The rule of seven touches

Dr. Atul Gwande tells the story in his New Yorker column of asking a pharmaceutical rep how he persuades “notoriously stubborn” doctors to adopt a new drug he’s promoting.  The rep’s response:

“Evidence is not remotely enough, however strong a case you may have. You must also apply the rule of seven touches.”

“Personally ‘touch’ the doctors seven times, and they will come to know you; if they know you, they might trust you; and, if they trust you, they will change.”

That’s why, explained Dr. Gwande, this drug rep stocked doctors’ closets with free drug samples in person.  Continue reading

Big Pharma’s remarkable powers of persuasion

Do you know why product demonstrators at the grocery store give you those tempting little free food samples when you’re out shopping on your way home for dinner?  It’s because manufacturers and retailers know that free samples result in significantly increased sales. They simply wouldn’t be doing this if it didn’t work to boost results. The food business is not doing charity work – their goal is to make more money.  This free sample strategy is based on a sociological concept calledthe rule of reciprocation.

It’s also the same concept that pharmaceutical companies rely on when they offer your doctors financial incentives – and even those free drug samples.   Continue reading

Fewer physicians are now agreeing to see drug reps

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:   Continue reading

How Big Pharma spends $20 billion a year on marketing their drugs to you

Pharmaceutical companies spend about twice as much on marketing their drugs every year as they do on research and development of new medications.  And it’s a pretty impressive marketing budget. The Wall Street Journal recently reported how marketing numbers broke down last year. The figures don’t include the value of free drug samples that companies distribute – the largest single marketing expense.

The other major categories include:

  • $12 billion for “detailing,” the industry term for sending sales reps to talk to doctors, nurses and other providers. Spending on detailing was highest for statins (such as Pfizer’s Lipitor), antidepressants (like Forest’s Lexapro) and antipsychotics (like Bristol-Myers Squibb’s Abilify). In each of those categories, branded drugs are competing against generics for a big market.
  • $4.7 billion for Direct-To-Consumer (“Ask your doctor”) advertising, and an additional $400 million on advertising in professional journals. TV ads accounted for almost 62% of drug company ad spending, print ads made up 35% and online ads 4%.
  • $3.4 billion for sponsoring professional meetings and events. This includes sponsoring courses and talks that doctors can attend (or watch online) in order to satisfy requirements for continuing medical education (known as CME). Industry-funding of CME has been getting some negative attention lately, with some physicians and academics calling for public disclosure of who pays for what.

And speaking of doctors, New Hampshire physician Dr. Kevin Pho writes in his always-enlightening blog KevinMD, about a type of pharmaceutical sales rep whose actions remain completely unregulated.

“These reps have unfettered access to the top academics of all fields of medicine, are invited by medical societies to give keynote addresses, routinely publish articles in the best journals, and offer advice about medications that is accepted as gospel by doctors everywhere. These reps have medical degrees, and some have become millionaires by taking fat payments from drug companies. The are “the hired guns of medicine”.

A revealing study presented at the American College of Preventive Medicine annual meeting by Dr. Mohammed Hassan Murad of Mayo Clinic reviewed 202 published medical journal articles that addressed the known association between heart attack risk and the GlaxoSmithKline diabetes drug, Avandia.  Among journal article authors who concluded Avandia does NOT increase the risk, 86% had financial relationships with GlaxoSmithKline. Among authors of articles offering unfavorable reviews, only 18% had relationships with GSK.

Read the entire Wall Street Journal article on drug marketing numbers.

See also:


The Drug Pushers

What has become a classic must-read for those interested in getting an insider’s perspective on drug marketing is bioethicist Dr. Carl Elliotts April 2006 piece in The Atlantic called The Drug Pushers.

It starts by describing the ‘good old days’ when his own Dad was a family doctor whose waiting room would be filled with serious, conservatively-dressed men with large heavy briefcases and sensible shoes. These were salesmen of the drug companies, and were known as ‘detail men’.  Elliott continues:

“Today, detail men are officially known as ‘pharmaceutical sales representatives,’ but everyone I know calls them ‘drug reps.’ Drug reps are still easy to spot in a clinic or hospital, but for slightly different reasons.

“The most obvious is their appearance. It is probably fair to say that doctors, pharmacists, and medical school professors are not generally admired for their good looks and fashion sense. Against this backdrop, the average drug rep looks like a supermodel, or maybe an A-list movie star. Drug reps today are often young, well groomed, and strikingly good-looking. Many are women. They are usually affable and smart. Many give off a kind of glow, as if they had just emerged from a spa or salon. And they are always, hands down, the best-dressed people in the hospital.” Continue reading

Doctor’s kiss and tell tale: “My 1-Year Career as a Wyeth Drug Rep”

drug reps. fourbags

Psychiatrist Dr. Daniel Carlat is a compelling storyteller. One especially compelling story, Dr. Drug Rep, was told in the pages of the New York Times Magazine about his own very brief career moonlighting as a Big Pharma drug rep.

Once upon a time, he explained, on a blustery fall New England day in 2001, a friendly sales manager from Wyeth Pharmaceuticals came into his medical office and made him an offer he found hard to refuse.

“He asked me if I’d like to give talks to other doctors about using Effexor XR for treating depression. It would be pretty easy. Wyeth would provide a set of slides and even pay for me to attend a speaker’s training session.

“I would be paid $500 for one-hour Lunch and Learn talks at local doctors’ offices, or $750 if I had to drive out of town. I would be flown to New York City for a ‘faculty-development program,’ where I would be pampered in a midtown hotel for two nights, and would be paid an additional honorarium.”   Continue reading