How do we get medications

The old problem - the struggle of advertising drugs with their real benefit for humans - acquires its own, special configurations in Russia. Arnold Khachaturov asked them an independent analyst of the pharmaceutical market. Since our interlocutor still conducts research in the field of pharmaceuticals, he chose to talk with a colta on an anonymous basis.

I study the problems of the interaction of the medical community with patients and the problems of choosing drugs and treatment methods. To do this, I conduct a series of interviews with doctors, pharmacists and patients.

Suppose how doctors determine which drug to prescribe to the patient? Of course, each pharmaceutical company is interested in prescribing precisely her medicine, so they are trying to influence doctors through medical representatives. In 2013, in Russia, amendments to the law “On the circulation of medicines” prohibiting the visits of medical representatives to hospitals and clinics were adopted, but the pharmaceutical companies still hold huge states-up to 500-800 people who continue to interact with doctors, formally not violating the law.

Different schemes are invented. You can come to the doctor in non -working hours. Since pharmaceutical companies often have agreements with the leadership of hospitals, medical representatives are freely missed. Or they can quite legally come to the doctors as part of the pharmacovence, collecting information about adverse reactions to drugs or as part of a clinical examination. Much depends on the specialty of the doctor. Surgeons, for example, are a special story. If we are talking about spinal surgery, prosthetics of joints, pharmaceutical companies can pay doctors for installing systems of a certain brand. Some time ago, for each such operation, doctors received about 15 thousand rubles in envelopes. Other approaches are used to influential doctors. For example, pharmaceutical companies can take them for free to scientific conferences somewhere in Australia or Hawaii.

The medical representatives cause everyday irritation among doctors. The clinical therapist, the most common medical specialty in Russia, and can take 30-40 people per day, and when a whole string of representatives comes to it, it is even more difficult to work. But the doctor takes them anyway, because he has no other source of information about new products. Most people buy doctors that most people buys with doctors. These are 80% of the drugs that you take with colds, influenza, pain, problems with the gastrointestinal tract, and so on.

In addition to medical representatives, pharmaceutical companies have a huge staff of pharmaceutical representatives who come to pharmacies and talk about their products there. Pharmacies, in turn, have their own advertising activity aimed at raising sales at specific points and at direct contracts. Pharmacy employees can even be fined if they have not fulfilled sales standards for certain positions. Recently, the promotion “Product of the day” began to gain strength, as pharmaceutical publications activelywrite about. A special place is allocated to certain drugs for a short time in the trading floor, discounts are installed on them, advertising is hanged, pharmacies are actively talking about the shares of customers. There are peculiar rules, what drugs can be “goods of the day”, how long they can be in this position.

But pharmaceutical companies can not only satisfy the real needs of the patient, but also create new ones. First, the circle of problems that concern people is determined, there are myths about health, and proposals that already exist on the market are studied. A concept is created that is tested on real people. If the product corresponds to the needs and fears of people, massive advertising support for the drug begins. For example: "You do not feel very good - it means that you have problems with the liver, you need to clean it." What does “clean the liver” mean is completely unclear, but after a three-month campaign, people in focus groups will say that they feel the need to clean the liver. Or at the end of 2016-early 2017, sales of antiviral drugs coincided with hysteria around the pork flu. I don’t know if there was really a flash, but the number of search queries of these precisely these drugs on the Internet was giant. What was primary - pork flu or advertising? Another example is the Miramistin antiseptic, which has long been used in gynecology. Then the manufacturer unexpectedly realized that there was another niche - it began to position it as a remedy for sore throat and a cold, just releasing another bottle.

Antiviral drugs are generally an absolute marketing product (means such means as Arbidol and Kagocel. - Ed. ). There is no such category in any country, this is a purely Russian invention. These are drugs with unproven clinical effectiveness, which are nevertheless actively recommended by doctors and are supported by pharmacies. The success of antiviral drugs is quite short: they last four to five years in the top of the best-selling over-the-counter drugs, after which another leader occurs. Moreover, a number of these drugs are included in the List of the GUNLP - “vital and most important drugs”, the prices of which are controlled by the state. The advantage of drugs from the USLP list is that they should always be available in pharmacies.

