Pharma Slashes Budgets for Physician Speakers--Why?

The nice folks over at ProPublica:
http://www.propublica.org/article/as-full-disclosure-nears-doctors-pay-for-drug-talks-plummets
--who gave us their Dollars for Docs web tool to track drug company payments to individual physicians, now report major drops in recently reported expenditures for promotional speakers. For example:

• Eli Lilly, from $47.9M in 2011 to $21.6M in 2012
• Pfizer, $22M in 2011, $8.3M in 2012
• Novartis, $24.8M in 2010-11, $14.8M the following year
• GlaxoSmithKline, $24M in 2011, $9.3M in 2012 (and announced last December it would stop using physicians as paid speakers entirely)

This was not true of all companies; AstraZeneca stayed flat (though they had declined sharply the previous year) and Johnson & Johnson posted a 17% increase. One company only began reporting figures in the past year, Forest Labs, and this relatively small company, interestingly, topped all the giants by spending $40M on physician speakers.

A brief reminder: Dollars for Docs became possible after several drug companies, either voluntarily or as a result of legal settlements for marketing infractions, began to make public their payments to physicians, which ProPublica then kindly gathered into one central location. The Physician Payment Sunshine Act, a part of the Affordable Care Act of 2010, does not kick in till later this year, after which all companies will be required to report.

So--why these steep cuts? One possibility, apparently favored by the ProPublica reporters, is the Sunshine Act looming, and the increasing degree of suspicion attached to payments to physicians from Pharma. But another possibility they outline is simply the dropoff in major drugs protected by patent--and the increasing tendency of the newer generations of brand-name drugs to be highly specialized drugs used by only a small number of docs, such as a new treatment for Hepatitis C. It may take fewer paid speakers to market these newer drugs, or else companies may be finding new ways to market via the Web that bypasses paid speakers altogether.

What about other types of marketing payments? More recently, ProPublica provided us with a clickable graph:
http://projects.propublica.org/graphics/d4d-slopegraph
This graph enables us to track company by company how spending for meals for docs declined by 20%, for "gifts" by 47%, for travel by 29%, and for consulting by 18.7% (among the companies reporting). That raises the interesting question of whether, for the first time in recent history, we may be seeing an actual fall-off in the total amount Pharma spends on marketing--or whether it's the proverbial balloon that if you push in one end it simply bulges out the other. Only just now no one seems clear on where the other end of the balloon might be. As I described in HOOKED, the companies themselves are quite secretive about the actual amounts they spend on marketing.