# E-DRUG: Feeding the beast? (cont'd)

**URL:** https://talk.edrugplus.org/t/e-drug-feeding-the-beast-contd/6688
**Category:** e-drug
**Created:** [November 19, 1999, 8:51am UTC](https://talk.edrugplus.org/t/e-drug-feeding-the-beast-contd/6688 "1999-11-19T08:51:08Z")
**Posts on this page:** 1
**Page:** 1

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### Author: ![peter.mansfield](https://avatars.discourse-cdn.com/v4/letter/p/c77e96/32.png) [@peter.mansfield](https://talk.edrugplus.org/u/peter.mansfield)
#### Post date: [November 19, 1999, 8:51am UTC](https://talk.edrugplus.org/t/e-drug-feeding-the-beast-contd/6688/1 "1999-11-19T08:51:08Z")

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E-drug: Feeding the beast? (cont'd)  
---------------------------------------------

In a personal message Halima Kagee, School of Pharmacy, University  
of the Western Cape has encouraged me to write more re:

Moving from rewarding drug companies according to increasing sales  
of more expensive drugs to rewarding companies according to their  
contributions to improving health care outcomes.

My special interest is misleading drug promotion. I believe that  
reforming the incentives would be better than regulation (but both are  
needed).

Because pharmaceutical companies are rewarded in proportion to sales  
regardless of impact on health it is unreasonable to expect them to be  
able to produce information which is not misleading. It is NOT  
something the companies have control over. It is a system problem.

Unfortunately it is difficult to measure companies contribution towards  
health care outcomes so that we can pay them accordingly.

However the "capped maximum annual contracts" used by PHARMAC  
in New Zealand show what can be done. These work by phasing out  
the subsidy once an agreed sales volume has been reached.

Under that system I have heard of drug reps persuading doctors who  
where overusing a drug to reduce their use of a drug which had  
exceeded the agreed sales volume. The reps motivation is to  
maximise profits for the company but in that case lower use is good  
for patients also.

There are 3 main problems:  
1. The NZ model is based on being able to subsidize drugs. This  
depends not so much on wealth but on the gap between the rich and  
the poor and thus the political support for equity of access to drugs.  
2. You need to be able to estimate the "sales volume" your  
country / region / organisation needs.  
3. You need to be able to get the company to accept a contract with  
maximum payment only if the target is reached but not exceeded.  
Because many companies are accustomed to driving demand up  
without limits rather than responding to customers needs, this requires  
them to make a major cultural shift.  
4. You could still have overuse in some areas and underuse in other  
areas. Measuring that and adjusting the rewards accordingly would be  
complex but not impossible and could lead to major improvements in  
health care outcomes.

This approach does open up the possibility of using non monetary  
rewards such as international good publicity.

Regards,

Peter

Dr Peter Mansfield  
GP  
Director, MaLAM (Medical Lobby for Appropriate Marketing)  
peter.mansfield@flinders.edu.au  
www.camtech.net.au/malam  
PO Box 172 Daw Pk SA 5041 Australia  
ph/fax +61 8 83742245

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