Too Close for Comfort?

Pharma companies have long targeted their more direct marketing efforts at the physicians who prescribe their drugs, with patients typically being reached only through advertising (where permitted) or disease awareness campaigns. However, a new study shows that some pharma companies are now putting a greater emphasis on direct patient interaction (1). In particular, the study found that manufacturers of hemophilia drugs have recruited hemophilia patients (and their family members) for “employment, consulting roles or advisory boards”. Others who are well connected in the hemophilia community, including staff and volunteers from patient advocacy groups, have also been targeted.

For now, the move seems to be limited to the hemophilia area. But could it signal a broader shift within the industry? The study authors are concerned; although the patient voice is crucial, close relationships can distort medical discourse.

“Even where there are restrictions on marketing to healthcare providers, there are almost no restrictions on marketing to patients in the US. This is an unregulated area that needs to be regulated,” says Adriane Fugh-Berman, Department of Pharmacology and Physiology, Georgetown University Medical Center, USA. “The same tactics that are used to affect physician choices of therapies are now being used to affect patient choices. Patients should be making healthcare decisions in partnership with healthcare providers who have no conflicts of interest.”

According to Fugh-Berman and her co-authors, the industry has begun establishing lifetime relationships with people with hemophilia. For example, Baxter sponsors Camp Superfly, a summer camp for children with hemophilia, to which it sends sales representatives to help staff the camps to “establish personal relationships with young campers”. Young adults with hemophilia may also be offered paid internships, college scholarships, awards, career counseling, and insurance counseling. They are also recruited to consumer and professional advisory boards, and offered paid consulting opportunities. In some cases, there have been reports of patients being taken out to dinner with sales representatives.

In hemophilia, about 50 percent of patients are involved in their own decision making, whereas this drops to 5 percent or 20 percent for other therapeutic areas. “Patients with hemophilia are targeted because they control the market share,” says Fugh-Berman. “Whoever controls the market share, be it physicians, patients, or payers, will be targeted for marketing.”

Fugh-Berman believes that it is time to consider regulatory controls on industry interactions with patients. “Pharmaceutical companies are using patients with hemophilia and other expensive diseases as sales people. These relationships should be regulated, and publicly disclosed and debated.”