Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: In their otherwise admirable article, Dr Brennan and colleagues1 accept uncritically the pharmaceutical industry's claim that its marketing budget is $21 billion. That figure covers only 4 specific items: the retail value of free samples, the cost of sales representatives, direct-to-consumer promotions, and medical journal advertising.2 Marketing budgets actually include much more than that, most notably expenditures for physician “education” of all kinds. According to their own annual reports, the top 9 US drug companies (those listed in the Fortune 5003) spent approximately $69 billion on marketing and administration in 2004. Although most companies do not break this down further, for Novartis approximately 85% of the combination goes for marketing and 15% for administration.4 A similar percentage for all the major companies would result in a marketing budget of approximately $58 billion in 2004 for those 9 companies alone.
Angell M. Academic Medical Centers and Conflicts of Interest. JAMA. 2006;295(24):2845–2849. doi:10.1001/jama.295.24.2848-b
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