Healthy Skepticism Library item: 5861
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Publication type: news
Nader C, Fyfe M.
Confessions of a pill pusher
The Age (Melbourne) 2006 Aug 11
Full text:
Confessions of a pill pusher
Author: Carol Nader, Melissa Fyfe
Date: 11/08/2006
The Age, Page: 15
In the last of a series on drugs and doctors, Carol Nader and Melissa
Fyfe examine the selling tactics of pharmaceutical representatives.
IT WAS a team-building session. The theme of the day was “upselling”.
The venue: a fast-food outlet.
But the pupils in this educational seminar were not teenagers working at
Macca’s.
They were sales representatives working for a major pharmaceutical company.
As one participant in the exercise recalls, it was almost a case of:
“While you’re buying antibiotics, would you like anaesthetics with
that?” It is an anecdote that still riles this insider, a veteran of the
industry, who retired this year. Instead of educating the drug reps on
the fine details of the product, the focus was on the spin.
The former drug rep, who declined to be identified, says his role was to
make “mountains out of molehills”. Minor differences between a company’s
drug and those of the competition are spun into major benefits.
It is a competitive industry. Even the number of drug reps employed by
the big companies is kept a secret, although the Australian Consumers’
Association estimates they number more than 3000 in Australia (compared
to the 120 Government-funded drug educators from the National
Prescribing Service).
They hire young, enthusiastic people who are, according to one study,
“the most beautiful, friendliest, helpful, persistent, flattering group
anyone meets”.
The reps earn a salary plus bonuses for meeting targets based on sales
and making a certain number of calls. They work long days, and many
nights and weekends. Those who excel can make good money. The best can
make six figures. But the turnover rate is high.
The insider says most drug reps are quite ethical but a small number
will stop at almost nothing to get to a doctor. He tells of a drug rep
who gowned-up and walked into an operating theatre, uninvited. As the
story goes, the rep sauntered up to the anaesthetist while they were
working on the gasses and said words to the effect of: “Why aren’t you
using our product?” The intruder was ordered to leave.
Nurse Marguerite Laughton worked in the late 1980s as a drug rep for a
large pharmaceutical company. She hated it. GPs, her boss said, were
like old dogs. Teaching them new tricks was difficult, so you just had
to try hard to persuade them your product was the best.
The product in question was a pill for blood pressure, angina and
abnormal heart rhythms. Her spin: it was the market’s best for high
blood pressure and did not diminish sex drive, as did other hypertension
pills known as beta-blockers (something she did not believe).
She remembers sitting in GPs’ waiting rooms, biding her time until the
receptionist went to the toilet or morning tea. Then she would bolt in
ness. “You’d rather support someone that you like than someone who you
don’t know.”
At a pharma-marketing congress in Sydney earlier this year, drug reps
were told how to better target female GPs, who make up a growing number
in the doctor workforce. “Female GPs think differently, work differently
and treat differently,” managing director of advertising company, H&T,
Steve Robson, told the congress. They also accept fewer visits from reps.
Some reps will wander through a hospital’s corridors, trying to grab
doctors for a spare five minutes.
If they don’t have any luck with doctors, they’ll try the nurses. Some
hospitals try to stop drug reps doing this with a requirement that they
sign in, and only see the person they have an appointment with.
One senior pharmacist at a major hospital says some reps do get into the
wards, even though they’re not supposed to. “They catch you in the
corridor if they can.”
Another says that the reps aren’t allowed to just wander into the wards
and lie in wait for the medical or nursing staff. But it is hard to
enforce, so some slip through.
If a drug rep is seen doing the wrong thing, a hospital might take
sanctions against the company. For instance, if there are marginal
differences between products, they’ll take the product of a company who
is playing the game by their rules.
To boost their chances of getting a sympathetic hearing, reps may pay
for lunches at doctors’ meetings.
Sometimes the drug rep will be allowed to sit in on the meeting.
Some hospitals might even let them ask questions, or give a short spiel.
Sponsoring these lunches is an opportunity to get to know the doctors on
a first-name basis.”
Instead of being professor so and to see a doctor. “It was really
intrusive behaviour,” she says. Lavish morning teas were provided to
receptionists to “butter them up”. Once in the GP’s rooms, Laughton
presented her laminated cards spelling out the benefits in bold,
colourful writing on the front, with the side-effects in “tiny writing”
on the back.
The lifestyle, she says, was glamorous: flights to meetings, posh
hotels. “I was living a humble life as a nurse. It was like a movie for
me, before I got bored of the script.”
All drug reps must do a “continuing education program” as part of the
industry’s code of conduct. It covers pharmaceutical industry issues,
policy, basic pharmacology and understanding clinical evidence.
The goal, a Medicines Australia spokesman says, is to ensure there is an
“industry-wide, very high standard”.
It is on top of the training that individual companies do.
Each rep has a territory. Within that territory, there are doctors. It
is the drug rep’s job to get to know as many of them as they can. Some
will even try to befriend them. The drug rep asks them several questions
and takes copious notes. Football teams.
Organisations they belong to. Family members. All the information is
carefully recorded, to be used next time they call. And if a different
rep turns up next time, the doctor’s personal profile is already at
their fingertips.
At one stage, some GPs were charging the equivalent of a consultation
for drug reps to see them. “The doctors think: `You’re making money out
of our time and we’re losing money because we’re not seeing patients’,”
he says.
But having a good relationship with doctors is essential in this busiso,
it’s `G’day John, Jack, Matthew’,” the insider says.
Once the drug rep has a doctor’s attention, they deliver a spiel that
has been constructed by someone in marketing. As the former drug rep
explains, you put a series of questions to the doctor to lead them to
the conclusion that your drug is the answer. Are you looking for “x” in
a particular product? Does your current prescribing achieve that goal?
