Drug Makers' Virtual Schmooze

It's the middle of afternoon rounds in the intensive care unit at Stanford Medical Center when the attending physician asks third-year medical student Nate Evans to order a dose of the antibiotic Cipro for an elderly patient. Evans plucks his Palm from his coat pocket, taps it a few times, then scrawls dosage instructions on the chart hanging at the end of the bed.

A few minutes later, in a room down the hall, the intensive-care staff is arguing about a patient's course of treatment. Evans consults his Palm again and announces confidently, "The patient was extubated on the 13th."

Like medical students everywhere, Evans and his classmates at Stanford Medical School have stethoscopes slung around their necks and textbooks weighing down their bags. But they also carry personal digital assistants in their pockets. All first- and second-year Stanford students are given brand-new Palms loaded with study materials, class schedules, and drug and disease databases. With the handhelds, Evans and his fellow M.D.s-in-training can look up patient records and drug dosages in seconds - while they're bedside - rather than poring over messy charts or thick manuals after rounds.

At med schools across the country, PDAs are becoming an integral part of medical training. While handhelds are not widespread among practicing physicians, the technology will benefit doctors, nurses and patients. And they're not the only ones. Drug companies think that a doctor toting a handheld device could be a great marketing opportunity. So they're working with software firms to put their drug ads directly on those PDAs. But the experiments are kicking up controversy, worrying those who think that Big Pharma's marketing efforts already exert too much influence over medical practice.

The drug industry last year spent $9.3 billion marketing to doctors, nurses and physicians' assistants, according to Scott-Levin, a health consulting firm; by comparison, drug companies spent $2.5 billion reaching consumers. Those investments are apparently paying off. The five drugs most commonly pitched last year - Celebrex and Vioxx for arthritis; Claritin and Allegra for allergies; and Lipitor for high cholesterol - each brought in more than $1 billion in revenue, and together grossed more than $14.5 billion.

Some of that money paid for traditional forms of marketing - advertising in journals, presentations at medical conferences and "detailing" (sending drug reps into doctors' offices to chat up the staff and drop off samples of the latest pills). But some of those dollars - drug companies won't say how much - were spent testing marketing programs that target doctors' handhelds.

Those experiments take many forms. Aventis, which makes Allegra and other drugs, is looking into e-detailing: Instead of physically visiting doctors' offices, drug reps would make their pitches via real-time video streamed to handhelds. AstraZeneca, maker of the blockbuster drug Prilosec, signed a three-year agreement with tech firm ePhysician; the deal allows doctors to communicate directly with AstraZeneca - and vice versa - using ePhysician software. Other companies are testing ads that pop up when a physician writes a prescription on a PDA. Some firms are opting to keep it more subtle, offering downloadable research reports and insurance coverage information for their drugs.

EPocrates, which supplies the drug databases for Stanford's PDAs, is trying out several approaches. For starters, the San Carlos, Calif., company makes its databases available for free on its Web site; anyone with a Palm can download them. Drugmakers pay ePocrates to put marketing messages in front of users when they update the software. "It's a paid message, not an ad," says John Voris, CEO of ePocrates, emphasizing that doctors can opt not to read these "docalerts."