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By Jennifer Couzin
Drug makers spend billions chatting up
physicians and giving samples. Now they're putting their message
in the palms of doctors' hands.
Like medical students everywhere, students at Stanford Medical
School have stethoscopes slung around their necks and textbooks
weighing down their bags. But they also carry personal
digital assistants in their pockets. All first-
and second-year Stanford students are given brand-new Palms
loaded with study materials, class schedules, and drug and
disease databases.
With the handhelds, medical students-in-training
can look up patient records and drug dosages in seconds -
while they're bedside - rather than poring over messy charts
or thick manuals after rounds.
At med schools across the country, PDAs
are becoming an integral part of medical training.
While handhelds are not widespread among
practicing physicians, the technology will benefit doctors,
nurses and patients.
And They're
Not The Only Ones.
Drug companies think that a doctor toting
a handheld device could be a great marketing opportunity.
So they're working with software firms to put their drug
ads directly on those PDAs.
But the experiments
are kicking up controversy, worrying those who
think that Big Pharma's marketing efforts already exert too
much influence over medical practice.
The Drug Industry Last Year Spent $9.3
Billion Marketing
To Doctors, Nurses And Physicians' Assistants,
By comparison, drug companies spent $2.5
billion reaching consumers. Those investments are apparently
paying off. The five drugs most commonly pitched last year
- Celebrex and Vioxx for arthritis; Claritin and Allegra for
allergies; and Lipitor for high cholesterol - each brought
in more than $1 billion in revenue, and together grossed more
than $14.5 billion.
Some of that money paid for traditional
forms of marketing - advertising in journals, presentations
at medical conferences and "detailing" (sending
drug reps into doctors' offices to chat up the staff and drop
off samples of the latest pills). But some of those dollars
- drug companies won't say how much - were spent testing marketing
programs that target doctors' handhelds.
Those experiments take many forms. Aventis,
which makes Allegra and other drugs, is looking into e-detailing:
Instead of physically visiting
doctors' offices, drug reps would make their pitches via real-time
video streamed to handhelds.
AstraZeneca, maker of the blockbuster
drug Prilosec, signed a three-year agreement with tech firm
ePhysician; the deal allows doctors to communicate directly
with AstraZeneca - and vice versa - using ePhysician software.
Other companies are testing ads that pop
up when a physician writes a prescription on a PDA. Some firms
are opting to keep it more subtle, offering downloadable research
reports and insurance coverage information for their drugs.
EPocrates, which supplies the drug databases
for Stanford's PDAs, is trying out several approaches. For
starters, the San Carlos, Calif., company makes its databases
available for free on its Web site; anyone with a Palm can
download them.
Drugmakers pay ePocrates to put marketing
messages in front of users when they update the software.
"It's a paid message, not an ad," says John Voris,
CEO of ePocrates, emphasizing that doctors can opt not to
read these "docalerts."
EPocrates is also testing a variation
on the Stanford program: The company buys machines directly
from Palm, which loads them with ePocrates software and stamps
them with the ePocrates logo. EPocrates then lines up sponsors,
which pay to put the Palms in the hands of select physicians.
Eli Lilly, for example, recently underwrote
a giveaway to 1,000 endocrinologists; Bristol-Myers Squibb
is running a similar pilot program targeting a couple hundred
cardiologists. Recipients get summaries of journal articles
and information about the sponsor's drugs; sponsors get a
highly focused audience for their marketing.
That targeting is what makes handhelds
such a tempting marketing venue. Physicians are already bombarded
with ads in medical journals and reference works. But PDAs
give drug companies an unprecedented opportunity to get in
front of the right doctors at the right time - when they're
on the job. "You can
potentially control what the physician writes,"
says Richard Evans, an analyst at Sanford C. Bernstein.
One form of handheld medical software
has remained ad-free. Interactive formularies - from Allscripts,
PocketScript and other vendors - let physicians order prescriptions
directly from their PDAs. Doctors choose a drug from a pull-down
menu; the handheld then wirelessly beams the script to the
pharmacy.
Drug companies would like nothing better
than to make sure their products get preferential placement
in those formularies. So far that hasn't happened, perhaps
because drug vendors know such manipulation could backfire.
"We can't ever have the doc think the device is biased
in one way or another," says Steve Burns, the founder
of PocketScript. For its part, Allscripts has declined to
sign marketing agreements with pharmaceutical companies, though
CEO Glen Tullman won't rule them out. "Few of the large
pharmaceutical organizations have not approached us."
Some in the medical community are skeptical
about anything that helps drug companies insinuate their marketing
efforts further into the doctoring process.
"There's
no way we're going to be hooked up with Palms that are hooked
up to pharmaceutical companies," says Al Fisk,
medical director of the Everett Clinic in Everett, Wash. It's
not just the Palm giveaways he objects to. His clinic - with
nine locations and about 185 doctors - took the unusual step
of banning drug reps from its premises three years ago.
Indeed, many believe that pharmaceutical
marketing is already out of hand, with or without PDAs. Says
internist Robert Goodman: "The literature suggests that
when physicians practice
on the basis of promotion, they prescribe expensive and inappropriate
medication."
Goodman grew so tired of drug reps dropping
by his office at New York's Columbia Presbyterian Medical
Center that two years ago he founded No Free Lunch. The organization's
goal: to get doctors to support a pledge promising to refuse
money and gifts from drug companies. So far, he's signed up
a couple hundred physicians.
The federal government keeps an eye on
pharmaceutical marketing generally; already this year, the
Food and Drug Administration has sent out 30 warning letters
to drug companies for a variety of marketing violations, on
the Web and elsewhere. But the handheld market is still too
young to attract much federal scrutiny.
For now, it looks like drug companies
may have found the perfect medium for reaching their market.
Already, med students wonder how anyone managed without a
PDA. Fresh from a morning class, second-year Stanford student
Ritu Gupta shows off MedMath, a program that calculates things
like water deficit and basal energy expenditure.
The formulas are complex, at least as
wide as the screen, but the software makes it as simple as
addition on a calculator. No one really knows these things
off the top of their head, says Gupta. "You have to go
and look it up after you see the patient. This makes the process
so much easier. Tap, tap, and there you have it."
The
Standard June 18, 2001
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