would not rely on a system that required one person to give the whole story. I think it would help the public if
we got away from the idea that this is a system where we have to be responsible for others. We have to promote the notion
that the responsibility falls on the patient and the consumer to do more.
SODEN: But part of the problem is that the public assumes FDA is not allowing anything to come up that has not been checked out
thoroughly. That's not necessarily true. Likewise, we're assuming that physicians understand all the epidemiology studies
and all the the science. That's not true either. Physicians understand very little of how studies really work. Even in peer-reviewed
journals, things slip by. The data just don't support what the abstract says is the final conclusion.
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