by Dr K Balasubramaniam
(June 13, Colombo, Sri Lanka Guardian) Unlike the door-to-door vendors of electrical appliances and household gadgets, drug reps do not sell their products directly to buyers. Consumers pay for prescription drugs but the doctors decide what drugs the consumers buy. Therefore, to increase their sales, drug reps are trained to influence the prescribing habits of doctors. During training, a drug rep is told that when entertaining a doctor to dinner to preserve this mental image: "The doctor is eating with a friend. You are eating with a client". An official job description for a drug rep would read; "provide healthcare professionals with product information, answer their questions on the use of products and deliver product samples". An unofficial, and more accurate, description would have been – "change the prescribing habits of doctors".
Several studies have confirmed that samples influence prescribing practices. Drug reps provide samples of the most promoted and usually most expensive drugs. Patients given a free sample for part of a course of treatment almost always end up by continuing to receive prescriptions of the same drug. This is the reason why patients with long term ailments such as heart disease and hypertension who go to specialists in private hospitals are always treated with the latest and most expensive brand name drugs whilst well established drugs that have been used for several years or even decades that are found to be quite effective, are never prescribed. Well-recognised therapeutic guidelines and model formularies always advise the treating of these patients with well-established lower priced drugs.
In 2000, pharmaceutical companies in the US spent more than 4.8 billion dollars on drug reps – the one to one promotion of drugs to doctors. Pharmaceutical companies monitor the return on their investment on drug reps. This monitoring is done by prescription tracking. Information distribution companies purchase prescription records from community and retail pharmacies. IMS health, the largest information distribution company, procures records on about 70 percent of all prescriptions from community and retail pharmacies.
Pharmaceutical companies are the primary customers for prescribing data which are used to identify "high prescribers" and to monitor the effects of promotion. Doctors are ranked on a scale from one to ten based on how many prescriptions they write. Drug reps lavish high prescribers with attention, gifts and unrestricted "educational" grants. Cardiologists and other specialists write relatively few prescriptions, but are targeted because specialist prescriptions are perpetuated for years by general practitioners, thus affecting market share. Gifts create both expectation and obligation. The importance of developing brand loyalty through gifting, however, involves carefully caliberated generosity. Many prescribers get pens, note pads and coffee mugs, all items kept close at hand, ensuring that a targeted drug name stays uppermost in a doctor’s subconscious mind. High prescribers receive higher–end presents, for example silk ties and golf bags. The essence of pharmaceutical gifting is "bribes that are not considered bribes". One industry article suggests some doctors are "hidden gems". Initially considered, "low value" because they are low prescribers, these doctors can be influenced to change their prescribing habits after targeted effective marketing. "Growers" are "Doctors who are early adopters of a brand". Pharmaceutical companies employ retention strategies to continue to reinforce their growth behaviour.
Drug reps use prescribing data to see how many of a doctor’s patients receive specific drugs, how many prescriptions the doctor writes for targeted and competing drugs, and how a doctor’s prescribing habits change overtime. One training guide states that an "individual market share for each physician pinpoints a doctor’s current habits" and is used to identify which products are currently in favour with the doctor in order to develop a strategy to change those prescriptions in to Merck prescriptions. Another quote from a drug rep, "while the doctor’s job is to treat patients and not to justify their actions, it is my job to constantly sway the doctors! It is a job I am paid for and trained to do. Doctors are neither trained nor paid to negotiate. Most of the time they do not even realise that is what they are doing".
Whether or not doctors believe in the accuracy of information provided, drug detailing is extremely effective at changing prescribing behaviour of doctors which is why it is worth its substantial expenses. For example, in the US, when expenses are added to income and training, pharmaceutical companies spend one million annually per primary care sales representative. The pharmaceutical industry averages 31.9 million dollars in annual sales spending per primary care drug. Sales spending for speciality drugs that treat a narrowed patient segment average 25.3 million dollars across the country. All these costs are included in the retail prices of these drugs.
Consumers will be interested to know details of marketing and promotional expenses in Sri Lanka.
Conclusions
= The concept that drug reps provide necessary services to doctors and patients is a fiction.
= Pharmaceutical companies spend billions of dollars annually to ensure that doctors most susceptible to marketing prescribe the most expensive, most promoted drugs to most people possible.
=Every word, every courtesy, every gift and every piece of information provided to doctors by drug reps is carefully crafted, not to assist doctors or patients but to increase market share of targeted drugs.
= In the interest of patients, doctors must reject false friendship provided by drug reps.
= Doctors must rely on objective information on drugs from un-conflicting sources and seek friends among those who are not paid to be friends.
Source: Excerpts from an article, "Following the Script: How Drug Reps Make Friends and Influence Doctors", by Adriane Fugh – Berman, a physician who researches pharmaceutical marketing and Shahram Ahari, a former drug rep, in a recent issue of PLoS Medicine, an online peer-reviewed international medical journal.
