Healthy Skepticism Library item: 7593

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

Brewer B.
Fewer Freebies, More Patient Time Since Doctor Said No to Drug Reps
The Wall Street Journal 2007 Jan 9
http://users1.wsj.com/lmda/do/checkLogin?mg=wsj-users1&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB116827645909270309.html

Full text:

I don’t hate drug reps. Really.

In my last column on prescribing drugs for “off-label” use, I mentioned that I no longer welcome drug reps in my practice. The reader response was intense — and worth following up on.

A couple of years ago I did something a little unusual: I stopped seeing drug company sales representatives. (See my column then.)

In an effort to simplify my professional life, streamline my daily workflow and spend more time seeing patients, I decided the sales-call distractions had to go.

My main concern was the time sap. My patients didn’t like to wait while I talked to drug company reps around the time of their visits. I find it easier to run on-time for appointments and do my charting when I don’t take time out to see salespeople. Patients that wait are unhappy, and
unhappy patients are bad for business.

Family medicine is a complex, low-margin business with high overhead and a huge personal time commitment. I couldn’t afford to run behind schedule and I couldn’t afford the inefficiency and loss of revenue during my office hours.

Seeing drug-company reps — it could be as many as six on a busy day — hasbeen replaced with one to two additional patient visits, adding an estimated $6,300 in annual profit.

The perception among the general public is that drug companies give doctors a lot of free stuff that influences their prescribing habits and drives up the costs of drugs. The halcyon days of doctor goodies were way before my time. The freebies aren’t all that great anymore, and
meal opportunities are limited. If I want to go to a company-sponsored dinner, they won’t
cover my spouse or kids.

Still, studies do show this gratis stuff can affect doctors. Plus, I didn’t want to fuel the perception of influence by making my office an unofficial billboard for the pharmaceutical industry. My partner still sees drug reps, so some promotional material finds its way in the common areas of our office. And while I’ve lost a few pounds from missing the lunches, I
occasionally slip to the culinary dark side and listen and nosh, or eat leftovers from the visits to her.

But I now carry my own generic-looking black pens, and the promotional materials are not in the patient rooms I use. I wanted my patients to get the message that my medical opinion is not for sale or overly hyped by marketing. That’s a differentiator in a market where the most
valuable thing I have to offer is my knowledge and advice.

One concern of mine was that I’d have fewer samples, especially for my lower-income patients. But other than a couple patients who continue to ask for large amounts of free samples of their maintenance medications on every visit, my patients haven’t missed out on much.

In any event, sample medications aren’t as useful to me as they once were, due to the proliferation of restrictive formularies — insurer drug lists — including for Medicare. The samples are often for expensive, new medications that may not have good formulary coverage or may have layers of preauthorization before I can prescribe them. Even if the patient gets
a good response from a sampled drug, they often can’t afford to continue on it.

As for information about new drugs, I’ve got plenty. I’m still an early adopter of new medications and treatments. Not seeing drug reps hasn’t changed that.

Online, I monitor multiple sources of breaking news on drug therapy. I get newsletters from sources I trust, like my practice area’s medical organization. I don’t need a company sales representative to bring me new ideas. What they’re really doing is pushing a product in a very
focused sales call; the educational component is a minor part of it.

Pfizer Inc. recently announced plans to cut 20% of its domestic sales force. I think a number of those 2,000-plus people had been coming to my office, but I don’t hold myself completely responsible for the restructuring.

I think it’s part of a larger trend. The era of the job security for drug sales reps is passing, like jobs for telephone operators and at full-service gas stations.

Is there an ethical way that drug makers can market to doctors about the latest advances in drug therapy?

Doctors like to make money, but they also deeply want to help people and learn about the latest treatments. These are desires that can be nurtured for mutual benefit.

I bet the drug companies have figured out how much a sales call costs. If that money was redirected for social causes in a public way, it would go a long way toward addressing the image problem of the pharmaceutical industry.

Rather than employ a host a people to make sales calls or bring lunch for my staff, I’d like the industry to put their educational programs online and make a charitable donation each time I view new material. There is a possibility of bias in the information, as with most any form of
communication or marketing. But at least with the Internet I can filter it better and won’t be as susceptible to slick in-person pitches.

Care of AIDS orphans and provision of medical care in the developing world would be my choice for donations for my reading time.

This way, companies could provide up to date information to doctors, patients benefit directly and I learn about the latest treatments while helping someone out. That sounds better than lunch any day.