Healthy Skepticism Library item: 3927

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

Olsen G.
The Doctor Will See You Now
Medical Accountability Network 2006 Apr 12
http://www.medicalaccountability.net/PagesArticles/GwenOlsenEssay.html

Notes:

Ralph Faggotter’s Comments:

Medical Accountability Network is an excellent website which shares many of the same concerns as Healthy Skepticism.

In this essay, a former (and reformed) drug rep looks back at her old job and her gradual awakening.

Full text:

The Doctor Will See You Now
…an inside look at prescription drug pushing
by Gwen Olsen

“The doctor will see you now, Sara.” The impeccably well-groomed blonde, wearing a stylish
summer suit, high heels and pantyhose in 90+ degree Texas heat, was quite a contrast to me
and the other shorts and T-shirt clad patients waiting to see the doctor. Sara quickly gathered
her detail bag and jar of candy. Grinning and chatting with the receptionist at the window,
she deposited her candy jar and a handful of scratch pads and ink pens bearing her company’
s logo and drug name at the nurse’s station then swept past the exam rooms to the sample
closet. I could hear the doctor’s gleeful reception and greeting in the hallway before the door
to the back office had completely closed. This rep was obviously one of his favorites. I had
been waiting over 45 minutes to see Dr. Dogood. Some of the other patients waiting had
been there when I arrived. Yet, Sara had gotten here only ten or so minutes ago, had left her
business card at the receptionist’s window, and she was already in the back talking to the
doctor. Probably has a lunch appointment, I thought to myself…just then, the deli delivery boy
stumbled into the office with his arms full of boxed lunches.

As I looked up from the latest issue of Ladies Home Journal, I allowed myself to reflect back
over what seemed like a lifetime ago when I had been young, naïve, and ambitious enough to
be one of the best in the pharmaceutical business. Just a decade ago, Sara could have easily
been me.

In 1985, I had joined the pharmaceutical industry at the age of 26. Although I considered
myself intelligent and a fast learner, I was at first unequipped with the knowledge I needed
to have even a basic understanding of the disease states and physiology or pharmacology
involved in the drugs I was selling. My undergraduate degree was a Bachelor of Arts in
Spanish and Portuguese. That meant I was completely reliant on the product managers and
marketing department for the accuracy of the information I gave doctors.

Reps are trained and indoctrinated in a semi-military style. In fact, basic sales training classes
are much like boot camp and are designed to weed out the faint of heart or easily intimidated,
as working with the egos of doctors can wear on even the strongest self-esteem. Trainers
push new recruits to the breaking point, often giving them long hours of homework
assignments into the night and weekends. Reps must videotape sales presentations and
continually test their medical product knowledge. The environment is highly competitive and
large numbers do not complete all tiers of their training before dropping out from the
pressure. Those that do are glorified as the “best of the best” and are then unleashed on the
medical field with a false sense of bravado that soon fades.

Reps are instructed to promote the company’s products in a given manner and with a
particular focus. This is called marketing direction. Each promotional period there is a “tagline”
or special message that the rep is supposed to drive home to the doctor. Sales literature and
visual aids are all geared toward the promotional message, and they are utilized in role-plays
until the presentations flow naturally. Reps are taught to handle and minimize the objections
physicians might have. They are given the specific wording that best represents the company’
s position. Often, these instructions come from the legal department who reviews the sales
documents for legal accuracy. If a visual aid initiates too many negative questions from
physicians, the bar graph, product comparison, and so forth is reworked for the next sales
quarter in a way that presents the information in a more favorable light. Having already
learned the manipulative advantage of semantics in my study of language, I soon learned the
semantics of research were called statistics.

