Pharmaceutical advertising down but not out

According to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health, advertising peaked in 2004, with industry promotion to physicians declining nearly 25 percent by 2010, to $27.7 billion or 9 percent of sales. Similar declines were seen in direct-to-consumer advertising, which remains concentrated among a small number of products. The number of products promoted to providers peaked at over 3,000 in 2004, and declined by approximately 20 percent by 2010.

Despite these changes, there was little change in the split of marketing between primary care physicians and specialists, and the proportion of all promotion taking place in physicians' offices also remains unchanged. Free samples and physician detailing accounted for over 70 percent of promotional expenditures in 2010, with the remainder comprised by consumer advertising as well as physician marketing through journal ads, e-promotion and sponsored conferences and meetings.

The results are featured in the February 2013 issue of the open-access journal PLOS ONE.

"There have been important changes in the pharmaceutical marketplace during the past decade, including changes in the types of therapies being brought to market as well as an overall aging of the drugs with FDA approval," said G. Caleb Alexander, MD, MS, senior author of the study and an associate professor with the Bloomberg School's Department of Epidemiology and co-director of the Johns Hopkins Center for Drug Safety & Effectiveness. "Since pharmaceutical promotion can influence demand for drugs and affect physician prescribing, it is important to know how drugs are being marketed and promoted."

Alexander, along with colleagues from the University of Chicago, the University of Pittsburgh, Massachusetts Institute of Technology and the National Bureau of Economic Research, analyzed annual data from 2001 through 2010 to examine inflation-adjusted total promotion spending for the pharmaceutical industry as a whole and for top-selling and top-promoted therapies. Expenditures were also broken down by type of promotion and, for physician detailing, by specialty.

The authors were surprised to find that, despite anecdotal reports and calls from professional societies, there was no substantial change in the amount of overall proportion of promotion taking place in physicians' offices. Lead author Rachel Kornfield describes, "There has been growing concern about the conflicts of interest introduced by physicians' relationships with pharmaceutical companies, but the data show that physician detailing and the distribution of free samples is still the dominant form of drug promotion."

In addition, despite enthusiasm and publicity regarding new forms of marketing via the Internet and other electronic media, these channels accounted for a very small amount of overall marketing spending to providers -- less than 2 percent over the decade examined. The authors found that the majority of marketing and promotion still takes place as it has in the past -- through the distribution of free samples to patients and office calls to physicians.

The research was funded in part by the Agency for Healthcare Research and Quality (RO1 HS0189960).