Drug App Comes Free, Ads Included

But like so much else on the Web, “free” comes with a price: doctors must wade through marketing messages on Epocrates that try to sway their choices of which drugs to prescribe.

The apps can select messages based on each doctor’s search and prescription histories, and the company has ambitious plans for expanded smartphone offerings. One possibility is a virtual sales rep that would help drug makers get their wares in front of physicians who decline to see human sales representatives.

The marketing messages are difficult to ignore. For example, a psychiatrist in Massachusetts who recently opened Epocrates (pronounced ee-POC-ra-teez) on his iPhone said that before he could look up any drugs, he had to click past “DocAlert” messages on hypertension, bipolar disorder and migraines. Two of the three showed they had been paid for by pharmaceutical companies promoting their products.

“Some doctors will not have time for that nonsense,” said the psychiatrist, Dr. Daniel J. Carlat, who also writes a blog and newsletter on medical issues.

Of course, any casual user of the Web is bombarded with ads derived from their browsing history.

However, the marketing through Epocrates is more insidious, according to Dr. Adriane Fugh-Berman, an associate professor of medicine at Georgetown University and founder of PharmedOut, a nonprofit group critical of drug companies’ marketing practices.

“With targeted ads in Google, you may buy something that’s an unwise purchase,” she said. “But when a physician is influenced in Epocrates, it’s the patient who’s bearing the financial and health risk.”

Dr. Fugh-Berman and other critics of drug marketing say the apps promote more expensive and sometimes less effective drugs. The companies say they are helping doctors find the best medicines.

Dr. Rachel E. Sherman, associate director of medical policy at the Food and Drug Administration, said the agency was trying to get a handle on all the emerging electronic channels of communication used by drug makers.“It’s a mess,” she said.

Epocrates is betting that the 320,000 physicians who use its apps, much like those who use Google and other advertising-supported data services, will tolerate some marketing to get the information they want at no charge. Epocrates is also used by a million nurses, pharmacists and medical students.

One in five doctors will not see drug sales representatives at work, according to the market research firm SKA, and Epocrates says that getting a smartphone sales pitch in front of doctors just as they are writing prescriptions is immensely valuable to pharmaceutical companies.

Epocrates says drug makers get $3 in increased sales from every dollar spent on DocAlerts. The claim comes from comparing prescription records of doctors who see DocAlerts with those who do not, company officials said. But they declined to share the research, saying it was paid for by drug companies and was confidential.

Pfizer, the world’s largest drug maker, has certainly found the marketing channel to be an effective way to reach doctors. “The beauty of the work we do with Epocrates is that we literally put ourselves in the palm of their hand,” said Dr. Freda Lewis Hall, chief medical officer at Pfizer.

Epocrates says drug makers can present alerts to doctors based on specific drugs or classes of drugs they have looked up and by specialty, geography and insurance plan. The company will also send alerts to “customer target lists” — specific physicians, like those identified by pharmaceutical manufacturers as being the most frequent prescribers.

Epocrates acknowledges the challenges of balancing the needs of its two groups of customers: medical professionals and drug companies.

“The credibility of our brand is dependent in large part on the medical community’s continued perception of us as independent from our health care industry clients, particularly pharmaceutical companies,” the company said in a securities filing this year.

Pharmaceutical companies provide at least 70 percent of Epocrates’s revenue, which totaled $104 million last year and is projected to be $125 million this year, according to analysts at William Blair Company, the investment house that helped underwrite the company’s initial public offering in February. (Shares sold for $16 then and closed at $16.83 on Monday.)

“Our first commitment is the value to the physician,” Rosemary A. Crane, president and chief executive of Epocrates, said in an interview.

Ms. Crane said the company’s drug descriptions were unbiased and opened “a trusted channel” for drug makers to communicate with physicians through doctor alerts, which are downloaded each time the doctor updates the frequently changing drug information on the app. Ms. Crane said that having alerts based on tracking what doctors look up made the alerts more relevant to the physicians receiving the messages.

But such data tracking is opposed by some doctors and lawmakers. The Supreme Court last month overturned a Vermont law that would have restricted IMS Health, an industry data firm, from providing to drug marketers the prescription histories of individual physicians.

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