Science -- Not Food and Flattery -- Sways Doctors' Prescription DecisionsPublished: December 13, 2007 in Knowledge@Emory
Tune in to your television any time day or night—over morning coffee and talk shows, your favorite soap opera or the evening news—and you’re likely to catch a commercial featuring medications for depression, insomnia, allergies, arthritis and even sexual dysfunction. The best way to know if this medicine is right for you? Just ask your doctor, they recommend.
The proliferation of these types of spots—known in the marketing biz as direct-to-consumer advertising—has helped consumers to become more involved in their own healthcare decisions. And yet some people argue that patients are powerless to the whims of their physicians, who are far too easily influenced by the marketing finesse of their favorite pharmaceutical sales reps (all the more prevalent as pharmaceutical firms continue to bolster their sales forces) and therefore dispense the prescription du jour, rather than the most effective treatment. This perception suggests a cozy relationship between doctors and pharmaceutical firms. The debate, fueled by the perspectives of doctors, pharmaceutical firm executives, and public policy administrators and studied from different angles by academics, questions how the marketing actions of pharmaceutical firms affect whether and when physicians write prescriptions or dispense samples. What’s more, how do other factors, such as patient requests for a specific drug, affect doctors’ decisions, both in writing prescriptions and dispensing out drug samples?
Marketing experts Sriram Venkataraman, an assistant professor of marketing at Emory University’s Goizueta Business School, and Stefan Stremersch, a visiting professor of marketing at Duke University’s Fuqua School of Business and a chaired professor of marketing at the School of Economics, Erasmus University Rotterdam, The Netherlands, are pleased to publish their latest research in the middle of this surging controversy.
Their paper, “The Debate on Influencing Doctors’ Decisions: Are Drug Characteristics the Missing Link?,” published this November in Management Science, provides evidence that the role of specific drug characteristics, such as a drug’s effectiveness and a drug’s side effects, may tip the balance in this debate. “We set out to see if we could help answer this debate over the effects of marketing on physician prescribing,” says Venkataraman. “Is this something regulators either need to crack down on if consumers’ healthcare is being compromised, or if that’s not the case, should we just let this ongoing practice be? Our paper is really addressing two touch points: marketing aimed at the physician directly via pharmaceutical firms’ sales rep calls (referred to as detailing) and also the indirect effect of marketing efforts, which comes through patient requests.”
Adds Stremersch: “We consider the effectiveness of marketing instruments with the voice of the patient and we look at the contrast between the two. That is really rare. Many more patients are requesting drugs by brand name to their physician, but we know little about the effect of those requests on physician behavior.”
Venkataraman and Stremersch propose a model using data that includes detailed information on drug manufacturers’ sales visits to physicians, physician attendance at manufacturers’ meetings, and drug requests of patients for 2,774 physicians in the U.S., as well as the number of prescriptions written and samples given out by each of these physicians on a monthly basis. They also compose their own two data sets on effectiveness and side effects of each drug in their database.
The authors’ analysis yields five key findings, all of which speak to how both direct and indirect marketing efforts affect doctor decision making. They find that marketing efforts are more rewarding for more effective drugs than less effective drugs; additional marketing efforts can actually hurt less effective drugs; marketing efforts are more rewarding for drugs with more side effects than drugs with fewer side effects; physicians will accommodate requests more often for drugs with fewer side effects than for drugs with more side effects; and physicians are more responsive to patient requests for more effective than less effective drugs.
Policy makers—as well as consumers and doctors—will welcome the outcome that marketing efforts are far more rewarding for effective drugs than ineffective drugs. “This evidence suggests that physicians are not being swayed to prescribe ineffective drugs over effective drugs to patients,” notes Venkataraman. What’s more, adds Stremersch, “The pharmaceutical firm that sends sales reps to physicians to talk about drugs that are not effective actually gets a negative return on its detailing effort. That’s very much in line with what public policy would want. More effective drugs get promoted and therefore get prescribed. Meanwhile, if the pharmaceutical firm decides to promote less effective drugs more heavily, this can actually cause doctors to write fewer prescriptions for their drug.”
Doctors are also good professors, according to the research, when it comes to the study’s analysis of another drug characteristic -side effects. “Basically, physicians are more responsive in prescribing if they get reps to talk about drugs with many side effects than drugs with fewer side effects,” explains Stremersch. “The beneficial role of marketing information not only tends to promote effective drugs and not ineffective drugs, but it also tends to give physicians more information about side effects than in the case where there are fewer side effects. A physician really is engaging with the pharmaceutical firm in an information exchange about effectiveness and the side effects that the drug might have.”
Venkataraman and Stremersch also conclude from their data that patients’ requests for certain drugs do have an influence on the prescriptions that physicians write -but not one that is harmful to the patient. They find that physicians are very accommodating when patients request a drug that is effective and has very few side effects. “Some people in the medical field have hinted that basically whatever you request from a physician you’ll get,” says Stremersch. “Our findings show that the physician really does moderate the requests he or she gets from patients by the effectiveness of the drug and the side effects. The patient request itself will not lead to a dramatic endangering of public health.”
Ultimately, doctors’ decisions about the drugs they use to treat their patients are based on science, suggest the authors, and not on some combination of food, flattery and friendship that they may enjoy from big-pharma marketing reps. “There is evidence that physicians actually rely on science while prescribing, as opposed to the concern out there that physicians are overlooking science and being swayed purely by the marketing efforts,” says Venkataraman. “We find across both dimensions of direct marketing to physicians and indirect through patient requests that physicians are actually taking the science into account.” The research also suggests that physicians seem to be as thoughtful about drug characteristics in their sampling behavior as in their prescription behavior.
In addition to validating docs as effective gatekeepers, “The Debate on Influencing Doctors’ Decisions” offers good news for those who value the role of marketing information in health care. This has important implications for public policy. “The entire frenzy of the need to cut firm behavior like some scary movie where we’re thinking of pharma firms shoving drugs in our veins just for the sake of profits doesn’t flow well with our results,” urges Stremersch. “Marketing information can have a scientific purpose. It’s not about buying off physicians. Also comforting for public policy is that our research shows that when pharmaceutical detailing [sales] calls are more scientifically grounded, meaning they are talking about the many side effects that a drug may have or they are talking about the scientific evidence that a drug has been shown to work in a patient’s body, they are more effective.” This bodes well for big pharma, suggests Stremersch, as the industry transitions to the practice of hiring sales reps with more sophisticated scientific skills, and supports the need for more evidence-based marketing.
Both Venkataraman and Stremersch hope their study triggers more balanced research on physician responsiveness to pharmaceutical firms’ marketing efforts and patient requests. Basically we are saying that there is no need for this mass hysteria,” says Venkataraman. “The uninformed hysteria could actually limit the amount of information exchange that happens between big pharma and physicians or patients and physicians. That might be more detrimental to health care than otherwise.”