Two recent news stories about how pharmaceutical companies' sales representatives market to physicians provided some interesting information....
The Philadelphia Inquirer noted that Wyeth has joined GlaxoSmithKline, AstraZeneca, and Pfizer in laying off sales representatives. A pharmaceutical sales consultant remarked, "this may be related to the issue of public trust. What we'ver realized is that we've probably gone too far." On measure of the distance traveled is the figure the Inquirer cited for the number of sales representatives working in the US prior to the lay-offs, over 100, 000, or approximately one for every seven physicians (see this post for numbers of physicians in the US versus numbers of managers). More striking was the statement that "a succesful sales representative can earn $150,000 to $200,000 a year, including a car and other perks. That's more than many primary care physicians make (see this post on physicians' compensation.)
Meanwhile, a reporter for the Los Angeles Times interviewed Jamie Reidy, the author of Hard Sell, described as a "slacker's tale," about Reidy's life as a sales representative for Pfizer. Reidy said, "I was the kid who didn't become a doctor because I almost failed high school chemistry. I was trained for six weeks and considered qualified to tell doctors which drugs to prescribe. Scary, isn't it?"
At the end, this becomes another story about the perils of blowing the whistle about the management of large health care organizations. Reidy had left Pfizer, and was working in the oncology division of Eli Lilly, advancing to a trainer of other sales representatives, until his book came out. Then Lilly fired him.
You Have Now Been Sampled
ReplyDeleteWhile the pharmaceutical industry’s image and reputation, complicated with their declining profits for a few reasons have occurred recently, these companies still apparently insist 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 for a few reasons as well.
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 of these employees is around 5 billion dollars a year for the pharmaceutical industry is a belief as well. Income for each rep grosses close to 100,000 grand a year on average, along with great benefits and a company car, along with stock options and working from their homes.
The main function these days of drug reps, I believe, is primarily offering doctors various types of inducements of a certain value, such as sampling doctors with the drugs they promote, as this is the most influential element for their choice of treatment by prescription for a particular disease state, and samples may cost the pharmaceutical industry about 20 billion dollars annually. While historically drug reps have used their persuasive abilities to influence the prescribing habits of doctors, 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, which 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.
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, an act is being considered presently called the SafeRx Act to have the government certify drug reps for such reasons- with a main reason being personal accountability for their tactics and statements, I believe, to ensure the safety and quality of the health care system.
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. This is usually due to ignorance, 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 tempted to implement such tactics such as to bribe doctors and the drug reps have the money that has been given to them by their employers to utilize for such reasons, upon the individual rep’s discretion, usually. 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 and are required to spend, and this mainly applies again with the big pharmaceutical companies. 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 many other ways to spend this money
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 tactics mentioned earlier that they perhaps normally would not do in another setting, and 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.
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 and encouragement that 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.
“What you don’t do can be a destructive force.” --- Eleanor Roosevelt
Dan Abshear