Most doctors would deny the influence that sales reps have on their prescribing behavior.
However, the fact of human nature is that we tend to support people that we like and feel are
supportive of us. The pharmaceutical industry knows this all too well, and it provides the
means for busy doctors to be accommodated in their practices by helpful, attentive sales
professionals. Some reps go to great lengths to access and influence physicians because
pharmaceutical companies provide lucrative incentives for reps who reach sales quotas. A rep
stands to make several thousand dollars in one lump sum as a bonus in addition to his or her
quarterly salary. Merchandise from catalogs and trip incentives are common as well. Reps who
don’t meet quotas are looked down upon in group settings and eventually are informed they
have no job security.

Not only do reps provide lunch, medical education, tools and devices, medical textbooks,
calendars, scratch pads and pens, but they can also influence the doctors’ personal lives. In
spite of the voluntary guidelines instituted by the PDMA several years ago which require that
gifts given to doctors remain of nominal (less than $25) value, reps make generous
contributions to office parties, fund-raisers, and golf tournaments with the assistance of
corporate funds. They provide tickets to local sporting events and entertainment venues with
a little creative financing and expense hiding, and they coordinate social functions such as
boating, fishing, and hunting expeditions disguised as continuing medical education
opportunities.

Even the most ethical, prudent practitioner can be influenced by interacting with a
pharmaceutical rep. Sometimes even against his/her better judgment. One of my most painful
memories as a sales rep was an illustration of this very point. I was new to the
pharmaceutical industry and had attended my first new drug launch. I remember the pride
and exuberance I felt at the national meeting in which loud speakers pumped out motivating
theme music and medical researchers and marketing managers gave exciting, emotional
speeches. I soaked in every word with anticipation and awe. I believed this new drug was
really going to help people!

During the breaks, scientists and corporate executives chatted amiably with reps while
feasting on an elaborate array of snacks and beverages. Sumptuous gourmet meals and
nightly entertainment further catered to the already inflated egos of the sales force. Open
bars accompanied every event. T-shirts and ball caps emblazoned with the Suprol logo were
distributed, along with sports bags that would transport all the rep’s acquired goodies back
home.

Pumped full of enthusiasm and focused on the key opinion leaders in my community, I
returned to my territory. I bombarded them with studies and marketing materials in an effort
to find support for my new drug. Marketing direction was very specific. Doctors in each
territory had been profiled prior to the launch, and I was well-informed as to who the Early
Adopters and High-Volume Prescribers (HVPs) of NSAIDs were. (Note: The majority of drug
companies know just what the doctor ordered, primarily because they subscribe to
prescription data service companies that provide their sales force with detailed information on
what doctors are prescribing in their practices. Pharmacies sell the doctors’ prescription
information, allowing companies to pinpoint who is supporting their product line and who is
not. Reps frequently know more about a doctor’s prescribing habits than he does himself! This
data often verifies what marketers already know, and that is, when detail activity or call
averages are increased in a doctor’s office, the result is generally an increase in prescriptions
for the products being promoted. The more memorable the presentation or information the
doctor receives, the larger the assumed impact.) I was also aware of marketing’s last-ditch
effort directive to ask a reluctant prescriber to give me just one new start patient, even if it
was his or her most difficult patient that had failed other therapies. The rationale was, if a
doctor had success in one of his or her most difficult patients, he or she would be more
inclined to write prescriptions for additional patients.

One of my doctors who practiced in a small, coastal town wrote large numbers of anti-
inflammatory drugs for his predominantly geriatric population. He was an older doc himself,
very nice, but set in his ways. He had been profiled as a Late Adopter/Skeptic. After a lengthy
debate about the benefits of my new product, he shared his philosophy with me, which was
not to prescribe a new drug until it had been on the market for a full year. This way, he could
avoid the initial unknown complications that invariably surfaced with each new product. In
other words, he preferred a “better safe than sorry” approach.

Still, I persisted in my enthusiasm and, as I had been instructed, asked for that most difficult
patient. I didn’t leave until the doctor had committed to try the drug on at least one patient.
He did finally commit, or, to use sales jargon, I closed him. I left triumphant…or so I thought.

