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Former Pharmaceutical Reps Tell All.
Among the more interesting genres of medical writing is that of the former pharmaceutical representative who reveals the “secrets” of promoting drugs to doctors. Here are some recent examples:
Shahram Ahari sold Zyprexa for Eli Lilly and is now with the School of Pharmacy, University of California San Francisco. In 2007 he published an article with Adriane Fugh-Berman in PLoS describing in great detail how pharmaceutical reps influence physicians. Their conclusion:
Pharmaceutical companies spend billions of dollars annually to ensure that physicians most susceptible to marketing prescribe the most expensive, most promoted drugs to the most people possible. The foundation of this influence is a sales force of 100,000 drug reps that provides rationed doses of samples, gifts, services, and flattery to a subset of physicians. If detailing were an educational service, it would be provided to all physicians, not just those who affect market share.
Ahari can be seen in a YouTube clip discussing the marketing of Zyprexa. He explains how the reps were instructed to downplay the side effects of the drug (specifically weight gain).
Gene Carbona was employed by Merck for 12 years and now works for the Medical Letter, an organization that provides independent evaluation of drugs and therapeutics. [The Medical Letter is one of our personal favorites]. Carbona was interviewed in an excellent article in the Atlantic Monthly about reps by Carl Elliot. He also appears in a film called Big Bucks, Big Pharma (another YouTube clip).
Kathleen Slattery-Moschkau worked for Johnson & Johnson and Bristol-Myers Squibb. She describes herself as a “former drug pusher (legally).” She has made a film based on her experiences entitled Side Effects and a documentary Money Talks: Profits Before Patient Safety.
Jamie Reidy worked for Pfizer and Eli Lilly and was responsible for promoting Viagra. He has written his book: Hard Sell: The Evolution of a Viagra Salesman and has his own blog on Amazon.
Michael Oldani worked for Pfizer until 1998 when he decided to become an anthropologist. He published a very interesting article in Medical Anthropology Quarterly in 2004 entitled Thick Prescriptions: Toward an Interpretation of Pharmaceutical Sales Practices. The abstract is as follows:
Anthropologists of medicine and science are increasingly studying all aspects of pharmaceutical industry practices-from research and development to the marketing of prescription drugs. This article ethnographically explores one particular stage in the life cycle of pharmaceuticals: sales and marketing. Drawing on a range of sources-investigative journalism, medical ethics, and autoethnography-the author examines the day-to-day activities of pharmaceutical salespersons, or drug reps, during the 1990s. He describes in detail the pharmaceutical gift cycle, a three-way exchange network between doctors, salespersons, and patients and how this process of exchange is currently in a state of involution. This gift economy exists to generate prescriptions (scripts) and can mask and/or perpetuate risks and side effects for patients. With implications of pharmaceutical industry practices impacting everything from the personal-psychological to the global political economy, medical anthropologists can play a lead role in the emerging scholarly discourse concerned with critical pharmaceutical studies.
Since the article is not open source, you may want to email him for a reprint. He is currently working at the University of Wisconsin-Whitewater.
Pharmaceutical representatives are sales people and it looks like they do a good job of selling the story of their past misdeeds. Indeed, the sophistication of these former reps is something for activists to emulate.
While we can be thankful for the information and perspective these reps bring, there does seem to be something wrong when they try to cash in on their confessions. Perhaps they should look upon their confessions as a form of public service and not charge for speaking, writing, or interviews. Or donate their profits to Healthy Skepticism.
8 Responses to “Former Pharmaceutical Reps Tell All”
1Dan Abshear.
Looking for pharma sales reps to interview for new documentary – so much being said about prescription drug abuse. Now you can have your say. On spec for the BBC and BBC America.
Are Drug Reps. Really Necessary?
One of the main functions of pharmaceutical representatives is to provide free samples to doctors’ offices instead of what has historically been their vocation:
implementing authentic and ethical persuasion via presentations.
Yet presently, samples are a priority and delivering them is the primary function for drug reps, and these samples in themselves cost billions to the pharmaceutical industry. Yet arguably, samples are the most influential tool in influencing the prescribing habit of the healthcare provider.
Let me be clear on that point: it’s samples, not a representative, as the true catalyst of establishing the prescribing habits of a prescriber.
Yet considering that drug promotion cost, overall, is approaching $20 billion a year, which includes the approximately $5 billion spent on drug reps themselves, what if there is another way for doctors to get free drug samples?
What if prescribers could, with great elation, avoid drug reps entirely, yet still receive drug samples for their patients?
There is actually a way to do this, but it is a limited process.
