The drug reps are deluding this student

Drug reps are people doing a job. They have families, careers, hobbies, interests outside of work. They are not evil. They don’t always agree with everything companies do just like physician don’t always agree with hospital policies.

This continued demonizing of Pharma and drug reps is just childish. I’m engaged to a drug rep so I’m literally “in bed with industry.” I socialize with with Pharm salespeople, managers, and executives and am embarassed (and frightened) by posts from physicians on this site.

I think we need to remember that fascism and medicine don’t mix.

One more time. Over 30 years ago I took a course taught by the sales manager of a drug wholesaler. One of the major points of the class was: THEY DON’T CARE!! The whole point of a drug rep is to sell a product. Period. The end.

These are sales organizations who’s sole purpose is to sell a product. Need and value have no part of the equation. You are promoted based on your ability to sell products. The senior people in these organizations are salesmen. This is their corporate culture. They want you to like them and feel that the information they are giving is all the information they need to diagnose and then prescribe their latest medication. They don’t make money off no stinking generic.

Following this industry through the WSJ I have been amazed at the process. A drug is hyped in trials, hyped when it is given approval, and then when it does not meet sales expectations the standards are changed, for the good of the patient, to cover a larger population. Going to doctors I have been appalled to hear, verbatim, the retail sales pitch for a drug. Questions then lead to the doctor reciting the marketing concept and how this fits my situation, even though we have yet to do any test or have a simple physical.

B12 shots, fen-phen, Vioxx, the list goes on of the next great drug. Yesterdays WSJ had an article about statins and strokes. Pfizer touted this as the dawning of a new age in care. One of the co-authors said the results were no better than aspirin.

Yes, these are folks doing a job and I am sure they are very nice away from work. Most salespeople are fun, it is part of their personality that makes them salespeople. Don’t confuse this with a real concern for your, or your patients welfare. They only want the sale.

Steve Lucas

The point that I’m trying to make is that the “influence factor” is a red herring. It’s no secret that Drug Reps try to influence physicians. I’d like to see someone compute the “effect size” of this influence in comparison to 4 years of medical, 4 years of residency, and daily experience with patients. I suspect that it is “real” but small.

More worrisome to me is that way that the academic medical community feels like it must “shelter” and “protect” trainees from this “evil” influence. Would someone please tell what is the legal “age of consent” in this country?

Medical trainees, provided that they’re over age 18, are free to associate with who ever they want, use what free pen or gizmo they like, and participate in a business lunch or dinner activity just like every other professional does. I don’t see the academic community haveing a legitmate interest in the private affairs of its trainees.

Oskie,

I am a businessman who 40 years ago started with a paper route and have worked in small businesses ever since. My parents did not see the need for higher education so I had to put myself through my undergraduate and graduate programs by working full time. Even though my programs were in the Midwest I had instructors who graduated from Harvard and MIT.

Today my friends include doctors, lawyers, college deans, as well as business people. My wife is a lawyer who just completed her CLE at Harvard Law.

The point of all this is that we talk about the impact of marketing on all businesses, with medicine being a hot topic due to the economic impact it has on society, business, and on us personally.

Your claim of being 18 and free to choose is the same argument made 100 years ago by snake oil salesmen and today by guys running a corner used car lot. The argument of training is negated by drug reps being in med school from day one. Pharma’s whole plan is to get true believers like you to defend their system. Remember, the US is the only country that allows this type of marketing and the bulk of farm’s profits come from the US. Drug reps train to do 15 second sales pitches. Drug reps were on the floor of the Maine legislature passing out checks when they were passing a bill establishing an approved generics first drug list.

When I was young we were taught to “follow the money.” If you look at any drug companies financials you will see their biggest expenditure are administration and marketing. R&D is far down the list of expenditures.

Pharma is an important part of our medical system. They have developed many new and wonderful drugs that are saving lives everyday. They deserve and should make a profit for those efforts. Keep in mind that $39B in sales will go generic in the next couple of years.

The problem arises when some of us view the system, and in my case, sees a predatory industry. Drugs are pulled and replaced with “new” more expensive drugs, so as not to allow a generic an opportunity to go to market. In the case of Plavix, they simply paid off the generic maker not to produce. The latest Lipitor claim is flawed by a co-author stating the benefit is no better than aspirin and even the reviewer for the article has a financial relationship with Pfizer. Doctors only receive the good spin, not facts from drug reps.

Oskie, at some point you need to accept that many of us have the education and experience with this system, and we don’t like what we see. My house is over flowing with pens, pads, and other gee-gaws from salespeople. Salespeople sell and being a true salesperson you are concerned with value and customer satisfaction. Today pharma is only concerned about moving units, and well, if it also worked, I guess you got lucky.

Steve Lucas

It sounds like doctors could benefit from unbiased, objective infomediaries to speak to the efficacy and cost-effectiveness of various drug therapy options for a given condition almost as much as patients could. The question is how would such infomediaries be paid, who would pay them, and how profitable a business proposition could it be?

