PhRMA: Reps Don't Influence Prescribing Habits

Ed,

You pulled out a statistic from the study that stated that "just 29 percent say they are very satisfied with info reps deliver." However, if you add in the 59% of physicians who are "somewhat satisfied," you end up with 88% are had a positive response (though much of it lukewarm) and only 12% who are dissatisfied.

Overall, despite what we may read regularly in the press, there is no great stampede by physicians to ban reps. Is it happening in some places--absolutely. However, based on these survey results, most physicians don't have any motivation to join in.

Atlex

Hi Atlex,

That's correct. But I did the same thing PhRMA did in discussing the results. The group highlighted the 11 percent figure in discussing sales reps as the source of info that greatly affects their prescribing decisions. Throw in the 63 percent of docs who say reps affect their prescribing decisions to 'some' extent and suddenly you have 74 percent of docs who say reps affect their decisions.

But PhRMA, in its press release (please see the link), emphasized 11 percent, which I thought was an interesting decision for reasons I state at the end of this post. So I chose to do the same thing PhRMA did - cite the strongest response.

Also, I ran a separate post yesterday about sales reps in which 76 percent of docs say they would see a rep any time or any day, while 17 percent say they won't see a rep at all. There was no historial comparative data, unfortunately, from the market research firm that conducted this other survey. So is the glass three-quarters full or nearly one-fifth empty? Or is it just a stupid glass?

Cheers ed

I agree. PhRMA's positioning is curious to say the least. If I was them, I'd be highlighting two findings: 1)physicians are influenced by a wide variety of sources; 2) pharma reps, while playing a role as one of the sources of information for most physicians, don't seem to be overly influential.

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The Health Care Business and the Desire for An Ethical Resurrection

If you have ever been inside a doctor’s office, you have likely seen them. They are the ones that are unusually well-dressed for this type of environment. In addition, they are typically young and attractive. Yet worst of all is they typically pay absolutely no attention to you, the patient, as you are not the objective of their presence at this location. So they will avoid any conversation with you, the patient, as the purposes of your visit at this location are in opposition. Not always the case, but often this is what the experience is unfortunately. And these others are called drug reps- the detailers….the pharmaceutical company promoters and markets that could care less about you, the patient, during their duties involved with this profession, even though both of you are sharing the same space at the same time. And these reps possibly will consume a portion of the valuable time of the very doctor that you are scheduled to see for a health care issue or concern, that may be of a serious nature. This is the one thing in common between you and the drug rep: you both want to see the doctor, but obviously for different reasons. Pharmaceutical marketing tactics, this scenario being one of them, have become more transparent to others over the past few years. Their additional methods have been exposed more now than in the past. And the public as well as the medical community does not like what they have heard and read about these tactics of pharmaceutical companies- which is largely valid and authentic information. This is why this industry’s image has suffered lately, which they have deserved, considering what they do and have done with deliberate intent and reckless disregard often, which has been not indicating that they are concerned with public health in any genuine way in order to gain immediate profits. This toxic focus of the pharmaceutical industry is a concern to patients and the medical community. As a result, various patient and health care advocacy organizations are addressing these concerns raised by the marketing and sales tactics of the pharmaceutical industry. I think highly of their continued efforts in various ways to eliminate these activities of the pharmaceutical industry to improve the health of the public health and the medical care they need to receive. One could say such groups are treating a disease of a different nature, and more toxic than other diseases. Factors such advocacy groups focus on their involvement with issues such as pharmaceutical industry marketing and are insisting that changes occur with such issues as the following: Data mining, which is the tactic of the representatives of pharmaceutical companies formulate based on having access to individual physician prescribing data to use for their own benefit to reap additional profits by these physicians. Sold by the American Medical Association, this data allows these representatives to essentially manipulate prescribers based on this data. Furthermore, this prescribing data allows pharmaceutical representatives to ‘reward’ those shown as being either a supporter of certain medications a pharmaceutical representative may be promoting, as well as illustrating the average volume of prescriptions a prescriber typically generates. Such factors disregard other doctors in the medical community who are entitled to the same attention that the representatives provide these select others who will benefit them more financially than others. After all, according to the pharmaceutical lobbying groups, pharmaceutical representatives are needed to educate all members of medical community, right? One solution to this marketing problem the pharmaceutical industry has presently is what is called the SafeRx Act, which was encouraged and insisted upon by certain advocacy groups. This act will require pharmaceutical representatives to be certified by the state in order to work as a pharmaceutical representative. Certification may and should involve ethics training, the importance of public health, and the complexities involved with health care in medical communities. In addition, a greater emphasis should be placed on such representatives to be better trained medically for the benefit of patients as well. Maybe in time the pharmaceutical industry will become more pragmatic if the public is more empowered with knowledge regarding these issues, as doctors should be void of interference by others when decisions are made in regards to treating their patients, and the medications they may receive. “Whenever a doctor cannot do well, he must be kept from doing harm.” --- Hippocrates

Dan Abshear

If reps aren't having much influence on doctors' prescribing habits, then what are they doing out there? This is a no-win situation from a PR standpoint - if reps are ineffective, it's really foolish to spend so much on them, but if they are effective, then comes all the backlash about those evil, corrupt, money-making drug companies. Stats like these are good for only one thing: spin 'em any way you like to reinforce your pre-conceived notions.