- Sri Lanka Guardian
(June 13, Colombo, Sri Lanka Guardian) Unlike the door-to-door vendors of electrical appliances and household gadgets, drug reps do not sell their products directly to buyers. Consumers pay for prescription drugs but the doctors decide what drugs the consumers buy. Therefore, to increase their sales, drug reps are trained to influence the prescribing habits of doctors. During training, a drug rep is told that when entertaining a doctor to dinner to preserve this mental image: "The doctor is eating with a friend. You are eating with a client". An official job description for a drug rep would read; "provide healthcare professionals with product information, answer their questions on the use of products and deliver product samples". An unofficial, and more accurate, description would have been – "change the prescribing habits of doctors".
Several studies have confirmed that samples influence prescribing practices. Drug reps provide samples of the most promoted and usually most expensive drugs. Patients given a free sample for part of a course of treatment almost always end up by continuing to receive prescriptions of the same drug. This is the reason why patients with long term ailments such as heart disease and hypertension who go to specialists in private hospitals are always treated with the latest and most expensive brand name drugs whilst well established drugs that have been used for several years or even decades that are found to be quite effective, are never prescribed. Well-recognised therapeutic guidelines and model formularies always advise the treating of these patients with well-established lower priced drugs.
In 2000, pharmaceutical companies in the US spent more than 4.8 billion dollars on drug reps – the one to one promotion of drugs to doctors. Pharmaceutical companies monitor the return on their investment on drug reps. This monitoring is done by prescription tracking. Information distribution companies purchase prescription records from community and retail pharmacies. IMS health, the largest information distribution company, procures records on about 70 percent of all prescriptions from community and retail pharmacies.
Pharmaceutical companies are the primary customers for prescribing data which are used to identify "high prescribers" and to monitor the effects of promotion. Doctors are ranked on a scale from one to ten based on how many prescriptions they write. Drug reps lavish high prescribers with attention, gifts and unrestricted "educational" grants. Cardiologists and other specialists write relatively few prescriptions, but are targeted because specialist prescriptions are perpetuated for years by general practitioners, thus affecting market share. Gifts create both expectation and obligation. The importance of developing brand loyalty through gifting, however, involves carefully caliberated generosity. Many prescribers get pens, note pads and coffee mugs, all items kept close at hand, ensuring that a targeted drug name stays uppermost in a doctor’s subconscious mind. High prescribers receive higher–end presents, for example silk ties and golf bags. The essence of pharmaceutical gifting is "bribes that are not considered bribes". One industry article suggests some doctors are "hidden gems". Initially considered, "low value" because they are low prescribers, these doctors can be influenced to change their prescribing habits after targeted effective marketing. "Growers" are "Doctors who are early adopters of a brand". Pharmaceutical companies employ retention strategies to continue to reinforce their growth behaviour.
Drug reps use prescribing data to see how many of a doctor’s patients receive specific drugs, how many prescriptions the doctor writes for targeted and competing drugs, and how a doctor’s prescribing habits change overtime. One training guide states that an "individual market share for each physician pinpoints a doctor’s current habits" and is used to identify which products are currently in favour with the doctor in order to develop a strategy to change those prescriptions in to Merck prescriptions. Another quote from a drug rep, "while the doctor’s job is to treat patients and not to justify their actions, it is my job to constantly sway the doctors! It is a job I am paid for and trained to do. Doctors are neither trained nor paid to negotiate. Most of the time they do not even realise that is what they are doing".
Whether or not doctors believe in the accuracy of information provided, drug detailing is extremely effective at changing prescribing behaviour of doctors which is why it is worth its substantial expenses. For example, in the US, when expenses are added to income and training, pharmaceutical companies spend one million annually per primary care sales representative. The pharmaceutical industry averages 31.9 million dollars in annual sales spending per primary care drug. Sales spending for speciality drugs that treat a narrowed patient segment average 25.3 million dollars across the country. All these costs are included in the retail prices of these drugs.
Consumers will be interested to know details of marketing and promotional expenses in Sri Lanka.
Conclusions
= The concept that drug reps provide necessary services to doctors and patients is a fiction.
= Pharmaceutical companies spend billions of dollars annually to ensure that doctors most susceptible to marketing prescribe the most expensive, most promoted drugs to most people possible.
=Every word, every courtesy, every gift and every piece of information provided to doctors by drug reps is carefully crafted, not to assist doctors or patients but to increase market share of targeted drugs.
= In the interest of patients, doctors must reject false friendship provided by drug reps.
= Doctors must rely on objective information on drugs from un-conflicting sources and seek friends among those who are not paid to be friends.
Source: Excerpts from an article, "Following the Script: How Drug Reps Make Friends and Influence Doctors", by Adriane Fugh – Berman, a physician who researches pharmaceutical marketing and Shahram Ahari, a former drug rep, in a recent issue of PLoS Medicine, an online peer-reviewed international medical journal.
- Sri Lanka Guardian
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