Oskie, that may be the way you do “business”. But ours is a profession, and our only goal isn’t the almighty dollar.

BC information intermediaries are called CMEs. And Journals. And colleagues. The cost you are paying your doctor should include time spent learning new information and refreshing old information. However, because most primary care doctors are so busy, they can’t keep abreast of everything. So you the public might need to revise their expectations about what primary care doctors can know (third line treatment for metastatic sarcoma is not one of them) and about what they should be paid.
b

I think Oskie is underselling the role of drug reps. The point is not simply that docs must be skeptical, that forbidding them from seeing drug reps is patronizing, or that the drug industry is a business in which we physicians indirectly participate. The larger point is that pharmaceutical advertising provides information, just as do other forms of advertising, which consumers are judged to be able to filter appropriately in a market economy.

There is no doubt that drug reps influence us (I wish db and others would stop announcing this as if it were a momentous discovery). And in medicine such advertising can lead to bad outcomes—if physicians are uncritical or venal; or if such advertising is positively mendacious. Yet if drug reps play by the rules, physicians likely learn about new drugs that they would not otherwise learn about; outside, that is, of academic medical centers and other settings where they have the time and incentive to keep up with the literature. In the world of practice it is doubtful that many succed in keeping up. So that practicing docs learning about unfamiliar drugs and using them appropriately is the good outcome of pharmaceutical advertising. The question is whether advertising influence balances out in favor of good or bad overall in this particular venue; as its influence is undoubtedly good (meaning that prices are lower and consumers get more of what they want) in others.

Those such as db and commenter b who don’t like drug reps appear to wish that pharmaceuticals weren’t part of the market economy or the business world; and that we physicians weren’t either. Yet medicine has always been business as well as profession, especially in America. And its business-like aspects are not necessarily a bar to integrity and professionalism. Physicians interacting appropriately with drug reps is not only possible but is something that medical educators ought to teach. And those who wish to declare drug reps persona non grata owe the rest of us an explanation as to how new drugs are to be developed, manufactured and promulgated to doctors (not marketed, heaven forbid!) outside of the market economy.

The word needs to get out, even about great drugs. For those docs who don’t take time to read, drug reps fill an information gap. Presuming that the upshot (on balance) is patients getting the drug who can benefit from it, such information is socially useful. Marketing costs are certainly an additional cost involved in patients getting the right drugs. As are the costs of journal articles, medical education, and our fees. And advertising for me-too drugs serves the very important function of publicizing competing products at (usually) lower prices.

Drug reps are indeed not high priests/priestesses of science; but the good ones make the best case they can within the constraints of the truth. Their companies want to make money, in exchange for a good product. So do we.

Oskie,

You are correct, life is full of contradictions and hypocrisy. I will leave the curriculum discussions to the academics.

Tom and you both make the valid point that pharma serves a purpose, in our current environment, where we expect medicine to include a business component. The problem arises, as you both point out, is when the doctor looses that critical component of what the drug rep is selling. All to often in their busy schedules, doctors do not read the literature, tear apart an abstract, or even solicit feedback from their patients.

This is the issue I think many of us contend with, how to bring doctors back to the critical thinking stage were they question the information they are being given. My business experience tells me this interaction is tainted when the sales rep has a position of prominence in the doctors information stream. The easiest way to do this is to remove the drug rep from the office environment.

This will not solve the problem, as you pointed out and any number of current cases exist, where the academic and professional journals have questionable ties to pharma which the are not disclosing. The leadership in medicine, in many of our most prominent institutions, do not feel a need to disclose their financial ties as they now feel this is business as usual.

Medicine is a zero sum game that consumes well over one trillion dollars of our GDP. We cannot devote more of our national resources to this portion of our economy without causing problems in other areas. b and I see such number as the $4B spent on direct to doctor advertising and see where these funds could be shifted to research or helping the poor. What would be the impact of $1B injected into the medical system be from just a 25% decline in this marketing area? PBM’s are restating earnings due to Zocor going generic. $39B of drugs are going generic in the next couple of years, how much money will that free up in the system?

b’s point is a good drug will sell itself. Tom’s point is the “me too’ create pricing pressure. Both points have merit and as long as doctors view all of the information with a critical eye this is a good system. My experience, and the experience of others is, doctors have lost the ability, due to time and other pressures, to be critical of the information they are receiving from the drug reps.

The key is for you, and other doctors, to remain critical of the information you are being given and do not allow even the appearance of conflict to enter your office. As you pointed out, your time belongs to your family and your patients, not the drug reps.

Steve Lucas

I am a nofreeluncher – through and through. I *NEVER* see pharma reps. EVER. Why is some 24 year old hottie telling me how to practice ? She’s bastardizing my brain for a free sub, diet coke and a cookie ?

Drug reps make me feel dirty.

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