At this time of year, I usually reflect on the year. But these days, my thoughts turn back my over three decades living and breathing the pharmaceutical industry.
Over the years, our industry has changed substantially – just has every other aspect of American life as we know it. Generally, the aspect of American life that was present when I started in this industry, and is ubiquitously absent now, is trust. Doctors trusted pharma sales reps and the companies they represented. Patients trusted doctors and hospitals. The FDA trusted the drug companies to supply honest data about products, and the drug companies trusted the FDA to act toward them with fairness and competence. And almost everybody had some level of trust in the Federal government. Maybe much of this trust was misplaced, even as far back as 40 years ago, but it was very real at that time, and it influenced the way that every transaction occurred. It's gone now, and I can't see it ever coming back, at least not in this country.
All that we see today – the shoddy oversight of drug approval and manufacture; the "less than 5 minute" sample drops that constitute a sales call today in the doctor's offices; the patients scanning the Internet for information to disprove what their doctor told them; the massive hospital billing fraud that is pervasive in every hospital financial section – choose your own medical horror story with a pharma connection-- all of this came about when trust broke down between the parties that made the drugs, and sold the drugs, and dispensed the drugs, and ingested drugs to alleviate medical problems. Pharma's pathetic image today has little to do with the drug companies or their products, but it has a lot to do with our broken culture and society.
But why did trust break down and why did things change? Looking back, I think there was an exact moment when I can look back and see it. It was when pharma started DTC Television ads. It wasn’t just one ad, it was the constant barrage of AstraZeneca’s constant bombardment of “purple pill” Nexium commercials and millions of dollars Merck spent on Vioxx ads (in fact, Merck spent more advertising Vioxx on TV than Nike or Budweiser spent). Personally, I felt that DTC advertisements were a good idea. I felt, and still feel, that DTC TV advertisements are not. And the consumer backlash against those ads was both predictable and significant.
I believe that DTC television advertising changed everything, and not for the better. In terms of eroding trust, pharmaceutical DTC ads did for pharma what the constant barrage of political ads did for politicians and our government. The patients watching TV came to trust their physicians less than before (which isn’t necessarily a bad thing), as they came to see the pharma messages as their main source of medical info. Obviously, the doctors trusted pharma companies less than before, as they saw their power and exclusivity eroding away. But mainly, the pharma companies realized that marketing money spent on TV ads produced more bang for the buck than research money spent chasing new drugs (definitely a bad thing). And none of this is any new revelation to anyone who has watched the U.S. healthcare system for any length of time.
And as patients began to see ever-increasing numbers of pharmaceutical sales reps clogging the waiting rooms of their doctor’s offices, they began to question what was happening behind the scenes. These young, hot fuck-bunnies (as one doctor referred to them in legal testimony) did not create confidence in our industry.
And I don’t see the trust coming back anytime soon.
