Drug Reps an Endangered Species

April 17th, 2009 | Sources: Amednews

Subjects:

Just 2 years ago, Big Pharma fielded 102,000 sales reps. That number has already dropped to 92,000 and it’s headed to 75,000 by 2012, according to Chris Wright, a principal at ZS Associates.

SidthedrugrepThat’ll save $3.6 billion for the beleaguered pharmaceutical companies, who are dealing with desiccated drug pipelines, patent expirations on blockbusters, blood thirsty politicians, and populist rages against the industry…and that’s before breakfast.

Decisions to make the cutbacks haven’t been that difficult since sales force effectiveness is way down.

Nowadays, only 37% of the drug reps who visit medical practices get to place products in the sample cabinet, and a measly 20% speak directly to a physician, according to TNS Healthcare.

About 25% of physicians belong to a practice that bans the reps altogether, and that was before new regs prohibited them from distributing tchotchkes!

“The old sales model is broken now, and who knows how it will look in the future,” Peter Nalen told AmedNews.

The president of Compass Healthcare Communications added “what’s happening is that pharmaceutical companies are realizing there are other ways to reach the doctor instead of banging on the door of the doctor who just doesn’t want to talk.”

Ari Silver-Isenstadt persuaded his Baltimore pediatrics practice partners to adopt a “no soliciting” policy for drug reps. “More than half of us doctors still just have a feeding frenzy of reps in our offices,” he told AmedNews.

“We should be ashamed of ourselves for allowing such an intertwining of our patients’ best interests with the convenience and niceties of drug reps.”

youcan'tbeseriousBut Ken Johnson, a senior VP for the Pharmaceutical Research and Manufacturers of America disagrees.

“Interactions between physicians and pharmaceutical company representatives benefit patient care through the exchange of information about new medicines, new uses of medicines, the latest clinical data, appropriate dosing and emerging safety issues,” he insisted.


 