Are you aware that our product does? And so forth, he says, “a bit like
the encyclopedia salesman”.
When it is time to move on to the next appointment, the drug rep will
leave behind “brand reminders” – pens, Post-it notes, notebooks or an
assortment of gimmicks. The idea, he says, is that the doctor will keep
it on their desk so that the product or company’s name is in their face.
Pharmacists, who are influential in deciding what drugs a hospital
supplies, are also a target. Two pharmacists who spoke to The Age are
matter-of-fact about the existence of drug reps, with one describing
them as “a fact of life, but sometimes they’re an annoyance”.”
There’s no doubt they try to get to know people and become friends,” he
says. “They generally can be a bit irritating at times and some of them
can be a bit pushy.”
He estimates at least 20 drug reps come into the hospital every day.
He says drug companies spend a lot of money on marketing. When they have
a campaign going, they “saturate” the hospital. “The reps will come in
every day and they’ll be talking to anyone they can get their hands on.”
The other describes most as reasonably ethical, “but there are a few out
there that probably take a few short-cuts”.
The retired drug rep agrees that most of his former colleagues are quite
ethical. He says the role of the drug rep can also be quite useful.
If they provide information that improves a doctor’s knowledge of a
drug, it is more likely to be used correctly. As for tactics that drug
reps use to try to influence doctors, he says doctors should be smart
enough to see through the schmoozing.”
At the end of the day, you’re talking about the top 2 per cent of the
population in intelligence. And you hope that when a drug rep makes
claims about a product that these guys use their experience and
education to look at the claims critically.”
LINK www.nps.org.au/
THE TOP-SELLING DRUGS*
1. LIPITOR (PFIZER)
TYPE: Cholesterol-lowering statin
SALES: $515 million*
TAXPAYER COST: $453 million**
World’s biggest drug company, world’s biggest-selling drug and the
largest single expense on the PBS. The Baker Heart Research Institute’s
Professor Garry Jennings says statins, the class of drugs Lipitor leads,
are “magic” and have done wonders for cholesterol.”
But one statin is as good as another; the pecking order largely reflects
the success of marketing.”
2. NEXIUM (ASTRAZENECA)
TYPE: Proton pump inhibitor for heartburn
SALES: $168 million
TAXPAYER COST: $144 million
Top-selling drug Prilosec, known as Losec in Australia, faced huge
profit losses from cheaper generic competition in 2001. So AstraZeneca
effectively cut Prilosec (generic name omeprazole) in half, patented the
active molecule, called it Nexium and told doctors it was better.
Lloyd Sansom, chairman of the Pharmaceutical Benefits Advisory
Committee, says there was “virtually no difference” between the two
drugs (except omeprazole is cheaper).
3. SERETIDE (GLAXOSMITHKLINE)
TYPE: Corticosteroid asthma inhaler
SALES: $165 million
TAXPAYER COST: $156 million
The National Prescribing Service – a Government-funded, independent drug
advisory service – says that Seretide should not be used as a first
treatment for newly diagnosed asthmatics. The NPS has told doctors that
the efficacy of these “fixed-dose” combinations in newly diagnosed
patients “has not been studied”.
4. ZYPREXA (ELI LILLY)
TYPE: Anti-psychotic for mania and schizophrenia
SALES: $135 million
TAXPAYER COST: $146 million (2005)
Last year, a US Government-funded study compared schizophrenia drugs and
found the newer ones such as Zyprexa offered few, if any, benefits over
older, much cheaper medicines (although older ones have some undesirable
side-effects). The study found Zyprexa helped more patients control
symptoms for significantly longer than the other drugs, but it had an
increased risk of weight-gain and diabetes.
5. SOMAC (PFIZER)
TYPE: Proton pump inihibitor for heartburn
SALES: $98 million
TAXPAYER COST: $95 million
Proton pump inhibitors are effective drugs but there are concerns they
are overused and turning into lifestyle medication. Says PBAC’s
Professor Sansom: “There is no question the use and doses of (these
drugs) are much higher than we would have thought.
We believe many people are being maintained on higher doses than they
would need.” If doctors stemmed overprescribing of these drugs, up to 40
per cent of the taxpayer cost could be saved.
- HIGHEST BY VALUE.
- SALES IN THE YEAR TO JUNE 2006.
- GOVERNMENT COST THROUGH SUBSIDISING THE DRUG ON THE PBS IN THE YEAR
TO DECEMBER 2005.
ONLINE
See the list of the top 10 drugs in Australia at theage.com.au
Good medicine or good marketing?
There is no doubt this list features most of the big brand-name drugs of
the moment.
According to the experts, doctors prescribe too many brand-name proton
pump inhibitors (Nos. 2 and 5), and perhaps overusing Seretide (3) for
newly diagnosed asthmatics.
But while doctors overprescribe in some areas, they may be
underprescribing in others. If Australian doctors followed clinical
guidelines to the letter, many more people would be on blood pressure
medication and, if the Government accepted the will of heart doctors,
thousands more would be taking statins. The thing to remember is that,
generally, drug-makers do not have to prove their new drugs are better
than existing drugs on the market. They just have to prove they are
better than nothing.”
We don’t have the data to know,” says Dr Lynn Weekes, from the National
Prescribing Service, “sometimes things are better but we just don’t know.”
Perhaps the last word goes to the PBS report on drug costs in the year
to June 30, 2005 (roughly $6 billion, for the record). The report
remarked that Government spending was outstripping the growth in
prescriptions and this was, it said, due to “the continuing trend of
doctors prescribing newer and more expensive drugs”.
— MELISSA FYFE