Pharma's terrible secret: companies spend the most to promote their least helpful drugs

There is a story that Charles Ornstein and Ryann Grochowski Jones published Wednesday at ProPublica and the Upshot that should make you furious.

The story is a deep dive into data about what pharmaceutical companies spend on marketing their new products. What it shows is that drug makers devote the largest share of their spending doctor interactions (things like meals and visits) trying to sell doctors on prescribing "me-too" drugs: pills that essentially do the same thing as another drug already on the market.

Big breakthrough drugs that substantially improve how doctors practice medicine don't get many marketing dollars. Build a pill that cures Hepatitis C in nearly all patients (as Gilead did earlier this year), and doctors will easily buy it.

Drugs that don't offer a big improvement, however, are an understandably tougher sell. So the pharmaceutical companies spending the most to promote their more mediocre products.

'"They may have some unique niche in the market, but they are fairly redundant with other therapies that are already available," said Dr. Joseph Ross, an associate professor of medicine and public health at Yale University School of Medicine. "Many of these, you could call me-too drugs."

In almost all cases, older, cheaper products are available to treat the same conditions. Companies typically try to differentiate the new drugs by claiming they are easier to use; carry fewer side effects; work faster than competitors; or have medical advantages.

It makes sense that the drugs that aren't that great take the most wooing and winning over of doctors to get them on board as prescribers. There's a blood thinner that Ornstein and Jones write about called Brilinta, which drug company AstraZeneca spent $7.7 million talking to doctors and hospitals about during the last five months of 2013 (the time period of the ProPublica investigation). That puts it in third place for marketing dollars.

Brilinta is pretty similar to Plavix, a much less expensive, generic blood thinner that does largely similar things. Of course, Brilinta needs a marketing budget; it's up against a cheaper product that treats the same type of issues.

Pharmaceutical companies offered ProPublica defenses about why they needed to educate doctors, and it is possible that these "me too" drugs work better for certain classes of patients. But generally, they're not especially innovative products and ultimately just drive up health-care spending.

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