Controlling Drug Promotion

The US and New Zealand are the only countries that allow direct-to-consumer (DTC) advertising of pharmaceuticals. The policy debate in the US involves whether or not DTC advertising should be controlled. On Wednesday, I presented a paper on the topic in the Health Care Track at the Winter Simulation Conference. My response to the policy debate: controlling DTC advertising is unlikely to have much impact and misses a better approach to controlling overall drug promotion.

The time plot above (from the Donohue et. al. 2007 data set), provides the simplest summary of my findings. DTC advertising has increased modestly since 1997 when the FDA modified its side-effect disclosure rules to allow television advertising. The real action, as can be seen from the time plots, involves free samples and promotional detailing (pharmaceutical sales agents direct contact with physicians). In fact, starting in 2004, there has been a substitution between free samples and promotional detailing. Detailing is expensive and physicians tend to discount claims of sales agents. The marginal cost of handing out free samples is very small and has a powerful effect on future prescribing. Controlling free samples and detailing, rather than the much more visible DTC advertising, provides the most direct path to controlling the effects of drug promotion on the sales of patent medicines.