HBO’s John Oliver takes on big pharma

On a recent episode of HBO’s Last Week Tonight with John Oliver, Oliver focused on pharmaceutical companies’ marketing techniques and their influence on doctors.

For those unfamiliar with the program, Last Week Tonight is a satirical news program that investigates a variety of current events and is anchored by Oliver, an alum of Comedy Central’s TheDaily Show. Oliver has also recently targeted big tobacco and Miss America, among other topics. But recently, Oliver questioned whether there was a conflict of interest behind pharmaceutical companies marketing directly to doctors.

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 “Drug companies know that doctors hold all the real power in the prescription drug business, which is why, while they spend nearly $4 billion a year marketing directly to us, they spend an estimated $24 billion a year marketing directly to doctors,” Oliver says.

“In fact, one analysis claimed that in 2013, nine of out the top ten drug makers spent more on marketing than they did on research,” says Oliver.

Oliver says that in the course of his investigation, his team had a difficult time finding out how all that money was being spent-the only evidence they could find came out during lawsuits years after the fact. In fact, he shows a flashy video from a 2001 Advair (fluticasone/salmeterol, GSK) sales meeting featuring pyrotechnics that Oliver compares to an NBA pregame show.

“The audience in that room were pharmaceutical reps-the foot soldiers in every company’s drug marketing efforts. Now, drug companies will tell you their reps are there to educate doctors, but behind closed doors, that message can be a little different,” says Oliver.

Oliver then cuts to a video featuring a Advair representative telling an audience, “There are people in this room who are going to make an ungodly sum of money selling Advair-and you know who you are,” to a whooping crowd.

Oliver then moves on to criticizing pharmaceutical companies’ practice of buying doctors lunch while the reps offer their sales pitch.

“Free lunch every day-now, that might not seem like a big deal, but think about it: lunch is awesome,” says Oliver. “Drug companies don’t do this to be friendly; they do it because they know it works. In fact, they know a terrifying amount about nearly every prescription coming out of a doctor’s office.”

Oliver goes on to say that pharmaceutical companies receive information about which doctors are prescribing their medications-and which ones are prescribing more from their competitors. The show features a clip of a pharmaceutical sales rep who says she would call up doctors to ask why they’re not prescribing enough of her company’s medication.

Next: Oliver takes on thought leaders and Open Payments

Oliver takes on thought leaders and Open Payments

“For the increasing number of doctors who will refuse even to see drug reps, the companies have one more trick up their sleeves: simply paying doctors to talk to other doctors about their products over dinner,” Oliver says.

And while that sounds ridiculous, he says, it’s not as ridiculous as the “ego-boosting title” they give these doctors. That title? Thought leader. Oliver goes on to explain the practice of doctors giving talks sometimes written and prepared primarily by pharmaceutical companies.

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But all of this is an accepted practice within the industry, he says.

“Even in its best form, hiring doctors as paid spokesmen seems like a conflict of interest. And multiple reports have found that many drugs’ top prescribers are also often getting money from that drug’s company, which is worrying because we trust doctors,” he says.

But, in all of this, he says, the good news is the recent debut of the Centers for Medicare & Medicaid Services’ Open Payments website. He encourages viewers to look up their own doctors on the site to see how much their doctors are making from pharmaceutical companies.

Related: Sunshine Act Open Payments reports available for review

Next: Watch the video

Watch the video

Editorial note: This video features language that may be offensive to some viewers.

Click here to see what the pharma industry had to say 

Click here to read responses from optometry's thought leaders

The industry responds

One of the companies mentioned in Oliver’s piece was Novartis. The show features a news clip describing a civil fraud lawsuit against the company filed by the Justice Department, which accused the company of paying kickbacks and lavish spending on doctors.

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Eric Althoff, head of global media relations for Novartis, told Optometry Times that the company disputes the allegations in the lawsuit and continues to defend itself in litigation.

“Novartis Pharmaceuticals Corporation is committed to ensuring that physicians and patients have the information they need to make informed healthcare decisions and believes speaker programs can help educate other healthcare providers about the appropriate use of medicines so they can make informed prescribing decisions, which in turn enhances patient care,” Althoff says. “We are committed to high standards of ethical business conduct and have a comprehensive compliance program in place to help ensure we consistently act in a responsible manner.”

Pharmaceutical Research and Manufacturers of America (PhRMA) is a trade group that represents the pharmaceutical research and biopharmaceutical companies in the United States and advocates on behalf of the industry on public policy issues.

PhRMA Director of Communications Holly Campbell says the biopharmaceutical industry supports the Sunshine Act-including Open Payments-and has worked to improve transparency around interactions with physicians by reporting data and complying with professional codes of conduct.

“The value of collaborations between biopharmaceutical manufacturers and physicians and the critical role these interactions play in advancing innovation and science need to be part of the conversation,” says Campbell, speaking exclusively to Optometry Times. “Working together, biopharmaceutical companies and physicians can improve patient care and help nurture the discovery of new medicines.”

Optometry Times also asked Allergan and Bausch + Lomb for a comment.

Next: Thought leaders respond

Thought leaders respond

“John Oliver is a very funny guy, and like all comedians he plays his point for laughs,” says Optometry Times Chief Optometric Editor Ernie Bowling, OD, FAAO. “So, I take what he says not with a grain but with a big dose of salt.”

Optometry Times Editorial Advisory Board members Pam Miller, OD, FAAO, JD, and Alan Kabat, OD, FAAO, both of whom have worked with pharmaceutical companies throughout their careers, say that the Last Week Tonight piece, while a comedic editorial, raises some good points. There is a lot of money being spent to market to doctors, and, as Oliver points out, some companies and doctors have crossed the line, says Dr. Kabat.

“While there is a lot of humor and exaggeration, the key points made are definitely worth taking note of,” says Dr. Miller. “It is very disconcerting to know that the drug makers spend more dollars to market than they do on R&D, let alone moving orphan drugs along.”

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Dr. Kabat says that doctors need to be educated in detail about the prescription medications available, and he doesn’t believe doctors should have to apologize for accepting a sandwich in exchange for 30 minutes in their already busy day. But Dr. Miller says she found the comments from former sales reps in the Last Week Tonight to be particularly disturbing-including the lack of education they said they received and their focus on sales results instead of patient benefit.

When it comes to Oliver’s comments on the term “thought leader,” Dr. Kabat says he’s more amused than offended. But Dr. Bowling says that was one comment with which he took issue.

“Having served in that position with a few companies in my years of practice, I have always found those meetings to be a chance to learn from the other doctors in attendance,” Dr. Bowling says. “The dinner presentations I’ve been part of from both sides of the podium. I’ve never considered there to be undue pressure from any sponsor to ‘toe the company line.’ I always considered it an opportunity to learn more about the product.”

Dr. Bowling, Dr. Kabat, and Dr. Miller all say that most doctors are more than capable of sniffing out those thought leaders with integrity and those without-something the Last Week Tonight commentary did not really give them credit for.

“I would hope that my peers can determine which individuals at the podium have a clear mastery of their topical area and speak from experience, and which are merely reciting an industry-created script,” says Dr. Kabat. “Likewise, I believe that most thought leaders who advocate for a particular therapy, whether from the podium or in practice, do so because they feel it represents an excellent therapeutic option, and not because it lines their pockets with disposable income.”

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“While many companies help speakers by providing data or slides, the line must be clearly drawn when a speaker is parroting the company line and not speaking from personal experience and knowledge,” says Dr. Miller.

“What this piece did not do is give doctors some credit for ability, education, and integrity. Commentaries are just that, even when some facts are included, but should not be regarded as the gospel truth,” she says.