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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.

Financial Disclosures: None reported.

Marcia Angell, MD
marcia_angell@hms.harvard.edu
Harvard Medical School
Cambridge, Mass

1. Brennan TA, Rothman DJ, Blank L, et al. Health industry practices that create conflicts of interest: a policy proposal for academic medical centers. JAMA. 2006;295:429-433. FREE FULL TEXT 2. IMS Health Incorporated. http://www.imshealth.com/ims/portal/front/articleC/0,2777,6599_44304752_44889690,00.html. Accessed April 9, 2006.3. The Fortune 500 Index. Fortune Magazine. April 18, 2005.4. Novartis Web site. Novartis Annual Report 2005. http://www.novartis.com/annualreport2005/index.shtml. Accessed April 9, 2006.

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295:2848.

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