Healthy Skepticism Library item: 8084

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

Phelps D.
Pharmaceuticals: No more free lunch
Star Tribune (Minneapolis - St.Paul, Minnesota) 2007 Jan 28
http://web.archive.org/web/20070212035505/http://www.startribune.com/535/story/962563.html

Full text:

The days of the free lunch are dying, at least for many doctors.
Just ask Keely Perry, owner of a St. Paul catering firm that used to do a brisk business catering lunches for doctors, with drug salespeople footing the bill. These days, business is way down — half of what it used to be.

“Two to three years ago, pharmaceutical reps made up 10 to 12 percent of our lunch business. Now they make up 6 to 8 percent,” said Perry, who runs a company called Waiters at Your Service, which delivers food from restaurants such as Famous Dave’s and Good Earth. “We felt the pain. We don’t see a lot of new reps, just our core clients.”

It’s part of a clampdown on the once cozy relationship between drug reps and doctors, fueled by concern that those who sell drugs might unduly influence the doctors who prescribe them.

It’s a national issue that is being addressed aggressively in the Twin Cities.

Park Nicollet, which owns Methodist Hospital in St Louis Park and metro area clinics, has banned sales reps from floors where patients are treated. HealthPartners, which owns Regions Hospital in St. Paul as well as a network of clinics, restricts drug samples. Sales reps must be invited to visit Hennepin County Medical Center and cannot bring food. Doctors at the University of Minnesota Psychiatry Department won’t use pens and notebooks that carry a pharmaceutical logo when seeing patients.

Fairview Health Services revised its vendor policy this month to require pharmaceutical reps and other vendors to call first for an appointment, check into a facility only at designated sites and to wear a special badge while in the building. Fairview’s network covers nine hospitals including the Universityof Minnesota Medical Center and multiple clinics.

The clinic arm of Allina Hospitals and Clinics stopped accepting free samples Dec. 31, and plans to review its relationship with sales representatives when it conducts a six-month review of its new samples policy this summer.

“There are ethical issues, educational issues and cost control issues,” said Dr. Jonathan Ravdin, chairman of the Department of Medicine at the University of Minnesota, where a strict no-access policy is enforced. “The real issue is what is the most efficacious therapy for the patient. That’s how we teach it and pharmaceutical marketing is totally out of the picture.”

Prescription drugs accounted for $1.7 billion of the $10.7 billion Minnesotans spent for health care overall in 2005.

A far cry from the old days

Michael Oldani is a former sales rep for Pfizer who left the business in the late 1990s to get a degree in medical anthropology from Princeton University. He said the market was exploding then with new name-brand drugs like Vioxx and Zoloft and reps had “carte blanche” to aggressively promote and market those products.

“For the most part, as long as we were selling product, we could get away with just about anything,” said Oldani, now a professor at the University of Wisconsin-Whitewater. “The goal of repping was to show how you differentiated from competitors. You got doctors to be loyal to you.”

One path to loyalty and access, Oldani said, was by awarding “unrestricted educational grants” to physician practices and clinics that would be used for training “retreats” at a resort. He bought medical equipment for doctors and pharmacists and funded clinical trials for specific drugs he was marketing.

Clinics that banned sales reps were called “no-see” clinics, Oldani said, but that only increased the challenge. “The whole goal is to sell product. You figured out how to get in the back door,” he said.

In a statement, the trade organization Pharmaceutical Research and Manufacturers of America (PhRMA) said sales representatives follow guidelines to “maintain ethical relationships” with doctors and other health professionals.

“In the end pharmaceutical marketing is one of several important ways for health care providers to receive the information they need to make sure medicines are used properly and patients are safely and effectively treated,” said Ken Johnson, PhRMA senior vice president, in response to a Star Tribune inquiry.

Fewer lunches

Glen Stubbe , Star Tribune

Business
Xcel plans to invest in its own wind farm

No merger dance likely for domestic airlines

Top-tier town: Twin Cities office market attracts national investors

Doctors protest insurers’ rules on approval for scans

Awards champion firms with flexible workplaces
The Twin Cities Pharmaceutical Representative Association and the National Association of Pharmaceutical Sales Representatives did not respond to several phone calls and e-mails seeking comment.
On average, drug sales reps are expected to make eight calls a day, the national trade organization says. The average salary last year, including incentives, was $91,700.

Not all doctors agree on the growing restrictions on sales reps and samples.

“There’s a feeling, somewhat, that drug companies have undue influence with physicians when they buy you lunch so they can peddle XYZ drug,” said Dr. Michael Ainslie, chairman of the board of the Minnesota Medical Association. “If you don’t have samples, you don’t get to try new, better things. You’re cutting off your nose to spite your face. Do I write 47 prescriptions after I have lunch with someone? No.

“Doctors are smart enough to figure out what’s good research and what’s a good product,” Ainslie said.

But critics say drug education should be separate from marketing. After all, drug samples are an important part of the pharmaceutical marketing plan. According to pharmaceutical trend monitor ISM Health, sales rep activity totaled $6.7 billion in 2005, or more than half the $11.1 billion the pharmaceutical industry spent on marketing in total.

“We don’t see these people as devious. We just have a different perspective on the cost of medicine for the patient,” said Dr. William Spinelli, chairman of the clinical practice council for Allina Medical Clinic.

And there is growing concern in the medical community that the presence of samples in the doctor’s office causes the doctor to prescribe those drugs when cheaper generics are available.

“When pharmaceutical representatives market their product to physicians, it changes their prescribing habit,” said Dr. Loie Lenarz, chief clinical officer for Fairview. “The newer drugs, if they have a track record, do not have a long one and they are more expensive.”

Nearly all health systems have imposed controls on samples. They range from an outright ban to substituting samples with vouchers that the patient can take to a pharmacist to fill and obtain written material about the drug.

“The average consumer doesn’t realize the impact of samples and marketing,” said Kathryn Schultz, director of pharmacy for HealthEast Care System, which owns four hospitals and a network of clinics in the east metro. “In the clinic system we used to see reps bring in breakfast, lunch and dinner for the staff. It looks bad to the patient to see a rep bringing in bags of Leeann Chin.”

Dr. Brian Rank, medical director of HealthPartners Medical Group, said the world has changed since he began practicing more than 25 years ago.

“When I was young we regularly had meetings and got doughnuts, pens, pads and sticky notes. Everyone knew this was marketing and sales under the guise of education. People would say this doesn’t affect my decision,” Rank recalled. “But it destroys trust in the patient-doctor relationship.”

David Phelps • 612-673-7269