Last Week Tonight with John Oliver is back on HBO and the pharmaceutical industry was the centerpiece of last night’s show in which Oliver spent more than 17 minutes educating the audience on the industry’s marketing practices.

Oliver began by citing some statistics such as annual sales of Rx drugs in America amount to over $1,000 per person. “Walter White could have made more money cooking up arthritis medications,” quipped Oliver.

I’m not sure arthritis is where the real pharma money is these days — maybe orphan drugs (see here and here) or cancer drugs (see here), certainly Hep C drugs (see here) are where the real money is.

Oliver focuses mostly on physician marketing and pharma sales reps. He begins by showing segments from direct-to-consumer (DTC) ads, all of which end with the phrase “ask your doctor,” which of course is often the butt of jokes (see, for example, here).

“Oliver says Big Pharma wants you to talk to your doctor,” says Time, “because they have spent billions of dollars marketing their drugs to physicians. Oliver’s research revealed that pharmaceutical companies spent $24 billion marketing directly to doctors last year. According to one study quoted by Oliver, 9 out of 10 top drugmakers spent more on marketing drugs than researching the drugs. In Oliver’s words, ‘Drug companies are like high school boyfriends: they are more interested in getting inside you than in being effective once they are there.'”

I’ve written about many of the issues that Oliver speaks about in his segment and I will provide the back stories below. There was one thing in this segment, however, that stood out for me. It was a claim made by a GSK executive in a 2001 Advair launch video that the Department of Justice uploaded to its website as part of a whistleblower suit.

In that video (which is included in Oliver’s segment; see the end of this post), the GSK executive claimed: “There are people in this room who are going to make an ungodly sum of money selling Advair.” To which Oliver said: “Ungodly! That would barely be an appropriate tone if they ere trying to get cereal into people’s bodies let alone drugs.” Which is an interesting analogy because many pharma marketing people have come from the ranks of the consumer goods industry (e.g., cereal manufacturers).

Of course, that’s just something to motivate the reps in the audience. We all know that the only pharma sales reps making an “ungodly amount of money” are whistleblowers (see here) and John Oliver cites testimony from several of these (former) sales reps.

Oliver covers these marketing practices:

  • Use of young and attractive sales reps to gain access to physicians. “This is so widely known,” says Oliver, “that it has become a sitcom punchline for years.” He also pointed out how you can spot sales reps in doctors’ waiting rooms, something I pointed out several years ago – read, for example, “Basics of Sales Rep Watching.”
  • Sales reps without any background in the sciences. “Many sales reps,” said Oliver, “don’t know the effects of the drugs they are pushing.” For more about that read “Dumb Blonde Reps vs. Slovenly Genius Reps.”
  • Free lunch for physicians. “Think about it,” says Oliver, “lunch is awesome! If Charlie Manson brought me lunch every day, I’d at least listen to his sales pitch on forehead swastika.” Of course, I’ve often written about this and even suggested how pharma’s free lunch program should be extended to patients (here).  Now THAT would be “patient centric!”
  • Off-label drug promotion. This, of course, costs the drug industry billions of dollars in fines. Read, for example, “J&J Is Now Top-Fined Company in the Pharma Criminal & Civil Settlement Planetary System.”
  • Key Opinion Leaders. Oliver notes that many physicians — so-called “key opinion leaders” — who are hired to make presentations promoting drugs to other physicians, often are just reading from scripts created by pharma companies. “If you’re a doctor just regurgitating a script,” says Oliver, “you’re not really a ‘thought leader’ so much as you are a ‘thought sayer.’ Abraham Lincoln was a thought leader. You’re more like the animatronic Lincoln at Disneyland.” Key opinion/thought leaders are very valuable for pharma. How valuable? Read “How Many Sales Reps is One Key Opinion Leader Worth?

There’s more, which you can hear in this Youtube post of Oliver’s Last Week Tonight segment: