What seems like very good news for those of us concerned about the too-cozy relationship between Big Pharma and our physicians is being viewed with alarm by the drug industry-funded website Policy & Medicine, whose motto is “Supporting Innovation Through Collaboration”.
This is a CorporateSpeak tagline that’s roughly translated as:
“We Put Doctors On Our Payroll So They’ll Flog Our Drugs For Us”
According to Policy & Medicine, a recent U.S. study is “troubling” for both patients and physicians. Oddly enough, as a heart attack survivor and consumer of a fistful of cardiac meds every morning, I am not remotely “troubled” by this study’s results. In fact, I’m considerably cheered up. Here’s why:
An AccessMonitor™ report from ZS Associates surveyed 500,000 American physicians, nurses and other drug prescribers. It also tracked both the planned and completed sales calls of 41,000 pharmaceutical representatives, which is about half of all drug reps in the U.S. The report found that the number of busy health care professionals now willing to see visiting drug reps is down by 20%.
This is significant because we know that these ‘detailing’ visits by pharmaceutical sales reps to your doctor are demonstrably effective in changing a doctor’s prescribing habits to favour that company’s drug. Here are some examples from Drug Marketing By The Numbers.
- Favourable change in a doctor’s prescribing habits after spending less than 1 minute with a drug sales rep: ↑16%
- Prescribing change seen after 3 minutes with a drug rep: ↑52%
The spring 2010 report of AccessMonitor™ measured three categories of physicians:
- “rep-accessible” prescribers who meet with at least 70% of the sales representatives who called on them
- “rep-inaccessible” prescribers who meet with fewer than 30% of the reps who called on them
- “rep-neutral” prescribers who meet with 31-69% of the reps who call on them
In the recently released survey, AccessMonitor™ found that:
- 58% of prescribers in 2009 were “rep-accessible,” which was down 18% from the spring 2007 study that showed 71%;
- 33% of physicians were “rep-neutral”;
- The number of “rep-inaccessible” prescribers increased to 9% from 6% compared to 2007
- More than 20% of prescribers considered “rep-accessible” in late 2009 fell to a “rep-neutral” rating in the spring of 2010;
- 11% of prescribers rated “rep-neutral” shifted to “rep-inaccessible” during the same period; and
- 94% of primary care providers and 83% of specialists did not see even the best representatives more than twice each month.
This, according to the industry’s Policy & Medicine website, is very bad news. For example:
“If doctors do not have the time to see drug representatives for a few minutes, they probably do not have the time to read peer-reviewed studies either. So where do they get their information about medicine they are prescribing their patients then?”
Unlike the old door-to-door vendors of cosmetics and vacuum cleaners, drug reps do not sell their product directly to buyers. Consumers pay for prescription drugs, but physicians control access to them. As the journal Public Library of Science Medicine described this:
“Drug reps increase drug sales by influencing physicians, and they do so with finely titrated doses of friendship.”
Physicians tend to view drug information provided by reps as a convenient, if not entirely reliable, educational service. A 2003 Blue Cross Blue Shield industry survey found that more than half of “high-prescribing” doctors cited drug reps as their main source of information about new drugs. The current ratio is one drug rep per 2.5 targeted doctors. Low-prescribing doctors are ignored by drug reps.
In a 2006 Kaiser Foundation study, three quarters of 2,608 practicing physicians described information provided by reps “very useful” (15%) or “somewhat useful” (59%). However, only 9% agreed that the information was “very accurate”; 72% thought the information was “somewhat accurate”; and 14% said that it was “not very” or “not at all” accurate.
Whether or not physicians believe in the accuracy of information provided, detailing is extremely effective at changing prescribing behaviour. If it weren’t, hiring drug reps would not be part of the estimated $7 billion a year that drug industry spends on marketing their drugs directly to doctors.
And as former Eli Lilly drug rep Shahram Ahari testified recently during litigation over New Hampshire’s ban on the commercial sale of patients’ prescription data:
“The concept that reps provide necessary services to physicians and patients is a fiction.
“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.”
If you’re one of the growing number of physicians who no longer see drug reps, download this No Drug Reps certificate for your waiting room from PharmedOut.