Comments

  1. Dan | 18/04/09

    Published on: http://www.pharmagossip.blogspot.com
    While the pharmaceutical industry’s image and reputation has and appears to continue to suffer, added damage has expressed itself with costly patent expirations with certain large corporations within this industry in particular.
    As the president of the lobbing group for the industry which is called PhRMA would likely concur to a degree if asked, the image of this industry has experienced noticeable trauma over the past two decades in particular, and cannot be repaired by this lobbying group.
    The atrophy of the image of the pharmaceutical industry is largely due to how they market and sell their medications. Let’s take branded drug samples as an example:
    Even though the ability for health care provider to request samples of a pharmaceutical company’s medications to bypass the company’s representatives is possible and legal, the pharmaceutical industry, overall, prefer to have their own representatives dispense samples of their promoted medications. T
    his also allows for the representatives to dispense inducements to certain targeted prescribers that are of a much greater monetary value than drug samples.
    These sales forces of pharmaceutical companies have been examined more now than in the past due to their unbelievable size, for one reason. The number of representatives of these sales forces of large pharmaceutical corporations tripled within a decade- starting in the mid 1990s.
    Also, the estimated total income for an individual pharmaceutical representative may exceed 200,000 a year, if benefits and perks are factored in to this cost. Overall, the amount spent on these reps exceeds 20 billion dollars annually by the pharmaceutical industry.
    Sadly, yet with a high degree of confidence, most big pharmaceutical sales representatives are viewed and evaluated by their employers as it relates to their ability to gift targeted prescribers. This is due to the large number of representatives promoting the same medications to the same doctors who work for the same pharmaceutical company.
    In fact, one could conclude that an individual representative in such a work environment with multiple partners with their employer is potentially exonerated from any individual responsibility in regards to their vocation.
    This is why they may be judged by their employers according to how much of their employer’s monetary ‘marketing budget spend’ one representative dispenses to targeted prescribers in a certain period of time. This will be further addressed later.
    Yet the inducements are never described by what they actually are, which are bribes. Who receives these bribes is largely determined by the volume of scripts the prescriber writes as it relates to the pharmaceutical company’s promoted products.
    The gift dispensing is also determined by the prescriber’s loyalty to a particular pharmaceutical company’s products as well.
    This data of the prescribing habits analyzed by certain pharmaceutical companies is certainly available, and this will be further addressed shortly.
    However, and empirically, the drug sampling of doctors may be considered the ultimate if not primary gift that influences the prescribing habit of a health care provider. Some pharmaceutical representatives are falsely led to believe that their territory’s performance is due in large part to their powerful ability to influence others as outstanding salespeople.
    Although such pharmaceutical representatives want to believe such a false premise, it is samples of medications that determine the prescribing habits of health care providers, and this has been proven.
    Many years ago, drug reps used their persuasive, yet ethical, abilities to influence the prescribing habits of doctors in an honest and credible manner. They focused on the benefits for the doctor’s patients with particular drugs that the detailer may promote to such a doctor, and how these drugs may and can restore the health of these patients.
    However presently, most health care providers now simply do not allow drug reps to speak with them, or even see them, because the paradigm had become darker than it was in the past. Medical establishments are progressively and completely banning drug reps from entering their medical facilities. This is happening for several reasons, which include the following:
    The doctors lose money. Doctors are normally busy, so their time is valuable. As a drug rep, you are an incredible waste of their time. Yet they will accept your samples still. The credibility you possibly have thought you had and were perceived as such by doctors as a drug rep is no longer viewed to exist to any noticeable degree by the prescriber.
    Also, the accurate perception of the prescriber is that now pharmaceutical representatives are more concerned by their financial health instead of the health of their patients. The health care providers do not find the pharmaceutical representatives with the knowledge they need to benefit their understanding of the drugs that the representatives promote.
    Any information shared by the pharmaceutical representative to them, either oral or written, is likely embellished if not fabricated.
    This view is due to the frequent statistical gymnastics the employers of drug reps engage in way too often with their promoted products, and the representatives are likely unaware of the data they have is as inaccurate as it is.
    Doctors by their very nature seek answers objectively. And doctors do in fact find out about drugs through other methods besides the representative who promotes particular drugs.
    This is further illustrated by reps being selected by pharmaceutical companies due to their perceived appearance and personalities judged by certain hiring managers of various pharmaceutical employers.
    Another trait desired by the pharmaceutical company is the potential candidate’s likelihood of being completely obedient to their directives, as well as their affinity for monetary gain.
    Qualities related to anything of a scientific, medical, or clinical nature is of little if any concern to most pharmaceutical companies, quite apparently.
    This is why pharmaceutical representatives have little if any interest or concern regarding public health, perhaps. This premise is further validated by the pharmaceutical employers’ minimal concern regarding the medical knowledge of their sales representatives, as mentioned earlier.
    What the pharmaceutical company is concerned with, however is the ability of their representatives to effectively offer inducements to targeted prescribers. The inducements are not gifts, but are bribes.
    Examples may be creating a check from the pharmaceutical representative’s employer to be issued to one of the targeted prescribers determined by the pharmaceutical company. This check, when given to such a prescriber, is often for doing little, if anything at all for the pharmaceutical company paying such a prescriber.
    Knowing this, it seems to validate the pharmaceutical industry’s overt apathy regarding this industry’s absence of focus regarding the essential medical knowledge of their sales representatives.
    In relation to non-monetary inducements given to certain prescribers, they may be of a certain value and are possibly without any clear medical benefit, such as TVs or DVDs, perhaps. And the autonomy that exists with some pharmaceutical companies results in authoritarian directions to their sales representatives to implement the activities with the inducements that are given again to targeted prescribers.
    Since pharmaceutical representatives understandably believe that since they are given such directives by their pharmaceutical employers, then they must be legal and ethical. This is further reinforced by the applause and rewards the pharmaceutical representative receives often for this behavior of giving bribes to prescribers. They are viewed by their employers as innovative and creative, instead of criminal.
    This appears to eliminate the need or desire for the pharmaceutical representative to examine the consequences potentially of some activities and tactics encouraged by their pharmaceutical employers. It is clear that most pharmaceutical representatives do not question what they are told to do.
    Targets are a result of what is referred to as data mining, which is a determining variable as it relates to who a pharmaceutical maker may choose to support financially in one way or another. Prescribing data is in the possession of pharmaceutical companies of the prescribers nationwide, and this data is analyzed to determine the prescribing habits of health care providers. This prescribing data is provided to the pharmaceutical companies by the American Medical Association.
    Further disturbing is the fact that this behavior is not prevented by our lawmakers. This data mining allows a pharmaceutical company to conclude who could potentially affect their business and therefore dispense gifts to the right prescribers for their business. The gifting establishes reciprocal relationship with the receivers of these bribes. Quid Pro Quo is now born, and the pharmaceutical company continues to thrive.
    Conversely, if a prescriber is determined by a pharmaceutical company to be harmful or of minimal financial benefit to their business, they will essentially be ignored and ostracized by the pharmaceutical company.
    While such unethical activities may appear to be ridiculous and without reason to some, this does not mean they do not occur. The illegal and unethical behaviors of certain pharmaceutical companies seem to be rather unbelievable by others on occasion.
    It seems that external regulation is necessary to prevent the drug companies from allowing this corruptive autonomy to continue to exist. It is rather obvious that internal controls of companies that perform such wrongdoing are void of self-regulation with deliberate intent.
    If regulation happens, then health it may be possible to resurrect the ethical element necessary as a participant in the health care system. The importance of public health should be the apex of their existence as a company that participates in this system.
    Overall, pharmaceutical representatives are decent and intelligent people who do not realize the results of the actions they perform upon direction are harmful to the health of others. And if they may do in fact realize what they do for their pharmaceutical employers is in fact wrong, they continue to please their employers, as financial benefit for them outweighs the results of their actions
    Fear ensures loyalty.” — Author unknown
    Dan Abshear (what has been written is based upon information and belief).

