This post provides no surprises for anyone familiar with these matters, but the quote that follows is so direct and succinct that I could not refrain from putting it out.
Shahram Ahari, former drug rep and now faculty member in Pharmacy at UCSF, has become deservedly prominent among critics of Pharma for publications such as:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040150
Recently (Nov. 8) Mr. Ahari spoke to Capitol Hill staffers regarding the Sunshine Law that would require disclosure of all Pharma payments to physicians nation-wide. He kindly shared his testimony with the National Physicians Alliance. He said, in part,
Part of our job as reps is to cultivate the illusion that doctors can’t be swayed by measly drug reps. And we help the doctors rationalize this by being one of the few friendly faces to enter their office not complaining about their symptoms or paperwork. Doctor, how can you who has 4 years of graduate education plus many years of training be swayed by little old me?
We all know that when physicians protest that they are immune to the marketing wiles of the industry, it's rationalization and not reality. This quote simply drives home what we have long realized, that the rationalization process is very much in the interests of the industry, and they are prime enablers in our own unprofessional behavior. (We docs must still own our own lack of professionalism and our willingness to lap up these convenient rationalizations from suspect sources.)
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3 comments:
Pharmaceutical marketing is composed of many different and destructive components, which include:
1. Embellishments of a rep's promoted products, as typically any literature associated with these products provided to them by thier employer is inaccurate.
2. The possibility of some form of inducement besides samples, which may include money or providing some tangible asset for the prescriber's office.
3. Marketing, while effective in other industries in particular, should be avoided in a medical setting to avoid possibly clouding the judgement of the doctor, which could then deprive he patient of appropriate restoration of thier health.
If a drug rep really wants to improve the well being of the patients of a particular doctor:
Take up as little of time as possible of the health care provider. Studies show they actually lose money the more time they spend with you. More importantly, you are delaying the care needed by thier patients.
Leaving samples of your promoted products is enough, and the primary influencer of thier prescribing habits.
Avoid utilizing any information provided to you as a rep by your employer. Likely, it's invalid and fabricated in one way or another. Prescribers know and frequently seek information on a med like the one you promote and the disease state for which it treats. There are exceptions, such as disease description materials.
Asking a doctor to prescribe your product during one of your visits, as a begger asks for money at an interstate exit, is ridiculous, as you as a rep are under the disillusionment that such an agreement has merit because of your persuasiveness and, worse yet, this tells the prescriber that the potential benefits for you are more important than the benefits for thier patients.
If a prescriber happens to be in a jovial mood during your visit and tells you that he prescribed one of the drugs you promote to a patient, please don't start dancing. Simply say. "thank you for making me aware of this, and I hope the med provides benefit for your patient."
If you are compelled, possibly based on the faulty premise that you have to talk to the prescriber in order to validate your excessive salary, discontinue this dialogue desire if the prescriber acknowledges awareness of whatever you may be trying to say.
Yes, many doctors are businesspeople and capitalists, but that does not mean that all prescribers are this way. Reconsider putting on your 1000 dollar suit and dressing like a winner. Lacks orininality, if nothing else.
Finally, and I can't stress this enough, never, ever tell a prescriber that you need thier business in order to meet your goals. You then infect that doctor with the presumed image of your industry and your apathy towards any perceived benefits that prescriber may have about the ethics of your organization, which is why there is this Dorian Grey image of the pharma industry.
'nuff said.
You Have Now Been Sampled (Drug Reps, Part 2)
While the pharmaceutical industry’s image and reputation has suffered, and has been complicated with their declining profits due to a few reasons, these companies still apparently insist on keeping most of their gift- givers on board. Known presently as simply drug reps today, this job has become a vocation void of a sense of accomplishment, which will be described below.
So they may be named at times in different ways, these promoters will be referred to as drug reps, which number close to 100,000 in the U.S. presently, it is believed. The cost to the pharmaceutical industry of these employees is around 5 billion dollars a year. Income for each rep grosses close to or above 100,000 grand a year on average, along with great benefits and a company car, as well as stock options as they gladly work from their homes.
The main function these days of drug reps, I believe, is primarily to offer doctors various types of inducements of a certain value. The drug sampling of doctors may be considered an inducement, and a rather valuable one for the drug rep, as many believe that these samples are what ultimately influence the doctor’s prescribing habits over anything else, including statements from drug reps. This may be why the drug industry spends around 20 billion every year on samples.
While historically drug reps have used their persuasive abilities to influence the prescribing habits of doctors in an honest and ethical manner. However presently, most health care providers now simply refuse to speak with them, or have banned all drug reps permanently from their practices for a number of reasons, including the recommendations from their colleagues. It is possible that this may be due to the following reasons:
1. The doctors lose money. Doctors are normally busy, so their time is valuable. As a drug rep, you are a waste of their time. Yet they will accept your samples still. The credibility you possibly have as a rep is not considered anymore to be present in your vocation due to various controversies associated with the pharmaceutical industry, it is speculated.
