Direct-to-consumer marketing of orthopedic implants has begun

Issue: June 2004

ByDouglas W. Jackson, MD

Douglas W. Jackson, MD [photo] --- Douglas W. Jackson, Chief Medical Editor

Marketing directly to orthopedic surgeons by drug and device companies has been a persistent and standard practice for years. These companies have become more sophisticated in their marketing approaches to physicians because they have our prescription-writing history and our implant-utilization history available to them. From experience, they know the cost of potentially changing not only our prescribing patterns but also our utilization of certain implants. They have their ace detail-teams who are used, on occasion, to target a group of doctors or an individual physician.

In my years of practice, however, I had never experienced the degree of the marketing efforts by drug companies to promote the introduction and stimulation of prescription usage of the COX-2 inhibitors. The pharmaceutical companies entertained orthopedic surgeons who were using or might use their medications with expensive dinners, trips to resort destinations, tickets for ball games or rock concerts, and an endless parade of individuals bringing free samples to their offices.

Ethical standards on both sides became the basis to put the brakes on business as usual. It took time, but after spending millions of dollars, the drug companies have agreed to establish some self-regulation standards. However, this came after some government agencies, citizen groups and physician organizations contended that the marketing techniques were out of control.

Direct to consumer

In addition to marketing to orthopedic surgeons, the drug companies expanded their marketing of new drugs directly to our patients. This direct-to-consumer marketing was seen on television, in advertisements in newspapers and periodicals, and even in marketing campaigns at health fairs for senior citizens.

Whether we like it or not, direct-to-consumer advertising has come to orthopedics. How will it affect us?

Our patients were barraged with frequent advertisements for different arthritis medications, osteoporosis medications, viscosupplementation products, etc. These advertisements usually recommend that a patient discuss the advertised medication with their physician. As treating physicians, we have grown accustomed to our patients bringing these advertisements with them to their office visits and asking us our opinion and questions about whether they should be taking the new drug.

In addition, most of these advertisements display a Web site address where the names of physicians in their area can be found. These lists, of course, include names of the physicians who prescribe a significant amount of that marketed medication. This technique has the built-in incentive for some doctors to have their names listed if they prescribe a specific drug.

Device ads directed at consumers

In recent months, even the device manufacturers have gotten into direct-to-consumer advertising. I have had numerous patients bring in an advertisement that includes a picture of a famous aging golfer. These patients want the same technology for their knee even though the ad is for a hip implant. Obviously, this direct-to-patient marketing is effective or these high-priced efforts would not persist.

After watching one of these ads on television I wondered what the patients were thinking who were seeing this same commercial. My impression is that the advertisement has at least one or even all of the following effects:

Makes a patient more likely to decide to have a joint replacement they were considering.
Encourages them to see their physician and/or orthopedic surgeon to discuss and help interpret the commercial as it relates to their care.
Makes them want the same prosthesis and technology, which encourages them to go to the Web site and find the list of preferred providers of that prosthesis in their community.

Orthopedists will have different opinions about direct-to-consumer marketing of orthopedic devices. As an example, one of our readers wrote to me to complain that Orthopedics Today had allowed an advertisement that showed a celebrity featured in an advertisement for an orthopedic implant. This reader, an orthopedic surgeon, felt our editorial staff should do something to stop this trend and not run this type of advertisement.

Perhaps this reader later noticed that the same advertisement is also running in many peer-reviewed orthopedic journals. I feel our readers (orthopedic surgeons) can recognize and understand an advertisement and evaluate its merit for themselves. An advertisement with a celebrity certainly attracts the attention of patients and physicians. However, I do not feel these advertisements change a great deal an orthopedist’s behavior or choice.

The real issue as we see these new efforts unfold concerns what the orthopedic industry can learn from the drug companies about direct marketing to patients. Can the orthopedic industry avoid some of the negatives and do this advertising in an acceptable and educational format?

I am interested in your views about the issue. Please write a letter to the editor for publication if you have a strong opinion or some specific insight you would like to share. Whether we like it or not, direct-to-consumer advertising has come to orthopedics.

How will it affect us?