Thursday, May 16, 2013

New Report: Harder for Drug Reps to See Doctors

Katie Thomas reports in the New York Times:
--about how the firms that sell data to drug companies are getting smarter and smarter at tracking more and more data about patients so as to fine-tune what the industry knows about each individual physician's prescribing patterns. They manage to do this without (supposedly) stepping over the line to identify any patient by name.

I didn't see any real news flashes here about how the firms mine data; most of this more or less confirms what we've long known. I was a little bit more impressed with some side comments about why companies are finding it worthwhile to invest funds in these more detailed data-mining techniques. Here is Thomas's account:

"Companies are refining their pitches to doctors in part because it is getting harder to market to them. Studies show physicians are less willing to speak to sales representatives, either because they are opposed to such pitches, or because they are under pressure to see more patients. At the same time, the industry has laid off thousands of sales representatives in an effort to save money as once best-selling drugs have lost their patent protection.

“'The industry is now having a harder time getting direct access to physicians,' said Edward Rhoads, a managing partner and principal at the New England Consulting Group. As a result, he said, drug companies are asking, 'How can we get the information into the community in a different way?...'"

As I have reported both in HOOKED and later in this blog, the era 2006-2009 (roughly) saw something of a sea change in drug marketing. Before that, Pharma seemed to have its own way and all the complaints of pharmascolds like me and many others fell on deaf ears. Suddenly it seemed that all the mounting criticisms had taken hold and that the landscape was rapidly shifting. I have still not seen reliable studies in academic journals to document just what changed, how much, and how quickly; so anecdotal reports like this may be the best we have to go on for the present. (And what I hear from my medical students who go out into the community to spend time with practitioners seems to suggest that the beaming drug rep who rolls into the office bearing lunch for the entire staff is still a staple of medical practice.)


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Michael S. Altus, PhD, ELS said...

RE: “(And what I hear from my medical students who go out into the community to spend time with practitioners seems to suggest that the beaming drug rep who rolls into the office bearing lunch for the entire staff is still a staple of medical practice.)”

I am a patient of a physician who recently completed an internal medicine residency and is a member of a big and busy internal medicine group practice that has weekly lunch visits from drug representatives. Replying to my questions, my physician told me that she does not go to these lunches. It just wasn't done at her residency, and she won’t start now.

I wonder how many practitioners would show up at drug-company activities in the office if lunch or other food was not served.

I reckon that modeling behavior of medical school professors and residency program directors shapes the culture of accepting gifts from pharmaceutical companies.

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Michael S. Altus, PhD, ELS said...

The NY Times article had comments from RockDoc, and I replied. My reply was too late to be accepted. Here is what I wrote:

RockDoc (Radnor, PA) PART 2 (May 17, 2013 at 9:50 a.m.) wrote in part:
Shame on physicians if they don’t trust themselves to avoid falling victim to alleged undue influence and “bad science” promoted by the pharmaceutical industry! Doctors should understand how to critically evaluate the medical information that is provided by drug companies and other sources in order to reject flawed data. They should receive adequate training in biostatistics, epidemiology, and clinical trial design and interpretation. Unfortunately most physicians practice behaviors lags behind the evidence by an average of 10 years. This is not the fault of drug companies.

Shame on the medical profession—physicians, medical schools, hospitals and other institutions, and medical associations and organizations—for not seeing to it that education is provided by financially disinterested sources!

One keyword that Big Pharma defenders use is “alleged.” But there’s nothing merely “alleged” about “undue influence and ‘bad science’ promoted by the pharmaceutical industry.” It has been documented amply. To see a list of books filled with documentation, see my comments in reply to a June 29, 2012, post, “Massachusetts Docs May Get Free Lunches,” at the Pharmalot blog (

I agree that doctors should understand how to critically evaluate medical information based on being adequately trained to do so. So instead of going to a lunch provided by a pharmaceutical company, why not instead go to a session about critically evaluating medical journal articles?

That physicians are not sufficiently adequate in critically evaluating the medical information that is provided by drug companies and other sources is no excuse for drug companies to provide this information in the first place—as in don’t lay a stumbling block in front of a blind person. Misleading ignorant people is unethical.

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