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10-03-2013 | Article

The week in review, March 3–9, 2013

medwireNews: This week's stories include: Washington DC shows unique draw of pharmaceutical marketing spending; medical establishment's notable change in prostate screening per controversial guidelines; FDA takes hard look at calcitonin salmon therapy's bad wrap with regard to cancer risk and efficacy; drug industry's overall dip in spending on marketing and ads while still relying on old-school approaches; the dangerous divide between what patient's are expecting and what the medical establishment deems as prudent.

Marketing capital

Washington DC's Department of Health is unique in that it put in place its own form of the Sunshine Act in 2004, called the AccessRX Act. The rule requires that pharmaceutical companies that advertize and market to various potential clients must report all expenditures, including any form of gift, directly to the city's government.

With this trove of confidential marketing information, Washington DC was able to commission George Washington University to find that drug companies spent $ 84 million on marketing to doctors, hospitals, and various organizations in 2011 - $ 19 million of which was spent on "gifts," such as grants, speaker's fees, and food.

The report author noted that Washington DC draws an "astonishing amount of money" per physician compared with any other part of the country.

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Shifting norms

The counter-intuitive concept of a guideline that recommends that a medical test is done less frequently is something that meets resistance and skepticism by both patients and the medical community.

Yet some seem to have heeded the US Preventive Task Force's 2008 recommendation that men aged 75 years and older refrain from prostate cancer screening; the demographic has shown an 8 percentage point drop in annual PSA testing over the 2 years since the controversial medical suggestion.

The study, which is in Health Affairs, highlights how a change in behavior occurred without regulatory coercion.

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Gutting a therapy

Calcitonin salmon is a hormonal therapy that has been around since 1975 and is mainly used to protect postmenopausal women from bone fractures as they age but also for hypercalcemia and even phantom limb pain. The synthetic hormone that is derived from salmon is found to be much more effective than the naturally occurring peptide hormone, by providing greater biological activity with a longer half-life and better receptor affinity.

Yet clinical trials of the therapy have found that a form that is taken orally has led to a greater incidence of prostate cancer, which has drawn serious scrutiny concerning its safety from the Food and Drug Administration (FDA).

Now the FDA has convened a joint meeting to address not only the evidence linking the therapy to cancer risk, but also to discuss recent evidence that questions its efficacy in strengthening bones.

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Shifting market, same approach

In 2004, drug companies spent $ 36.1 billion on marketing and advertizing, which was 13.4% of total sales that year. In 2010, this expenditure dropped by a notable degree to $ 27.7 billion, or 9.0% of sales.

Analyzing this trend in PLoS ONE, a John's Hopkins University researcher viewed the downshift in marketing dollars as a manifestation of the changes in the pharmaceutical marketplace over the past decade, which include the "graying" of the products that are on the market.

Yet despite this shift in the degree to which drug companies now spend, the study authors were surprised to see that how it is spent has not altered much, as visits to physician's offices and office-based detailing are still going strong.

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On different pages

The multitude of references people make to the concept of "value" when discussing healthcare reform has almost made it sound cliché. But according to a commentary in the New England Journal of Medicine, a stark divide is becoming apparent in how physicians and patients view this.

The author of the article warns that turning healthcare into a "customer-service industry" is incentivizing a split where goal expectations clash to a degree that affects outcome and wellbeing.

The uncertainty that is resulting from this conflict, warns the author, has led to a divide in medicine between the delivery of objectively necessary health measures versus the medical attention that patients expect.

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By Peter Sergo, medwireNews Reporter