Healthy Skepticism Library item: 1363

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Ranii D.
Sales reps overwhelm doctors: Doctors appreciate drug samples but are a little overwhelmed by all the visits
newsobserver.com 2003 Jul 29

Full text:

Dr. Mott Blair, a family practice physician in the Eastern North Carolina town of Wallace, typically meets with a few drug industry sales representatives at his office each week.

“I turn many more away,” Blair said. “I don’t have time. Patient care comes first. … As a solo practice, it is very difficult for me to see every sales rep who comes into the office.”

But the drug reps keep coming and coming and coming. The industry has increased the number of reps employed in recent years as the prescription drug market has become more competitive — the same force that also has unleashed a torrent of print and broadcast ads aimed at consumers.

Now it’s not unusual to walk into a doctor’s office and find three or four drug reps in the waiting room.

As a result, physicians with busy practices have been forced to limit more than ever their dealings with drug reps, whose mission is to persuade doctors to write prescriptions for their drugs rather than for rival products . A small but growing number of physicians refuse to meet with drug reps at all, making it harder for manufacturers to disseminate information about their newest drugs.

Since 1999, the number of U.S. sales reps employed by the 40 largest pharmaceutical companies jumped more than 50 percent to nearly 90,000, according to Verispan, a health-care research firm partly owned by Durham-based Quintiles Transnational.

And there’s no sign that the trend is diminishing. GlaxoSmithKline recently agreed to augment its 8,000-person U.S. sales force with 572 contract sales people, and the company is exploring additional expansion, said spokeswoman Mary Anne Rhyne. London-based GSK, whose products include the asthma drug Advair and the antidepressant Paxil, has one of its two U.S. headquarters in Research Triangle Park.

But the effectiveness of drug reps — who dispense free drug samples to physicians in addition to talking up their company’s products — appears to be diminishing because of their sheer numbers. A recent study by consulting firm McKinsey & Co. found that for every 100 sales reps who visit a doctor’s office, just 20 actually get to meet with the physician. And only eight of those encounters are remembered by doctors later.

Perhaps that’s understandable, given that these sales presentations aren’t lengthy. Two minutes or less is typical.

That brevity is why the encounters between doctor and sales rep are sometimes called “bump and run.” McKinsey & Co. calls it the “pinball wizard” sales model, with sales reps bouncing from doctor’s office to doctor’s office with the aim of getting a few minutes with a physician.

Dr. Conrad Flick of Family Medical Associates of Raleigh estimated he probably comes into contact with 30 or more sales reps weekly. But probably only two a day “get more than 20 or 30 seconds of my time.”

“Most of the time it is, ‘Hi, Dr. Flick. I’m leaving samples for so-and-so. Do you have any questions?’ “ Flick said.

Still, many doctors say they get some value out of these rapid-fire sessions. Being in a rural area makes it difficult to keep up with the latest news on drugs, said Blair, who is president of the N.C. Academy of Family Physicians. “My experience has been that [sales reps] give you good information.”

But, he added, “You have to temper that by knowing they are salespeople.

… Like all good salespeople, they give you information positive to the company.”

Some doctors, such as Dr. J. Carson Rounds of Village Family Care in Wake Forest, find it worthwhile to have lengthier lunch meetings with sales reps — with the reps typically bringing the lunch.

Nevertheless, Rounds said the No. 1 reason to meet with sales reps “is probably the free medicine for patients, the samples. It is nice to have free samples for patients.”

Sales executives at Raleigh-based Salix Pharmaceuticals and at Biogen, a Massachusetts-based biotechnology company that manufactures its drugs in RTP, contend it is easier for sales reps who call on specialists to gain access than for those who target primary care physicians who prescribe medications for a wide variety of illnesses. The latter simply have more reps vying for their time.

“It is a totally different environment,” said Irene Hunt, U.S. marketing director for Biogen’s Avonex, a multiple sclerosis drug that the company markets to neurologists.

Because most people who take Avonex inject themselves at home with the drug, which requires training, Biogen doesn’t provide free samples. “You can’t really sample an injectable,” Hunt said.

Lacking free samples as a sales tool, she added, “has forced us to use education to provide value for the physician. … We have become an information source for physicians on MS.”

“There is definitely a difference between calling on specialists and calling on family practitioners,” agreed Scott Plesha, executive director of sales at Salix. “Many reps want to get to the specialty level — that is their goal.” Salix markets its ulcerative colitis treatment Colazal to gastroenterologists.

Jace Sullivan, a Salix sales rep based in New Orleans, said the most common question he gets from physicians is Colazal’s efficacy rate — that is, what percentage of patients who take Colazal will get better.

“As high as 75 percent,” he replies.

“I think there is true value to what we do,” Sullivan said. “Some people see us as the UPS man — we come in and simply drop off samples. But that rarely happens.”

A small but growing number of physicians, however, have stopped seeing sales reps altogether, other than to sign the legally required form acknowledging receipt of the samples the reps bring with them. Such action comes against a backdrop of criticism that has been leveled against the drug industry for wining and dining physicians in hopes of winning their business.

Dr. Jonathan Klein of Orange Family Medical Group in Hillsborough decided to stop seeing sales reps about five years ago. “I stopped because I didn’t find it was personally valuable,” he said.

Klein keeps abreast of the latest data on drugs by reading medical journals and periodicals, which he says provide information without bias.

Sales reps, in his opinion, are anything but unbiased. “Their job is to sell a product,” he said. “The more drugs they sell, the more successful they are. Their job is not to critically evaluate a drug for a patient.”

“The whole system, there is a lot of wasted time, money and effort,” he continued. “Many physicians, if not all, are fed up with it.”