With some select, smaller pharmaceutical companies, doctors have the ability to order samples by printing order forms obtained on certain drug company sites on the internet for medications associated with the manufacturers.
Examples of such branded medications that can or have be ordered in this way are Keflex, Extendryl, and Allerx. Possibly several more can or are available to prescribers in this way.
Others, however, cannot be acquired by this method, yet this method may be the most preferable both from a business and efficiency point of view. Customer satisfaction would clearly be elevated.
So in some situations, a doctor can go online, print off a sample order form, fax it into a designated fax number after completion of the form, and the samples are shipped directly to the doctor’s office.
There is no review of the doctor’s prescribing habits nor are there any possible embellishments from reps. And that appears desirable to many health care providers, yet most drug companies apparently place unneeded value on the impact potential of a sales rep of their company to a level of some sort of delusion based on metrics that are possibly categorized as types of fantasies with the copious amounts of drug reps today.
Now, why is this not done more often? Apparently, it is legal. If samples are the number one influencer of prescribing habits, why spend all the money on drug reps to deliver samples personally, as this is essentially their primary duty?
It’s worth exploring, possibly, since the drug rep profession has evolved essentially into those who become a specialized delivery person, dressed in a nice suit, one could say. In other words, and in my opinion as a drug rep, most doctors will not and prefer not to dialogue with you during your visit to their medical clinic.
Think of the money that could be saved if more pharma companies offered samples to doctors in this manner. Furthermore, there is no interruption of the doctor’s practice. And again, there is no risk of bias presented to the doctor.
Doctors again would be able to order and utilize samples according to their discretion, and would be free of interference from the marketing elements of various pharmaceutical corporations.
Patients benefit when this occurs, likely. For example, health care providers would be free of possible embellishments and exaggerations voiced by reps on their promoted meds. Inducements would not be offered or accepted. Reciprocity would not be so insisted upon with the absence of drug reps, possibly.
In fact, doctors may write more scripts for shipped samples than delivered samples because their discretion is free from interference they have experienced to some degree, and doctors are or would be possibly thankful for this.
Considering the high costs associated with the pharmaceutical industry, having samples shipped directly to doctor’s offices should be utilized more than it is presently — regardless of the size of the pharmaceutical company, perhaps.
And the pharmaceutical companies would save quite a bit of money as well without a sales force that may likely not be needed after all. Drug prices may improve.
Something to think about as one ponders cost savings regarding this issue, and improving the efficiency of patient care and treatment.
“The new source of power is not money in the hands of a few but information in the hands of many.”
A Brief Manifesto Offered For Pharmaceutical Representatives.
The word, ‘Manifesto’ is one of Latin origin, and means ‘to make public’. It’s an open statement of standards related to good behavior based on principles related to the intention of the author.
What will follow is not in any way to be interpreted by the reader as being absolute directives or rules you should adopt in order to be successful.
Nor am I, as a veteran ex-big pharmaceutical representative, suggesting the contents are an outline of what is considered an ideal pharmaceutical representative, and what is needed for your own success as you define this as a pharmaceutical representative.
So, these are some simple, yet possibly preferred, ideas I wish to offer to those who are pharmaceutical representatives related to the nature of their vocation, as well as the image of the industry of your employer, and how this can be improved:
Never park your free company car closest to the entrance of a doctor’s office or clinic. Obviously, both places treat sick people- some worse than others. Aim for the back of the parking lot. Exercise is good for you. Others need that ideal parking space more than you do. Show some consideration.
Upon entering a medical location, such as a doctor’s office, if you happen to notice more than one pharmaceutical representative sitting in what may be a small waiting room, leave immediately and return at another time. Do not be so insistent or persistent that you disrupt those in that waiting room who need to see the doctor much more than you do.
Conversely, a similar suggestion is that if you enter a waiting room of a doctor’s clinic, for example, and there are no other drug representatives at such a location, do not necessarily be in a hurry. There may be only a few patients waiting to be seen by the health care provider.
Consider striking up a conversation with one of these patients as you both wait to see the health care provider. This rarely if ever happens- drug reps having a nice conversation with a patient in such a manner. You know, they are not Lepers, and you might provide some public relations for the industry that employs you, and certainly for the company that employs you.
Make an effort not to become vexed if you are unable to see one of your targeted prescribers that you desperately feel a need to speak with as dictated by your employer. Do not view yourself to be a complete failure at your vocation if this occurs.
More importantly, if a health care provider accepts your promoted drug samples from you, yet refuses to see or speak with you, you still have accomplished something positive for your employer. The samples in themselves will influence their prescribing habits more than you may realize.