  2. Dan | 1/07/09

    Published on http://www.pharmagossip.blogspot.com

    You Have Now Been Sampled

    While the pharmaceutical industry’s image and reputation has and appears to continue to suffer, added damage has expressed itself with costly patent expirations. Yet the big pharma task forces still insist that reps provide incredible value, and the more the better, as the drug reps are the givers of gifts, and reciprocity in the form of prescriptions just has to occur, as the samples reps dispense are around 20 billion a year, along with the reps themselves costing about 5 billion a year by the pharmaceutical industry.

    It is possible for prescribers to order samples on the internet to be delivered to their practice, but this remains rare presently.

    As a big pharma ex drug rep for over a decade, which during that period the number of drug reps actually tripled, the drug rep’s vocation has become more ridiculous, and possibly void of any true sense of accomplishment due to their customers preventing them from interaction or even presence in order for the drug reps to follow directives of the health care givers, and not their own employers, which is to influence their prescribing habits via direct dialogue along with the giving of gifts.

    The job has become nothing more than doing lunches and leaving samples at offices, for the most part. My perception formed from my own analysis of how drug reps operate in today’s environment in the medical community has led me to draw such conclusions, which I believe to be accurate.

    So they may be named at times in different ways, these promoters will be referred to now only as drug reps, which number close to 100,000 in the U.S. presently to influence close to 1 million prescribers in this country, it is believed, yet is probably less now due to big pharma cutting thousands of reps recently.

    The cost to the pharmaceutical industry of these drug reps 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 and set their own hours, which I understand is much less than 8 hours a day.

    The main function these days of drug reps, I believe, is primarily to offer doctors various types of inducements of a certain value that are not gifts, but bribes, by definition. And these prescribers visited by drug reps are known as targets.

    Targets are determined by what is known as ‘data mining’. The American Medical Association releases identifying information on doctors that allows pharmaceutical companies to track their prescribing habits. If a doctor, for example, is a high prescriber of prescriptions for particular disease states, or a doctor has an affinity for a product promoted by a drug company, they become a target.

