Physicians, Educate Yourselves...

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http://www.nytimes.com/2004/12/30/opinion/l30drug.html

December 30, 2004

Physicians, Educate Yourselves

To the Editor:

" Prescription for Confusion " (editorial, Dec. 28) correctly observes that

doctors, as well as drug companies and the Food and Drug Administration,

share responsibility for the pain medication fiasco, but you do not

sufficiently emphasize the role of marketing.

According to its annual report, Merck, the maker of Vioxx, spent 28 percent

of its revenues (more than $6 billion) on " marketing and administrative "

expenses last year, while spending only half that on " research and

development " and keeping 30 percent in net income. Figures for other major

drug companies were not much different.

We are all aware of the incessant direct-to-consumer advertising, but that

pales beside the amounts spent on marketing to doctors, including what the

companies call " education. " That is why doctors learn to practice a highly

drug-intensive style of medicine and to use the newest, most expensive

brand-name drugs, even when there is no evidence, as in the case of Vioxx,

that they are more effective than older, cheaper drugs.

The medical profession should break its dependence on the pharmaceutical

industry and educate its own. Until then, the industry should come clean

about all the money it spends influencing doctors' prescribing habits.

Marcia Angell, M.D.

Arnold S. Relman, M.D.

Cambridge, Mass., Dec. 28, 2004

The writers served as editors in chief of The New England Journal of

Medicine.