Three weeks ago, British Big Pharma company GlaxoSmithKline GSK +0.02% (GSK)
announced plans to dramatically reform the way it sells and markets its
drugs to doctors. For years now, drug makers have been operating on the dark
side, financially incentivizing doctors and health care providers to promote
their drugs, and compensating pharmaceutical sales reps based on the number of
prescriptions written by the doctors they call on. It’s a practice rife with conflict of interest, leading to
over-prescription of medications that may not even be the most appropriate for
patients, and it’s been the cornerstone of drug marketing for decades.
Granted, it’s far better than the 90s when high volume prescribers, called
“champions” (conjuring up images of a Vegas high roller) were treated to free
“conferences” in exotic locals and routinely wined and dined at the most
expensive restaurants. But, when you incentivize a sales person with a hefty
bonus check based on the number of prescriptions emanating from their
territory, they’ll find a way to get doctors to write their drug.
GSK started implementing these changes in the US back in 2011, and plans to
have the new system completely in place globally by the end of 2015. This new
compensation system, which will apply to all GSK sales employees who work
directly with prescribing healthcare professionals, will be a patient-focused
approach instead of counting the number of pills that are pushed. GSK
will also take steps to end direct payments to healthcare professionals for
speaking engagements, as well as for attendance at medical conferences.
Explaining the
move, GSK’s CEO, Sir Andrew Witty, said: “We
recognize that we have an important role to play in providing doctors with
information about our medicines, but this must be done clearly, transparently
and without any perception of conflict of interest.”
As a doctor who, in the past, has been on the receiving end of an
occasional perk, let me go on the record by saying, “It’s time!” Most of us in
the medical profession have long felt a bit squeamish about the way drug
companies have been doing business.
Back when I was practicing psychiatry full time, not a day went by when I
didn’t see someone, usually a charismatic, attractive person, stopping by with
a briefcase full of their latest products and gifts. The sales reps were
constantly in our offices, giving out free samples, setting up promotional
material in our waiting rooms, and “building relationships.”
While some among us have benefited from the dinners and paid conferences,
we always knew that, on some level, it was wrong, even when we told ourselves
that the freebies would in no way influence our judgment as doctors or
dictate what we prescribed. We all took an oath to protect our patients and put
their needs first. But the line between what’s best for the patient, and what’s
new, shiny and expensively promoted, has blurred.
The 2000 landmark study on this, titled Physicians and the Pharmaceutical
Industry: Is a Gift Ever Just a Gift?, concluded
that simply meeting with pharmaceutical reps was “found to impact the prescribing
practice of residents and physicians in terms of prescribing cost, non-rational
prescribing, awareness, preference and rapid prescribing of new drugs, and
decreased prescribing of generic drugs.”
Based on this information, perhaps GSK is not going far enough since they
are not doing away with drug reps. But at least these reps will no longer
have a direct incentive to generate scripts. And to be fair, pharmaceutical
reps do serve a need by bringing new information to doctors that may be too
busy to keep up. This is key, because, no matter how principled we believe we are as
doctors, we are only human, and the dark side of Big Pharma casts a long
shadow. There can be no doubt when a charming drug rep visits your practice and
introduces you to the latest product, it’s going to be at the top of your mind
the next time you pull out your Rx pad.
Of course, many of these drugs are good ones, and may well be the best
solution for the patient, but not always. A case in point: ADHD drugs. In
addition to Novartis Pharmaceuticals’ Ritalin, several major pharmaceutical
companies have launched a variety of drug treatments for the so-called
disorder, which is currently being medicated as if it is some kind of major
epidemic.
As The New York Times pointed out earlier this month the number of children on medication for ADHD has grown
to 3.5 million from 600,000 in 1990, according to the Centers for Disease
Control and Prevention. A diagnosis is now found in 15 percent of high-school
age children when, in fact, the true rate is closer to 5 percent, with only a
small minority of that group truly needing to be medicated.
This gross over-diagnosis and prescription is a direct result of intense,
multi-million dollar marketing campaigns by the drug makers, both through
celebrity endorsements as well print and television ads that prompt patients
and their families to ask doctors about those specific drugs. The result is to
sway doctors to go for the easy, quick fix solution of a pill (when you have a
hammer, everything you see is a nail). And the tactic has paid off, with a
quintupling of stimulant sales since 2002, to over $8 billion in revenues.
The practice has created a situation of widespread drug abuse, affecting
the long-term health and well-being of millions of young people. This mess has
prompted long-time ADHD advocate Dr. Keith Conners to call the rising diagnosis rates a “concoction to justify the giving out
of medication at unprecedented and unjustifiable levels,” that has resulted in
“a national disaster of dangerous proportions.”
As someone who has long
been lamenting the fact of ADHD over-diagnosis and the over-prescribing of
stimulant medications (I’m writing a book on this very topic) I could not agree
more. So I applaud any drug company’s effort to better align drug sales with
patient interests and focus more on health outcomes than the bottom line.
To be sure, it may be
recent circumstances that have prompted GSK’s change in policy. As BusinessWeek
points out, the
company has been facing a criminal probe in huge markets like China, where
officials allege the company has hired prostitutes and set up fake medical
conferences to entice local health care providers. In 2012, GSK also paid a $3
billion settlement for practices which included promoting the antidepressant
Paxil for children.
But even though it has been
dragged, kicking and screaming into the light, the fact is that GSK is one of
the industry giants, and other Big Pharma companies will likely follow suit.
GSK is taking additional steps, like giving the public more access to research
and clinical trial data, and is being a good global citizen by making
medications more available and accessible in emerging markets.
I believe these positive
changes will take hold in the marketplace relatively quickly now that GSK has
set the tone. It’s a bit of good news on the healthcare
front (for a change) to ring in the new year.