    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. Perhaps this may be why the drug industry spends around 20 billion every year on samples.

    Yet I want to be clear on what I am saying: drug reps are some of the smartest people you will meet that do in fact have great paying jobs with great benefits. Most importantly and my opinion, I believe most reps really WANT to do well for their employers, yet are prohibited from doing so now because of how their employers are now viewed in their medical community.

    Many years ago, drug reps have used their persuasive, yet ethical, abilities to influence the prescribing habits of doctors in an honest and ethical manner, as they focused on the benefits for the doctor’s patients with a particular drug that the detailer may promote to such a doctor.

    However presently, most health care providers now simply prevent drug reps to speak with them- now this is especially true when they are in clinic treating and assessing patients. More and more medical establishments are completely banning drug reps from their locations, and I speculate that this is occurring for many reasons, which may include the following:

    The doctors lose money. Doctors are normally busy, so their time is valuable. As a drug rep, you are an incredible waste of their time. Yet they will accept your samples still. The credibility you possibly have thought you had and were perceived as such by doctors as a drug rep is no longer viewed to exist to any noticeable degree by the prescriber. For example and this is based on my experience and my colleagues, doctors view any information you may provide to them as biased and embellished.

    In my opinion, based on information and belief, their view regarding their assessment of you as a drug rep is accurate due to the statistical gymnastics the employers of drug reps engage in, which effectively and ultimately is permitting and encouraging the drug reps to lie to the doctor and likely are unaware of the statements stated by them are misleading.

    Doctors by their very nature seek answers objectively. And doctors do in fact find out about drugs through other methods besides the representative of the drug’s maker, such as the internet and experience with certain medications. Most drug reps in this country in particular mostly hire drug reps based on such qualities as the candidate’s looks as well as their personality, overall.

    Furthermore, it is possible that pharmaceutical companies desire their drug reps to be obedient and to not question what is asked of them. Upon speculation, this can be possibly determined by the background of the candidate, which may indicate they seek popularity as well as are money driven. In addition, most drug reps do not have degrees remotely related to any aspect of anything of a scientific or clinical nature.

    During my decade as a drug rep, I would encounter on very rare occasion another rep that may have been a nurse or researcher, and this is concerning that others do not have similar backgrounds because the type of training necessary is rare for a drug rep. In fact, based on my opinion, many do not particularly care to acquire education related to such medical or clinical topics.

    They learn the basics in order to sell their promoted products. Yet anyone who has ever worked with doctors in a clinical setting, or in a hospital working in a clinical nature, likely they would agree that a drug rep should want to and seek all related to the complexities involved in the restoration of another’s health.

    Many drug reps, it is believed, are void of any complete interest in medicine completely, and I believe this to be necessary. In addition, ethical considerations due to their possible deliberate ignorance created by the necessity of what they are required to say or do by their employers may be viewed as a disturbing fallacy as well.

    This allows them with the encouragement and coercion of their employer to embellish the benefits of their promoted products at times in addition to offering inducements to doctors in various ways- most of all of which are rather covert, yet performed and issued to select prescribers upon instruction of their employer.

    Examples may be creating a check from your company to a certain supporting doctor and handing this check to thank a doctor for supporting your company’s products for doing little if anything for your employer to justify this check. Or tangible items are given to such prescribers, such as TVs or DVDs which may or may not be utilized in a particular doctor’s office. It happens often, such activities.

    From the drug rep’s perspective, it is unlikely they will even consider the possibility to question their pharmaceutical employer due to the great risk of losing income and benefits that they are unlikely to acquire at another place of employment.

    Because of their consistent and conscious effort to keep their high-paying jobs, the drug reps always appear overtly anxious to please their superiors- regardless of any ethics or legalities regarding any activity they may be required to perform.

