Healthy Skepticism Library item: 1763

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

Hensley S.
New Rules Will Push Drug Firms To New Tactics in Wooing Doctors
The Wall Street Journal 2002 Apr 23
http://online.wsj.com/article/SB101950641556616040.html?mod=googlewsj

Full text:

How will pharmaceuticals sales reps woo doctors without dinners, golf trips, and giveaways to get their attention?

Most likely they will break their old habits by embracing some new ones.

On July 1, a new drug-industry voluntary code of conduct goes into effect, requiring drug salespeople to relinquish some of the most flagrantly promotional but effective tools for getting a few minutes of doctors’ time. No longer will they be able to chat up a surgeon during intermission at a “Lion King” performance, or bond side by side in half-court seats at a Lakers game.

Clearly, though, drug companies won’t roll over and stop making pitches to doctors. The trick will be harnessing other, perhaps less visible, tactics than entertainment to influence what doctors prescribe to their patients. For instance, the companies may rely more heavily on paying doctors as consultants, despite planks of the code aimed at curtailing abuses of the already common practice. Companies also may redirect some of the money saved from cutbacks in entertainment to direct-to-consumer advertising, a tool to mobilize patients to pressure doctors to prescribe a certain brand. Drug makers are also likely to experiment more with the Internet for ways to get their messages across, as the Web currently accounts for only about 1% of drug companies’ interactions with doctors, according to ImpactRx, a Mount Laurel, N.J., firm that tracks how drug companies promote their products.

Drug companies spent about $12.5 billion promoting their products last year, including $2.1 billion on meetings and events and $7.2 billion for sales forces, according to Quintiles Informatics Inc. The old ways may die hard, though. Even if companies try to pull back on entertainment, many physicians may resist because they consider entertainment and other industry largess to be an entitlement, say some people.

Relying on Their Smarts

“The doctors have been spoiled,” says Bernie Ness, an independent sales rep for clinical testing products in Toledo, Ohio. He says many offices he calls on won’t let him see the doctors unless he buys lunch for the entire staff. “They even tell you what they want and from what restaurant,” he says. Now salesmen will have to rely on their smarts, charm, and small giveaways, such as pens, to get in the door. For Mr. Ness, that change can’t come too soon, he says, because he has been unable to match the lavish spreads offered by some of his competitors.

The voluntary code, adopted by the Pharmaceutical Research and Manufacturers of America last week, would eliminate a pizza dropoff for the staff unless it is accompanied by an in-person educational session. Entertainment for its own sake would be eliminated entirely. The code came about as a way to blunt criticism of drug-industry marketing, stave off regulation and reduce escalating sales spending on an entertainment arms race that many companies acknowledge privately had gotten out of control.

Drug salespeople are always looking for ingenious ways to get doctors’ attention because the market has become ultracompetitive. More than 80,000 drug sales representatives now compete for a few minutes each to talk to physicians. The legion of reps is almost twice what it was just five years ago, yet the number of physicians has remained constant and they are busier than ever. On average, doctors talk with about 10 reps a week for a total of 35 minutes, figures that have held steady during the past year despite some big new drug launches such as Clarinex by Schering-Plough Corp. and Bextra by Pharmacia Corp. and Pfizer Inc., according to ImpactRx.

Consulting arrangements clearly will remain an important, if controversial, tool for the pharmaceuticals industry. Consulting agreements first became popular years ago as a way to recruit leading academic researchers whose opinions have outsize influence on their colleagues. But stretching the definition of consultant, sales reps now recruit local doctors, paying them hundreds of dollars for an evening meeting in town or thousands to attend a national event a few hours’ flight away.

“These are one-night stands,” says Benjamin Crocker, a psychiatrist at Maine Medical Center in Portland. Bona fide consulting arrangements, he says, involve real work as part of a relationship between industry and physicians. Companies that entertain doctors for an evening or weekend and require them in a consulting agreement “not to disclose anything that was discussed,” he says, are engaging in “bribery” that doctors must reject.

The new code forbids such token arrangements, and many drug makers vow to steer clear of them, but doctors can earn their keep by participating in discussions of medical science and offering their opinions on everything from advertising campaigns to patients’ experiences with company drugs. A doctor also can earn a consulting fee by helping a company study a drug or joining a company’s speakers bureau and lecturing colleagues.

One sales rep, who requested anonymity, says his employer began cracking down on some entertainment practices earlier this year but that didn’t stop the company, which voted for the code, from this month inviting doctors around the country to attend a meeting at a posh hotel. “How can you say you’ll take a stand on these ethics and the same month invite doctors to a consulting panel in Las Vegas?” he says. “You can’t have it both ways,” he says.

The guidelines allow the industry to recruit doctors as consultants, but would forbid sham agreements to justify lavish spending. Companies would have to specify by contract the work physicians are expected to perform. In addition, the code preaches restraint on the hiring of consultants, saying their ranks shouldn’t be “greater than reasonably necessary.” It is an attempt to keep thousands of doctors from being deputized as a way to pay them for listening to a company’s message.

No More ‘Dine and Dash’

Companies say they want to return to sales methods that are about patient care and medical science. “What concerned me and others was that there were some practices that didn’t live up to the standard,” said Henry McKinnell, chairman and chief executive of Pfizer Inc., of New York. “Dine and dash — that doesn’t pass the smell test.” In a dine-and-dash event, a doctor orders dinner to go and listens to a rep, who pays the bill, while the food is prepared. Mr. McKinnell said Pfizer will abide by the voluntary guidelines.

David Stout, president of GlaxoSmithKline PLC’s U.S. Pharmaceuticals unit, says his company supports the code and will honor it, including strictures on arrangements with doctors who serve as consultants. He says drug companies need consultants, both nationally and regionally, but “we expect that consultants would be a very small percentage of the entire base” of prescribing physicians.

During recent months, even before the code was passed, several prominent drug makers already were retrenching on wining and dining. “We’re seeing a couple of companies have already stepped up and totally eliminated entertainment as a venue for dissemination of their latest clinical information,” said Tim Margraf, chief executive of ImpactRX.

Since January, about 10% of all meetings and events held between industry reps and primary care doctors were in entertainment venues, he says. Yet two companies — Merck & Co. and Wyeth — avoided entertainment entirely. A Wyeth spokesman said “we support the new guidelines, participated in their development and have been adhering to similar [company] regulations for quite a while.” A Merck spokesman said the company “welcomes the voluntary guidelines” and that it “won’t require any changes in Merck’s business practices.”

At the other end of the scale, Takeda Pharmaceuticals North America, a unit of Japan’s Takeda Chemical Industries, held a quarter of all meetings and events with doctors in entertainment settings. A spokesman said Takeda’s “overriding objective is to have a high standard in everything that we do.” He said Takeda salespeople are trained to comply with American Medical Association standards for interaction with physicians. “If we need to make adjustments, we will,” he says.