According to MediaScope , each third advertisement for TV is an advertisement for pharmaceutical products, and in the incidence season - already every second. In one of the advertisements (“Ingavirina”. - Ed. ) It was said that an innovative drug appeared to combat the influenza viruses and SARS, which “scans cells and selectively treats infected”. How can such messages get on the air? For this, there is a disclaimer compiled by a group of lawyers and doctors, which allows companies to comply with formal requirements of the Law “On Advertising”, conscientious and reliable.

If the company creates an original drug with a new formula, it receives a patent for 20 years to repel investments. Then the patent ends, and the formula can be copied by everyone who is not lazy without conducting additional clinical studies. Cheaper analogues appear, or generics. But the drug consists not only of the active ingredient - this is a mixture of different substances, and the quality of everyone is important. There are high -class generics that are not inferior to original drugs even in areas such as oncology. And it is much worse. If you take serious diseases like multiple sclerosis, then this can be extremely important: the patient’s life expectancy depends on the quality of interferons.

In our country, this problem unfolds in a new way. In recent years, Russia has been moving towards import substitution. As part of the Strategy-2020, it is assumed that a significant redistribution of forces in favor of domestic manufacturers should occur by key nosologies. Many completely new domestic brands entered the market, despite the fact that earlier foreign drugs were mainly imported into Russia. Certained concessions are received by local manufacturers - domestic or foreign companies with factories in Russia. But, firstly, building a plant is a very laborious story, not every company can afford it. Secondly, foreign companies have their own production standards, and, unfortunately, not all of them can be respected in our country. But now, according to the law, if a foreign and domestic company is present in the tender purchase of the state, the domestic one wins by definition - simply because the law is drawn up. It turns out that foreign companies have no way to come to a special or preferential segment. At the same time, for a number of nosologies - hepatitis, HIV, multiple sclerosis - if there are domestic drugs, then these are precisely generics, because original drugs in Russia are practically not produced. We have no laboratories, relevant education and infrastructure in the field of biomedicine, which would create unique competitive formulas here.

In pharmaceuticals, competition is high, but monopolies or oligopolies can appear inside individual nosologies, which affects the increase in price. Some time ago, in the USA there was a loud story with Martin Shkrel, who received the rights to a cure for Daralopim toxoplasmosis and raised a price of 5,000%to it, and at one time no one could find a council for him. And the production of drugs is a very profitable business. The cost of drugs, as a rule, is two to three times lower than the final vacation price. The pricing mechanisms themselves are opaque. An ordinary person does not know and cannot know how much the drug costs, what it consists of and how it was developed. It always seems that everything should be very expensive. In fact, the price is determined depending on the competitive environment - that is, on what price other players in the market will set.

In other words, when the doctor recommends something first to you, and then the pharmacist, this does not mean that you have objective information. It is very difficult to get out of the illusory world of marketing. Inevitably, situations where the doctor cannot convince the patient.

I had a curious interview with one surgeon. The company -manufacturer of screws and artificial joints paid him for each installation of systems the same 15 thousand rubles in the envelope. In addition, the decision on the supply of systems of this brand was made at the level of the leadership of the hospital. But the doctor himself did not consider this product the best in the market. In this case, the doctor should explain this situation to the patient, devote him to especially high -tech production of spinal systems, offer options? Complex question. But the doctor had an absolutely clear position that, of course, he should not explain anything, this is extra information for the patient. Doctors aggressively defend their right to retain a monopoly on professional judgments. This gives rise to conflicts and distrust between patients and doctors. On the other hand, doubts about professionalism irritate and upset doctors. All discussions are reduced to the search for the guilty and responsible, there is no constructive dialogue between the doctor and the patient. How to deal with this?

It is important that the professional community feels enough strength in itself to defend the territory of independent examination, treatment and diagnosis. But even more important is to be able to talk with a patient without moral pressure and veiled blackmail. The doctor must have all the necessary information and be able to explain it to the patient. If the doctor and the patient cannot just talk to each other, then perhaps the disease is a task that will not have a solution.