    With big pharma in particular, each drug rep is given a variety of budgets, such as a chunk of cash for doctor office lunches that they are required to spend in a certain period of time. Another chunk of cash may be assigned to a rep to pay assigned or registered speakers of their employer to speak to other prescribers about a disease state related to the drug rep’s promoted product.
    These activities, in my time with big pharma, were never monitored or questioned by managers or superiors. What I did notice is that my annual raises were greater than others according to the amount I spent for that particular year, as this, according to a big pharma company, was a very objective and noticeable variable with securing and keeping your employment in big pharma.

    While legally risky, the drug companies continue to dispense to their reps these large budgets their drug reps are in effect coerced to dispense with complete autonomy and possibly the spending can be fabricated, which is too complicated to fully explain.

    This design perhaps is why there are now various state and federal disclosure laws that are presently being considered to mandate the release of all funds dispensed from pharmaceutical companies as far as why a company’s funds were spent and for what reason or method. Because, according to the lobbyists of pharma companies, they consistently insist that whatever they spend always is for the benefit of public health. As mentioned earlier, presently such activities are quite covert.

    Yet if such laws are mandated, it is likely the accounting of pharma companies will become rather creative and incomplete. In summary, as a big pharma drug rep, my budgets were unlimited, and I typically spent more than I made though the activities I have mentioned so far. And this is not an isolated case. Historically, pharma lavished doctors with expensive gifts and trips. Now it is about funding for them, such as financial grants. Basically, the two remain synonymous and ethically conflicting.

    Then there is the issue is what again is referred to as data mining. The American Medical Association sells this prescribing data on individual doctors to pharmaceutical companies or pharmacies, by providing others identifying numbers of a particular doctor, such as a state license number or DEA number, which allows them to track the scripts a doctor writes not far from real time availability.

    This data shows the volume of scripts of a particular doctor and what the doctor has been prescribing for the doctor’s patient for their disease state, and this data reveals competitor products to the drug rep as well. Aside from being deceiving and dishonest, the data allows a pharma company to ‘reward’ those doctors who support their products, while treating the other doctors with ‘neglect’, which means the non-supporters of a pharma company will not receive any inducement or remuneration from a particular pharma company.

    The data, by the way, only reflects numbers linked with particular products, and fortunately is free of patient names- this data that is provided to all drug reps. What has been described is the method typical with all big pharma companies, in my opinion, and I worked for three of them. It appears to be manipulative in a psychological paradigm- a combination of Pavlovian responses combined with positive and negative reinforcement.

    So such methods create a toxic culture required to be absorbed by those members of such a pharma company. Furthermore, the tactics implemented by pharma companies vacuum the judgment of prescribers, which may prevent patients from receiving objective treatment. Yet on the most basic level, it is the samples left with prescribers that ultimately determine their prescribing habits- with various inducements to some doctors running close in second place.

    Yet remarkably, prescribers are prescribing more and more generics, which typically are not sampled to prescribers. I find this comforting that the manipulation efforts of the pharma industry are not as effective as they believe they are in a rather delusional way. Yet what is happening now in regards of branded meds vs. generic meds, insurance companies are flat out paying doctors to switch patients to a generic if one is available, as well as initiating generic medication treatment for their patients.

    I speculate they are paying doctors for this as a response of what pharma has been doing for quite a long time. From a clinical paradigm, if a medication is providing desired treatment and good tolerability for a particular patient, one could argue it would be unethical to switch treatment for financial gain, further complicated by the fact that most patients are aware that insurance company payments to doctors for this even occur.

    It is likely and I believe 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. In other words, the drug reps have compromised their integrity, 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. Because it is obvious that internal controls with such corporations exist on paper often, but clearly are discouraged to be enforced. It is possible that these pharma companies falsely believe that being an ethical company would make them a company without excess profit. One can only speculate on their true motives.

    Yet it appears that overt 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. Perhaps most frightening is that most drug reps fail to dig deep enough to realize that what they do at times may damage public health.
    “Fear ensures loyalty.” — Author unknown
    Dan Abshear (what has been written is based upon information and belief)

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