By Martha Rosenberg*
More than a
decade ago, the job of the pharmaceutical rep was enviable. Direct-to-consumer
advertising pre-sold many drugs so doctors already knew about them. Medical
offices welcomed the reps who were usually physically attractive and brought
lunch. In fact, reps sometimes had their own reception rooms in medical
offices.
By 2011
thanks to drug safety scandals and new methods of marketing, the bloom had
fallen off the pharma reps’ roses. The number of prescribers willing to see
most reps fell almost 20 percent, the number refusing to see all reps increased
by half, and eight million sales calls “could not be completed” at all,
reported ZS Associates.
Some
doctors did not hide their antipathy. Salt Lake City family doctor Ross
Brunetti estimated six reps called on his office every morning and six more in
the afternoon. “In a week, I might see three people trying to sell me the same
thing,” he complained. “There are more drug reps than patients. It’s like a
minefield.”
While some
medical offices tolerated reps for the drug samples they left behind, even that
began to change. The samples began to be viewed as nothing but inducements to
prescribe more expensive drugs. Nor were they usually going to needy patients
but rather to staff members themselves and their families and a move to refuse
free samples started.
In fact,
even before the Affordable Health Care Act’s “Sunshine Law” requiring payments
to doctors be reported, the ethics of drug marketing were under scrutiny. Three
years before the Act, In 2007, the 62,000-member American Medical Student
Association (AMSA) rolled out a “scorecard” program that graded the nation’s
150 medical schools on their policies toward Pharma gifts, consulting and
speaker fees and their financial disclosures.
“The
scorecard program has changed the landscape because medical schools really
understand grades,” said Nitin Roper, MD an AMSA member. “Schools which
originally wouldn’t give us their policies suddenly thought their grades were
unfair. In a revealing turn of the tables, one medical school contacted our
student organization to request its D grade be changed to a C+.”
Medical
schools also began acknowledging rep pressures. At the UIC College of Pharmacy,
former sales reps were used to demonstrate to students how one-on-one
encounters can become psychologically coercive in an elective and how to fight
back.
“Refusal
skills” were also being taught for overzealous patients. Writing a prescription
may seem quicker but “explaining to a patient why a highly advertised drug
might not be appropriate only takes three minutes,” said Richard Pinckney, MD,
professor at the University of Vermont College of Medicine where such a program
existed. “The insurance savings could pay for programs like these,” he said.
The Vermont
project included “secret shoppers” who asked doctors for an expensive brand
name drug they had seen on TV after the refusal training.
“Doctors
have a hard time saying no if a drug is effective, even if it is expensive,”
said Audiey Kao, MD, vice president of ethics at the American Medical
Association at a 2010 conference. Doctors are “nervous” that rebuffed patients
will go elsewhere, agreed Dr. Pinckney.
After the
Vytorin scandal in 2008 in which the expensive drug was found to work no better
than the lower priced Zocor, there was an especially big cloud over pharmaceutical
reps.
“Got my a*s
chewed,” wrote a rep on the website Cafepharma who had been selling Vytorin.
The doctor asked “if I knew … when was I going to give him the head’s up” and
said he “looks like an a*s in front of his patients. I just nodded and said that
I got the information just about the same time he did and that I’m heartsick
over it,” wrote the rep. “I got thrown out.”
Since
Vytorin, the drugs Darvon, Bextra, Vioxx and Meridia have been withdrawn. There
are heated battles over the five digit prices of new medications like hep C
drugs and drug companies trying to incorporate overseas to flee taxes. It is
not a great time to be a pharmaceutical rep.
*Martha
Rosenberg is a health reporter and the author of Born With a Junk Food
Deficiency.