So I suggest you visit such offices, regardless if you see the prescriber or not. You still will or may have a positive effect on what you feel you need to do with your job, which is to increase the market share of your promoted medications.
However, if you have an opportunity to be invited into the medical office to ‘check samples’, which means an opportunity to speak with the health care provider, make an effort to read the environment in this patient treatment area you are a guest in at this time.
For example, are staff members in this patient treatment area moving quickly? Do they appear overwhelmed? Are you not receiving any eye contact or dialogue from such staff members? Does the health care provider seem less than jovial?
If so, do not discuss any business or promoted product issues at such times. The doctor and his or her staff have more concerning tasks at hand than your presence there, likely, if this occurs. Their needs are always more important than your own.
Likely, you will visit this same location again and again that is in your territory assigned to you by your employer. So you will not receive immediate results- both with your business, and your relationships with those in the medical community for which you serve.
As you continue with your career, strive to learn as much as you can about not only the benefits of the medications you promote, but also the disease states for which they treat.
You are, or should be, viewed as somewhat of an expert with both as you interact with others who are clinicians and patient care providers with great knowledge, often, of what I am suggesting to you as a pharmaceutical representative.
So many others in your profession are a bit apathetic regarding any interest with medical issues, and the importance of restoring the health of others. This paradigm is in large part the apex of the profession in which you dialogue with during the course of your day.
Quite frankly, if you have no interest in the importance and complexities involved with medicine or health care, you should consider another job.
Keep in mind the ‘detail pieces’- based on the clinical trials your employer gives you to persuade prescribers in fact often contain data that is largely embellished, incomplete, or completely fabricated. You are not told this because your employer wishes you to believe that your promoted drug is in fact superior, and safe.
Find avenues of information on the drugs you promote from legitimate sources you can easily find on the internet. You should do this not only from a stance of credibility, but for the benefits of patients who may be prescribed your promoted drugs as well.
I can assure you that such authenticity will not ruin your life, and will be appreciated by those who may prescribe the drugs you promote.
Furthermore, and as with so many other pharmaceutical representatives, I’ve read those aggressive and brutally subjective commentaries, if not essays, from other pharmaceutical representatives on the ever so popular Cafepharma website- that great bathroom wall where others express their anger in the written word.
I know your concerns as a pharmaceutical representative, as well as the ridiculous activities you are required to do by your employer at times that either appear or in fact are pointless and absurd, if not unethical and/or illegal.
With this said, I suggest you not be in a constant state of understandable anger or unhappiness as you work during the day visiting those in the medical community.
People, including pharmaceutical representatives, are more transparent that you may realize (psychopaths are an exception). Those in the medical community that you interrupt (and you do) would rather not view you as upset or joyless if you are fortunate enough to visit them at their medical facilities.
Attempt to make yourself in a presentable mood before entering such medical location. Who knows? You might actually make another’s day. Try gently to make medical staff laugh appropriately, for example. This may be more important than the 1000 dollar suit you may be wearing, or the BMW you may be driving.
Also of particular note, and this applies in particular to rather large pharmaceutical corporations, there seems to be a constant theme with their sales forces:
Members of these sales teams are always striving to make a favorable impression for their employer- specifically their manager. This in itself is understandable and not necessarily a bad thing to do in the corporate world to ensure employment security.
Yet do not ever confuse your misperceived creative or innovative acts. Such acts possibly could be unethical if not criminal activities you may engage in upon your own discretion, or upon a recommendation from another employee you work with at your pharmaceutical company.
Yet often, you may be directed to implement such activities by your manager, and those above your manager on the corporate ladder.
It happens often at times, and it is not a good thing for many others, these activities that are simply not the right thing to do.
So I suggest that you learn about laws relevant to your profession as a pharmaceutical representative. There are many, and you are likely not told these legal statutes and acts mandated by lawmakers by your employer at all.
Learn about the terms associated with such laws, such as misbranding, kickbacks, off-label promotion, and disease mongering as well, for example.
Why do pharmaceutical representatives follow at times directions of this nature by their superiors, as uncomfortable as it may be for them at times with some of them?
This happens for two reasons: First, it’s understandable with a pharmaceutical representative that if their superior directs them to implement certain activities related to their employer’s objectives, the directives are appropriate and necessary.
It is also reasonable to conclude that such acts planned deliberately could in fact ethical and legal. So rarely do pharmaceutical representatives ever question what they are told to do by their employers and managers.
For example, do not ever engage in what is called quid pro quo. This is Latin as well, and means, ‘this for that’.
