American drug companies spend almost twice as much on promoting their pills than on researching and developing new ones, finds a new Canadian study.

Marc-Andre Gagnon and Joel Lexchin of Toronto's York University found that American drug companies spent US$57.5 billion on promotional activities in 2004 (the latest year for which figures were available).

By contrast, the industry spent only $31.5 billion on industrial pharmaceutical research and development in the same year, the researchers found using a report by the National Science Foundation.

The analysis, called "The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States," is published this week in the journal Public Library of Science Medicine.

Lexchin says the results startled even him.

"I think that this figure of $57 billion is much more than anybody expected," he told CTV Newsnet. "The usual figure that has been thrown around is about half that amount. I must admit that I was surprised to see just how large the amount was."

The types of marketing included in the $57.5 billion figure, compiled using data from market research companies IMS and CAM, included:

  • Free samples,
  • Visits from drug reps (called "detailers"),
  • Direct-to-consumer advertising,
  • Meetings with doctors to promote products,
  • Email promotions,
  • Direct mail,
  • And "seeding trials," which are clinical trials designed to promote the prescription of new drugs rather than to generate scientific data.

The authors believe that $57.5 billion is likely an underestimate, since there are other more secretive ways that drug companies can market their products. These other methods include the ghostwriting of articles in medical journals by drug company employees, or the promotion of drugs for off-label uses.

Lexchin says in the United States, drug companies spend more on advertising to doctors than they do on direct-to-consumer ads.

"In the United States, there is one sales rep for every five doctors. That is a lot of money," Lexchin notes.

"We estimate that the drug companies are spending $20 billion per year on these sales reps, another $15 billion a year giving out free samples. And, as I said, the drug companies wouldn't be doing that if they didn't think that these things worked."

Lexchin says he would hope that doctors are not just relying on the information that drug companies provide about their products but are doing their own reading and research as well. But he says it's easy for doctors to be swayed by drug reps.

"The research that's been done also shows that the information that the sales reps give is very selective. They will tell you what the drug is used for; they usually won't tell you what the price is of drug is, nor will they spontaneously bring up side effects or safety issues around the drugs."

Gagnon and Lexchin suggest governments should be more closely monitoring pharmaceutical advertising.

"Right now, what we do is we leave most of the regulation for promotion up to the drug companies themselves," says Lexchin. "There's a system of voluntary self-regulation, which means that the drug companies get to act as their own police."