I like Atlex's spin best.

Once again, PhARMA never ceases to amaze. Docs don't prescribe based on rep interactions! Come on! Of course they do! Why in the world would pharma companies spend billions of dollars for decades on reps if detailing didn't work? Either PhARMA is trying to halt the criticism by claiming reps have no effect, deliver an excuse for why DTC should continue, or prepare for the next big strategy from pharma - get rid of most reps! Billy and PhARMA simply cannot be trusted - they must have ulterior motives.

Surveys measure perception...not reality. They are also biased by the respondents giving the socially acceptable answer. These kinds of surveys have been done for years...none measure what is actually going on. In one old survey, the respondents said they used journal articles for their primary source of prescribing information. When the respondents were followed and observed...their primary sources of prescribing information were drug reps and colleagues. The Pharmaceutical Industry would not spend a large amount of money on reps, if they did not work (ie, influence prescribing).

Steve, Doc and Sisyphus,

I think you are reading too much into Ed's headline. The press release from PhRMA actually states the following:

"The vast majority of physicians report that they appreciate information from pharmaceutical company representatives on drug interactions, the latest drugs and treatments, and patient assistance programs, but only 11 percent say this information greatly impacts their final prescribing decision, according to the survey. In fact, echoing the findings of earlier research from multiple studies, physicians cite patients’ coverage options and drug formularies as having more of an impact on such decisions."

Given the way the survey was conducted, the term "greatly" is critical. You can't assume that the remaining physicians (89%) are not influenced by reps, just that they are not "greatly" influenced by reps. As I reread the press release, I think PhRMA was trying to demonstrate that reps have a place, but they are not the centerpiece to physician knowledge regarding prescribing.

Atlex

The whole point is that doctors use MULTIPLE sources of information to learn and to make decisions! Which is fine with me.

I am with Steve and Doc. I will believe this 'no influence' BS when Pharma starts firing reps and just mails new drug info to docs.

This does not pass the sniff test.

Oh Billy Boy, How clever of you. PHRMA has two objectives with this new 'study'.

1.) In light of the massive off-label fines paid in recent years and the fact that there are several hundred such cases still under investigation, what better way to try and neutralize the arguement that legions of sales reps promoting off-label have any effect on MD prescribing habits.

2.) The companies need to cut the number of reps, 100,000 is about 2-3X what is actually needed to do the job effectively.

Now as we move forward in time it will be interesting to watch the 'no effect' argument used in future off-label cases.

However, to the points made above - if reps have little to no effect, it is a foolish strategy to pay them $100K+ per year (with all benefits).

As the wise one said, "Watch what they DO, not what they say".

So what if we have an influence on prescribing habits? That's the point. I for one have quit apologizing for the fact that I aim to influence physicians--medications are a product/service just like everything else--including the local hospitals which are frantically marketing themselves and their physicians as hard as they can. Profit is not a dirty word--it is what drives the American economy. Every single person who posts on this board benefits from profit-making enterprises, including pharmaceuticals.

We mail information to physicians now, Ginger. They throw it away. Important information, like rare side effects that show up only after you have a million prescriptions. And the PI is a vast wealth of information that physicians don't read.

In the past two days, I have had three physicians ask me questions to which they couldn't get the answers on the internet, in the literature or from other physicians. Specifically, how to get past a costly co-pay problem. I fielded a dosing question from a doc who admitted he didn't know the dosing of my drug or any of its competitors (they all involve paperwork and my nurse does that), a physician who wanted to know about pharmacokinetics (that would be in the PI, BTW), pregnancy and my drug and the current state of the pregnancy registries for the whole class of drugs (oh, that was information I had because I attended an all-day Saturday seminar, where I DIDN'T see this doctor)...I could go on an on.

This bizarre adulation of physicians, that somehow they are more moral, more curious and more diligent than normal folks (and therefore don't need reps), combined with the polar opposite view that somehow they are gullible idiots who will believe anything as long as it comes from a rep, just makes my head explode.

A good physician gets information from a variety of sources, including reps, measures it against his clinical experience (hello? who could claim they didn't know Zyprexa causes weight gain??), and prescribes the best medication for the patient--taking in formulary considerations and patient preference. I believe that a physician who asserts that he believed a rep about the absence of a side effect or the unbelievable efficacy of a drug (i.e., weight gain and Zyprexa) simply is retrospectively trying to get himself off the hook for making what he thought at the time was the best presribing decision.

I'll take a doc who sees reps over a no-see doc anytime. The best docs I know (and I know A LOT of them) get as much information as they can from as many sources as possible. They may not see reps during clinic, but they make time before, after or at lunch. The most hard-core anti-pharma, no-see offices I have are the patient mills, busy running patients through triple-booked and giving 4-5 minutes of the docs' precious time to the patient. They don't see reps because they don't let anything interfere with the billing factory--including the patients' needs.