Just because you or those from your employer has bought the staff of a medical office lunch often, or leave the health care providers samples of your promoted products in great amounts, or placed a fancy TV in their medical clinic, since the prescribers in such a clinic are ‘top’ prescribers- these gifts do not mean in any situation that the doctor owes you prescriptions for the medications that you promote to such doctors.
If your sales numbers are down, do not blame the medical professionals in your territory in such a way, and it happens at times. You have no right to remind a prescriber of the inducements that you have provided a particular prescriber.
To be clear, this scenario of potential wrongdoing is possible, yet not always. In summary on this topic, exercise caution on what you may be directed to do by your employer, and your manager. If it is in fact illegal, or potentially illegal, you do not want to do such actions, of course.
Finally, there are certain intrinsic human traits that others rarely discussed or examined, and I believe they should be acknowledged. Examples include qualities such as character, integrity, or kindness- as well as honesty.
I am not suggesting that you consider you adopt such moral and ethical concepts if they are of no importance to you. I’m suggesting these concepts because they appear to be absent from your industry as an entire entity.
What I am suggesting is that you discover the meaning of such words and at least consider the possibility of acquiring such traits within you if they are absent.
At the very least, consider the value of such traits, and this may be for your benefit as you continue through your life span and your career.
Thank you for your time, and good selling,
You Have Now Been Sampled.
While the pharmaceutical industry’s image and reputation has and appears to continue to suffer, added damage has expressed itself with costly patent expirations with certain large corporations within this industry in particular.
As the president of the lobbing group for the industry which is called PhRMA would likely concur to a degree if asked, the image of this industry has experienced noticeable trauma over the past two decades in particular, and cannot be repaired by this lobbying group. The atrophy of the image of the pharmaceutical industry is largely due to how they market and sell their medications. Let’s take branded drug samples as an example:
Even though the ability for health care provider to request samples of a pharmaceutical company’s medications to bypass the company’s representatives is possible and legal, the pharmaceutical industry, overall, prefer to have their own representatives dispense samples of their promoted medications. This also allows for the representatives to dispense inducements to certain targeted prescribers that are of a much greater monetary value than drug samples.
These sales forces of pharmaceutical companies have been examined more now than in the past due to their unbelievable size, for one reason. The number of representatives of these sales forces of large pharmaceutical corporations tripled within a decade- starting in the mid 1990s. Also, the estimated total income for an individual pharmaceutical representative may exceed 200,000 a year, if benefits and perks are factored in to this cost. Overall, the amount spent on these reps exceeds 20 billion dollars annually by the pharmaceutical industry.
Sadly, yet with a high degree of confidence, most big pharmaceutical sales representatives are viewed and evaluated by their employers as it relates to their ability to gift targeted prescribers. This is due to the large number of representatives promoting the same medications to the same doctors who work for the same pharmaceutical company.
In fact, one could conclude that an individual representative in such a work environment with multiple partners with their employer is potentially exonerated from any individual responsibility in regards to their vocation. This is why they may be judged by their employers according to how much of their employer’s monetary ‘marketing budget spend’ one representative dispenses to targeted prescribers in a certain period of time. This will be further addressed later.
Yet the inducements are never described by what they actually are, which are bribes. Who receives these bribes is largely determined by the volume of scripts the prescriber writes as it relates to the pharmaceutical company’s promoted products. The gift dispensing is also determined by the prescriber’s loyalty to a particular pharmaceutical company’s products as well.
This data of the prescribing habits analyzed by certain pharmaceutical companies is certainly available, and this will be further addressed shortly.
However, and empirically, the drug sampling of doctors may be considered the ultimate if not primary gift that influences the prescribing habit of a health care provider. Some pharmaceutical representatives are falsely led to believe that their territory’s performance is due in large part to their powerful ability to influence others as outstanding salespeople. Although such pharmaceutical representatives want to believe such a false premise, it is samples of medications that determine the prescribing habits of health care providers, and this has been proven.
Many years ago, drug reps used their persuasive, yet ethical, abilities to influence the prescribing habits of doctors in an honest and credible manner. They focused on the benefits for the doctor’s patients with particular drugs that the detailer may promote to such a doctor, and how these drugs may and can restore the health of these patients.
However presently, most health care providers now simply do not allow drug reps to speak with them, or even see them, because the paradigm had become darker than it was in the past. Medical establishments are progressively and completely banning drug reps from entering their medical facilities. This is happening for several reasons, which include the following:
The doctors lose money. Doctors are normally busy, so their time is valuable. As a drug rep, you are an incredible waste of their time. Yet they will accept your samples still. The credibility you possibly have thought you had and were perceived as such by doctors as a drug rep is no longer viewed to exist to any noticeable degree by the prescriber.