I continued drumming up support for Suprol® and had just gotten it added to my major
teaching hospital’s formulary when I got the bad news. An emergency teleconference was
called, and the company announced a “Dear Doctor” letter would be sent to all physicians that
day addressing “new complications” associated with Suprol®, primarily flank pain. Nearly
twenty-five percent of the patients affected had required hospitalization. Flank pain is a very
serious side effect because it indicates the possibility of kidney damage.

Little did I know at the time, one of the doctors who had reported an adverse event, which
eventually resulted in death due to dialysis complications, was in my territory. I was later
contacted and instructed by management to have my doctor complete an Adverse Drug
Reaction (ADR) report. Much to my surprise, the doctor referenced in my instructions was the
Late Adopter/Skeptic, who had promised me his “most difficult patient” against his better
judgment. Even more startling would be the discovery that the patient had been his very own
mother. Of course, I didn’t find that out until I visited him to do the ADR. (By the way, the ADR
was a daunting ream of paperwork that appeared to be designed to discourage busy doctors
from reporting. That reporting process has since been streamlined online with MedWatch.) I
will never forget the betrayed look on his face or his terse remark to me that “the company’s
marketing strategy had obviously been more thoroughly tested than our drug!” I was
devastated and riddled with guilt. I didn’t call on his office again for nearly six months. I didn’t
have the nerve!

Suprol® was eventually recalled in 1987 after it had first been banned in Europe. I found
myself back pedaling in offices, embarrassed as I picked up samples. Reps were instructed to
take a proactive stance with providers by pointing out the swift, decisive action taken by the
company to remove the product once the adverse events surfaced. What reps were not told
was that Public Citizen, Ralph Nader’s consumer activist organization, had actually sued the
FDA in order to protect consumers and have Suprol® pulled from the market.

So, I was somewhat surprised later on to discover that not all of my pharmaceutical cohorts in
the marketing and sales departments subscribed to the medical Hippocratic Oath: “First, do
no harm.” Marketing strategies were designed to do one thing: maximize profits. If
information could have a negative impact on the bottom line, reps were instructed to
downplay it. The opposite was true of even the most ridiculous perceived benefit. Patent
extensions were sought for minute enhancements, and tons of marketing hoopla would tout
the “new and improved” products.

Over the years as my knowledge base grew from the specialized training I received, I started
to better understand the drugs and the effect they had on the body systems. I also became
more adept at interpreting clinical trial data and laboratory results. I realized that drugs which
were nominally effective were touted as phenomenal progress. I observed drugs being over
utilized, overdosed, and improperly promoted “off label” for indications that were yet untested
and/or unapproved. I watched as year after year the FDA approved dangerous drugs that
were later removed from the market. I observed the defensive cover-ups and posturing
employed by the industry to save those ill-fated products. But most importantly, I witnessed
the demise of fair-balanced education in medicine.

A series of haunting images ingrained themselves in my memory banks-disturbing
experiences that would completely alter my perception of medicine and the institutions that
guard its ethical practice. I started awakening to the truth about the greed, deception, and
corruption that permeated my industry. But it would take many years and dozens of
conscience-altering experiences before I really comprehended the scope of just how much my
profession affected the medical industry and the contribution I had made to harming
thousands of trusting, innocent people. That sad moment of truth had changed me forever.

“Mrs. Olsen, the doctor will see you now,” the nurse’s voice brought my attention back to the
present as she gestured me toward the back. We passed Sara in the hallway on her way out,
as we stopped at the scale to take my weight. Brimming with a huge smile and now hands-
free of her trinkets and treasures, she waved to the office personnel, “See you next month!
Hope Dustin’s team wins tonight!” she chirped to the receptionist, then exited the office out
the back door. “God, wouldn’t you just love to have her job?” mused the nurse as she
wistfully watched the departing fanfare. “Thanks, but no thanks,” I said knowingly, “especially
not in today’s heat!”

Ethics Codes
selling drus and disease
Additional Resources
send this site to a friend