HorusCat, You mention Zyprexa, the drug that killed my son. You suggest that the overworked psychiatrist who talked him into going on it and off safe, cheap lithium, was partly to blame for his death from profound hyperglycemia. But who started it in the first place? Well, first we have Lilly literally hiding the lethal side effects, lying and obfuscating to the doctor, bribing the doctor, flattering the doctor - especially Medicaid doctors as this man was. Medicaid is a gold mine for drug reps peddling psychotropic drugs for those with chronic mental illness, many of whom are unable to work and therefore stuck on Medicaid. Whenever I think of the panoply of players that killed my son, the drug rep is always in the line-up.

There is no question that the "Cagey Cajun" is up to something. I think that Doc has it right. He's trying to say that since docs don't listen to reps, the pharma companies can't be held accountable for the off-label promotion that is rampant throughout the industry. Therefore, it's the docs that should be held responsible Here's one word for the Cajun - Bull!

Catman, Your arguments sound good, but truth is in your way. How many companies have already settled in off-label promotion cases - and how many over the next ten years WILL pay? Many, many. Make you calls, stay in label and you have no argument - but be aware that your company may not be as trustworthy as you believe.

I have to agree with a few of Horuscat's points.

In my observation from being a pharma rep for the past 23 years, the physician's who take time to listen to reps, read journel articles, and attend CME programs are usually the most well informed and caring physician. One that comes to mind is an internal medicine physician from North Carolina that absolutely enjoyed bantering back and forth with pharma reps. His office door was usually open and he delighted in "grilling the reps" across from his desk. He was thirsty when it came to knowledge, reading journel articles that were piled high in every corner of his office. He frequented the internet on his lap top or palm held. In other words he used every source of information that was available to him and was always curious about EVERYTHING that had anything to do with the possibility of helping his patients. Pharma reps would reccommend him to their friends who were looking for a good caring physician that would spend time with them. I selected him as my personal physician as most reps did.

It's the physician's that close the door to reps or any other source that are not well informed enough to come up with sound clinical decisions. I know that type well after years in this industry. They refuse to see any representatives, they hate the invention of the computer and they think they know it all. You hear patients complain about the lack of sympathy or the lack of time this "dollar chaser" takes.

I do admit that the pharma industry has misbehaved over the past 15 years or so. I believe that there are too many reps in numbers and too many that have no business being in health care. However, this source should not become extinct....the pharma companies just need to reduce the size of their forces, be more careful in selecting the people who represent the products and get back to the premise of DETAILING and NOT SELLING. Companies owe it to the public to deliver the good, the bad and the ugly of these compounds.

Another vote of confidence for "Doc" he has nailed it yet again...

The biased perception study produced makes a good attempt to neutralize the arguments of late. Intelligent people out there can see through the smoke screen.

The bottom line is the reps "filter" the information just as much as the published studies and the "rigged" CME events.

There's been so much in the news lately about massaged trial data and misinterpretations. We are all to blame, we all want one block buster after another. Everybody wants to "fast track" the earnings and get just as rich as the other guy.

Anyway, my experience is Docs speak to reps more about drug access issues. Smart docs go straight to the medical affairs directors for information on drug to drug interactions, side effects problems and SE management and in my opinion that is the way it should be. H C all due respect, there are very few sales reps with PhD's..

Former, No, there are few reps with my technical knowledge, but I readily admit I am a total geek. I sometimes find I know more about current research and controversies than my docs, which can actually be kind of embarrassing. Those conversations obviously don't occur in a 45-second call--they happen over lunch or early morning coffee, and I don't suppose they do much selling of my product. They are just fun. They do build my credibility with the docs, so when I say something about my drug, they listen.

I share the posters' here frustration with reps who go off-label (we are dealing with that in my class of drugs, and it is an instance where going off-label could literally be fatal for patients). I think there is a huge difference between saying an SSRI that works for GAD and panic will probably also work for "social phobia" (whatever that is) versus telling a doc to use a drug first-line that the FDA regulates closely and insists must only be used as a last resort.

I also share the frustration with reps who while they may stay on label, just regurgitate the same message over and over, like a Bud commercial (actually, they are not as entertaining as a beer commercial). When we sold Zoloft, we would get apoplectic because we were using approved clinicals (that at least attempt to be scientific) and our competition simply bombarded offices with reps and having no clinicals to speak of, just gave the same 30-second blurb over and over. (They also were not members of PhRMA and gave give baskets, etc.)

Ultimately, I agree with Monyonyo--we need fewer, better educated reps, probably concentrated on the specialties. I think that is happening now--I would not be surprised to see radical changes in the way companies approach primary care in the very near future.

Excellent article! The new Prescribing Guidelines is an effort to improve patient care and safety. I have been using DrFirst for all of my e-prescribing needs. Check out their website I am sure you will be just as satisfied as I am. http://www.drfirst.com/eprescribing.jsp

Thanks for all of the great information! In this day and age various doctors are benefiting from the internet to conduct web consultations. E-prescribing is more accurate and safer than traditional hand written scripts. No more handwriting errors and when you e-prescribe you don’t have to worry about drug interactions or allergies because all your information is in the system. Web Prescribing is a great way to get online and get the prescriptions that you need!