2. Most drug reps in the U.S. are hired for their looks and their personality. As a result, many are somewhat ignorant in regards to anything that is clinically relevant to a medical practice, so doctors seem to know this and have responded in such ways. Most drug reps have college degrees that do not correlate with their profession as a drug rep, which is to say that the clinical training of drug reps is limited. In fact, many consider this of such a serious nature that an Act is presently being considered called the SafeRx Act that would certify pharmaceutical reps, and this would be mandatory. One main reason would be to ensure personal accountability for their tactics and statements, I believe, which may improve the quality and safety of their function in the medical community.
3. Many drug reps, it is believed, are void of any ethical considerations due to ignorance of what they are coerced to do or say to prescribers by their employer, and this allows them to embellish the benefits of their promoted products at times in addition to offering inducements to doctors. This is usually due to the rep being unaware of the consequences of their actions at times, yet at other times what reps say is with premeditated intent for potential financial gain for such a drug rep. Worse yet, due to pressure to keep their high-paying jobs, they always are anxious to please their superiors, who require them to offer various types of inducements to physicians that are designated targets of a particular drug company. Such tactics are especially true with the larger drug companies. These reps are in fact coerced to spend these individual promotional budgets assigned to them by their employer. While legally risky, the drug companies continue to dispense to their reps these large budgets reps have been forced to be responsible for dispensing, and are required to spend these budgets. In fact, so much emphasis is placed on this promotional spending, there seems to be an association between the money a rep spends and the progression that occurs with their career working for their pharmaceutical employer. Disclosure laws are being considered presently to mandate the release of all funds dispensed from pharmaceutical companies, which is to say to allow others to see where their money goes and who it goes to, as it is presently very secretive, overall. It is not unusual for a big drug rep to spend 50 thousand dollars a year for clinic lunches alone. In addition, drug reps hire doctors as speakers for certain disease states, and they find many other ways to spend this money they are required to spend.
4. Another issue is what is referred to as data mining. The American Medical Association sells this prescribing data on individual doctors to pharmaceutical companies, which allows them to track the scripts a doctor writes, and the data is free of the patient names. Yet the names the products prescribed are well illustrated and available to the drug reps. This allows reps to tailor their tactical approach with any given doctor, if they see the doctor at all during an office visit. Worse yet, doctors who greatly support the promoted products determined by this data allow reps to reward those doctors who favor the rep’s products that they promote, and this could be considered a form of quid pro quo. Laws are being considered presently to prevent this practice of allowing reps to have this data. Doctors are opposed to the data the reps have as well about them for privacy and deceptive reasons, so they say.
5. Overall, reps can be best described as far as their function goes with their profession is to, whenever possible, manipulate doctors with remuneration or other forms of inducements, as they also continue to sample such doctors along with others their promoted meds. Also, frequent lunches are in fact bought often for doctors’ offices and their staff as a method of access, primarily, as stated earlier with the money reps spend earlier for this type of function. Essentially, because of the income and benefits the drug reps receive that they would likely not be able to obtain with any other job, they are compelled to do such unethical if not illegal tactics mentioned earlier that they perhaps normally would not do in another setting. Usually these drug reps rarely refuse to implement such tactics encouraged to them by their employers.
6. Samples keep the prescriber from selecting what may be their preferred choice of med due to cost savings from samples left with a medical office by a drug rep. In addition, doctors are now being paid by prescription providers, which are called pharmacy benefit managers (PBMs) that are typically owned by a managed care company to have a doctor switch their patients to generic substitutes, if they exist, and this is often not disclosed to such patients. Apparently, these PBM companies are doing this in response to the activities of the branded drug companies, as they continue pay doctors often for various reasons, which are questionable in themselves.
It is likely that most drug reps are good and intelligent people who unfortunately are coerced to do things that may be considered corruptive to others in order to maintain their employment, ultimately. It seems that external regulation is necessary to prevent the drug companies from allowing the autonomy of drug reps that exists, with their encouragement, which forces the reps to do the wrong thing for the medical community, possibly. Clearly, greed has replaced ethics with this element of the health care system, which is the pharmaceutical industry, as illustrated with what occurs within these companies. However, reversing this misguided focus of drug companies is not impossible if the right action is taken for the benefit of public health. Likely, if there are no drug reps, there is no one to employ such tactics mentioned earlier. Because authentically educating doctors does not appear to be the reason for their vocation. This is far from being the responsibility of a pharmaceutical sales representative.
“What you don’t do can be a destructive force.” --- Eleanor Roosevelt
Dan Abshear
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