Wednesday, September 12, 2012

From the Belly of the Beast: The Future of Drug Reps

"Dear Howard," begins the e-mail, "here at Cutting Edge Information, we have done extensive primary research about some of the hurdles and roadblocks you may be facing as a sales representative or sales manager at University of Texas Medical Branch." These nice people want me to download a free summary of their report, "Reinventing Pharmaceutical Sales Forces."

I have to search around a fair amount to find that if I wanted to actually buy the complete report, it would cost me $7695 for a single-user license or $23,995 for an unlimited license. So it's not too surprising that the free summary gives very little away. What's there, however, may be a bit of a further clue as to what the drug industry is doing in the face of recent changes and pressures on its marketing model.

The summary starts out by citing the Wall Street Journal that after reaching a high of 100,000 just after 2000, we can expect the number of drug reps in the US to drop to 70,000 by 2015. Different companies, it seems are all over the map--a couple have drastically cut their force by as much as 50-60%, with the average being around 15%.

How can they make these big cuts and still peddle drugs? The big discovery seems to be that there were way too many drug reps during the peak season, and they were tripping over each other streaming in and out of the docs' offices and in the process, getting the docs ticked off. I gather that the fancy name for that was "mirroring" and the industry has decided that less mirroring is better. "The arms race of the previous decade is dead," pronounces the summary, referring to the time period when it seemed an article of faith in the industry that simply hiring more reps than your competitor was a guarantee of success.

If you don't "mirror," then what do you do? Two things it seems. First, while companies differ a lot on how much and how they are using electronic detailing, most seem to be moving as fast as they can in that direction, to supplement rather than replace face time between rep and doc. Second is the good old bread-and-buttter of detailing-- real, personalized and persistent attention to the docs (and especially the office staff). The summary gushes: "At still another interviewed company, drug reps who maintain one-to-one relationships with targets are greeted like 'rock stars' within the physicians' offices. On a recent ride-along with a rep, everyone within the doctor's office knew the rep by name and was excited to see him. There was no hint of 'the doctor's busy, so come back later.'"

With all this back to the future, you might wonder--what is changing on drug reps' compensation packages? And what impact have the most recent (2009) "ethics" rules from PhRMA had on the reps' operations? The full report answers those question, if anyone cares to shell out the 7-grand-plus to read it. I'd like especially to know about the latter question as the peer-reviewed medical literature, so far as I know, has been silent on that topic.

In past posts I have opined that Pharma really has discovered no alternative to the traditional rep model, which consists of making the doc believe that you're a good buddy and not a sales person, and If You Feed Them They Will Come. From what I can see of the free portion of this "Cutting Edge" report, that does not seem to have changed, arms race or no arms race. So if medicine ever wishes to reassert its professionalism and get out from under the cloud of having our clinical decisions distorted by commercial marketing, the answer is still, just say NO to drug reps. The report seems to hint that we have a really hard time doing that.

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