Healthy Skepticism Library item: 10999

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Publication type: news

Wechsler A.
For drug reps, doctor is out
Times Union (Albany, NY) 2007 Jul 19
http://timesunion.com/AspStories/story.asp?newsdate=7/26/2007&navigation=nextprior&category=BUSINESS&storyID=607248&TextPage=1

Full text:

Critics say they push too hard to influence physicians with little time

COLONIE — As Peter Pappas sat back in the seat of a local diner, ready to talk about his 42 years as a drug salesman, his eyes drifted to a group of professionals a few tables over.
Five men, all in white button-down shirts and ties — maybe five or 10 years out of college — were at the table, along with a woman in a pink top.

They were drug reps, too. Pappas paused to listen. Technical terms like moderate in cognition and high-level function drifted over the tabletops.

They were strategizing about how best to get to a busy doctor, he explained.

“The doctor is head of the emergency room,” Pappas said. “If they can get to him, they can get to other doctors, and his prescription habits could rub off on other doctors.”

He listened some more.

“It’s dirty,” he said. “This would never have taken place 30 years ago.”

He was referring not to the table, but to the trade as a whole; this need to form a strategy, almost a battle plan, to break into the fortress commonly known as a doctor’s office.

As a salesman, it’s one of the reasons Pappas is leaving the business. Part is his age; part is the increased difficulty of reaching his core constituency. Salespeople have to strategize, because to not do so is to not do their job.

The practice of selling drugs has come under increased scrutiny over the last few years. Never mind the 60-second prime-time commercials lauding the newest pharmacology breakthrough in insomnia or toe fungus.

Critics, even within the industry, are concerned that doctors are being influenced in their prescribing habits by sales tactics used by drug reps.

“There’s no controversy,” says Sidney Wolfe, a physician with the watchdog group Public Citizen in Washington, D.C., who monitors medical issues. “There’s so much documentation that I don’t think anyone reasonably has dispute with that.”

The drug companies, meanwhile, point out that they spend tens of billions of dollars on research every year to help patients, and that sales reps have to follow a strict code of conduct.

“In the end, it all boils down to helping make certain patients are safely and effectively treated,” said the Pharmaceutical Research and Manufacturers of America in a prepared statement.

But still, there’s a Web site, http://nofreelunch.org, where doctors sign a pledge to refuse to accept free stuff from salespeople. And there’s Pappas.

Now 68, Pappas comes from a time before any of that mattered. A Colonie native, he started selling drugs in 1965. Ten years later, he joined what was then Alza Pharmaceuticals. That company eventually became the international drug giant Novartis AG, and Pappas stayed for the next 32 years.

Sales were relatively easy back then. A rep would make an appointment, the same as any patient, and get 15 minutes to a half-hour to discuss products with doctors. Pappas was quite successful, often earning a six-figure salary with numerous bonuses.

“There is only one Peter Pappas,” said East Greenbush physician Paul Colletti. “He always managed to get his pitch in.”

But as Pappas contemplated retiring, he said he was increasingly uncomfortable with the steps drug salespeople had to take to see doctors.

Part of it was time. Doctors often have only a few minutes to see patients, much less drug reps. Many medical practices have banned sales calls entirely, or severely limited access.
Kristen Pappas Kurtz, Pappas’ daughter, discovered that when she went into the industry a decade ago.

“You spend a lot of your time driving around, hoping to see a doctor,” said Pappas Kurtz, now 32 and a full-time mother living near Boston. “You need to make eight to 10 calls a day, and that’s just unrealistic. Doctors just don’t want to see you.”

With access limited, reps started providing lunch or dinner for a doctor’s entire office in exchange for a few minutes of time. While not everyone sees this as a bad thing, some decry the practice, saying studies show that a physician’s prescribing habits can be influenced by any gift he or she receives from a drug rep.

Dr. Mark Fruiterman disagrees. Two weeks ago, the Albany endocrinologist went to a lecture sponsored by Novartis at upscale steakhouse 677 Prime. The lecture was from a world-renowned hypertension specialist.

“When do I have time? Dinner,” he said. “Obviously, the salespeople would have an interest in their product. But as an attendee, if I don’t like the drug, I’m not going to use it.”

The event had a second purpose: to say good-bye to Pappas. Fruiterman helped by roasting the salesman, whom he has known for 30 years.

“He would track you down no matter where,” he said. “He would talk to anyone who would listen.”

Alan Wechsler can be reached at 454-5469 or by e-mail at awechsler@timesunion.com.