Also, the accurate perception of the prescriber is that now pharmaceutical representatives are more concerned by their financial health instead of the health of their patients. The health care providers do not find the pharmaceutical representatives with the knowledge they need to benefit their understanding of the drugs that the representatives promote. Any information shared by the pharmaceutical representative to them, either oral or written, is likely embellished if not fabricated.
This view is due to the frequent statistical gymnastics the employers of drug reps engage in way too often with their promoted products, and the representatives are likely unaware of the data they have is as inaccurate as it is.
Doctors by their very nature seek answers objectively. And doctors do in fact find out about drugs through other methods besides the representative who promotes particular drugs.
This is further illustrated by reps being selected by pharmaceutical companies due to their perceived appearance and personalities judged by certain hiring managers of various pharmaceutical employers. Another trait desired by the pharmaceutical company is the potential candidate’s likelihood of being completely obedient to their directives, as well as their affinity for monetary gain.
Qualities related to anything of a scientific, medical, or clinical nature is of little if any concern to most pharmaceutical companies, quite apparently.
This is why pharmaceutical representatives have little if any interest or concern regarding public health, perhaps. This premise is further validated by the pharmaceutical employers’ minimal concern regarding the medical knowledge of their sales representatives, as mentioned earlier.
What the pharmaceutical company is concerned with, however is the ability of their representatives to effectively offer inducements to targeted prescribers. The inducements are not gifts, but are bribes.
Examples may be creating a check from the pharmaceutical representative’s employer to be issued to one of the targeted prescribers determined by the pharmaceutical company. This check, when given to such a prescriber, is often for doing little, if anything at all for the pharmaceutical company paying such a prescriber.
Knowing this, it seems to validate the pharmaceutical industry’s overt apathy regarding this industry’s absence of focus regarding the essential medical knowledge of their sales representatives.
In relation to non-monetary inducements given to certain prescribers, they may be of a certain value and are possibly without any clear medical benefit, such as TVs or DVDs, perhaps. And the autonomy that exists with some pharmaceutical companies results in authoritarian directions to their sales representatives to implement the activities with the inducements that are given again to targeted prescribers. Since pharmaceutical representatives understandably believe that since they are given such directives by their pharmaceutical employers, then they must be legal and ethical. This is further reinforced by the applause and rewards the pharmaceutical representative receives often for this behavior of giving bribes to prescribers. They are viewed by their employers as innovative and creative, instead of criminal.
This appears to eliminate the need or desire for the pharmaceutical representative to examine the consequences potentially of some activities and tactics encouraged by their pharmaceutical employers. It is clear that most pharmaceutical representatives do not question what they are told to do.
Targets are a result of what is referred to as data mining, which is a determining variable as it relates to who a pharmaceutical maker may choose to support financially in one way or another. Prescribing data is in the possession of pharmaceutical companies of the prescribers nationwide, and this data is analyzed to determine the prescribing habits of health care providers. This prescribing data is provided to the pharmaceutical companies by the American Medical Association.
Further disturbing is the fact that this behavior is not prevented by our lawmakers. This data mining allows a pharmaceutical company to conclude who could potentially affect their business and therefore dispense gifts to the right prescribers for their business. The gifting establishes reciprocal relationship with the receivers of these bribes. Quid Pro Quo is now born, and the pharmaceutical company continues to thrive.
Conversely, if a prescriber is determined by a pharmaceutical company to be harmful or of minimal financial benefit to their business, they will essentially be ignored and ostracized by the pharmaceutical company.
While such unethical activities may appear to be ridiculous and without reason to some, this does not mean they do not occur. The illegal and unethical behaviors of certain pharmaceutical companies seem to be rather unbelievable by others on occasion.
It seems that external regulation is necessary to prevent the drug companies from allowing this corruptive autonomy to continue to exist. It is rather obvious that internal controls of companies that perform such wrongdoing are void of self-regulation with deliberate intent.
If regulation happens, then health it may be possible to resurrect the ethical element necessary as a participant in the health care system. The importance of public health should be the apex of their existence as a company that participates in this system.
Overall, pharmaceutical representatives are decent and intelligent people who do not realize the results of the actions they perform upon direction are harmful to the health of others. And if they may do in fact realize what they do for their pharmaceutical employers is in fact wrong, they continue to please their employers, as financial benefit for them outweighs the results of their actions.
Fear ensures loyalty.” — Author unknown.
Dan Abshear (what has been written is based upon information and belief).
[…] of interactions that have long characterized the work of drug reps. (See our previous posting Former Pharmaceutical Reps Tell All). The PharmedOut website has some interesting new videos in which drug reps discuss how they ply […]
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