Yesterday, The New England Journal of Medicine published in its periodical, the results of a survey taken by physicians. The survey included physicians in various specialties such as anesthesiologists, cardiologists, family doctors, surgeons, internists and pediatricians. This group had experience ranging from less than 10 years to over 30 years. Half were reported to be in private practice while the rest worked in hospitals and medical schools.
The survey was in the form of a questionnaire to 3,167 doctors around the nation and more than fifty percent (1,662) replied. The objective of the survey was to "determine the extent of the relationships between doctors and pharmaceutical sales representatives."
Although it’s been decades since I have held the position of a ‘drug rep’ — I could have saved them time and money by providing the answer to this relationship. Furthermore, even though The Pharmaceutical Research and Manufacturers of America, the leading trade group, in 2002 adopted voluntary rules limiting the value of gifts to $100 or less and banning free entertainment tickets; I still could have provided the answer to this relationship. I thought the study results were common knowledge. Having your drug the drug of choice when a doctor writes a prescription means everything [$$] to a drug rep and the pharmaceutical company. These PharmaPerks, as I’ve called them, can make the difference.
If a doctor is able to give samples of a drug along with the prescription, that drug is assured of becoming #1 in its class, e.g., anti-hypertensive, anti-inflammatory, when that happens. When a physician writes your drug as first choice, you are guaranteed approximately eighty percent (80%) market share on your class of drug. If it’s written second or third choice, you share that remaining twenty percent (20%) with the competition. I ask you, if you could not have the whole pie, would you think having 80% of it were crumbs?
When your prescription is filled, the drug store must have placed orders with a wholesaler who has purchased directly from the manufacturer. The idea is to get the wholesaler to order volume and frequently from the manufacturer. One reason there are hospital reps in pharmaceutical sales is to get drugs on formulary at hospitals pharmacies. The drug rep receives a Data Drug Distribution report to inform him or her of these orders.
The responses to the questionnaire were anonymous. About ninety-five percent said they had contact with drug or device companies. “These finding are fairly disturbing. There appears to be no dialing back at all on these relationships," said Merrill Goozner of the Center for Science in the Public Interest.
Many "favor an all-out ban on small gifts and free meals" because such rewards don’t benefit patients. What I feel they are not taking into consideration is that drug sampling is a service a physician provides their patients. I have been the beneficiary of such service. I am not hesitant to ask for samples of the medication being prescribed to me. Many times, I have not had the need to get a prescription filled because of the samples provided.
Other findings:
_83 percent received food and drinks.
_78 percent accepted free drug samples.
_35 percent were reimbursed for costs associated with professional meetings.
_28 percent pocketed consulting or lecture fees.
_7 percent took free tickets to games and events.
The extent of the interactions varied by specialty and sales reps tend to target doctors with the most influence. For example, it was reported that cardiologists were more than twice as likely than family doctors to receive fees. Doctors who were in private practice were six times as likely than family doctors to get gifts than those at hospitals. Family doctors met with sales reps far more than their counterparts — about 16 meetings a month, the survey showed.
It must be noted that previous studies have suggested that cozy relationships with industry can affect doctors’ prescribing patterns and judgment. But companies have defended the practice as a legitimate way to educate physicians about the latest drugs and technology.
I will not state my position, whether for or against. I will unequivocally assert, if all PharmaPerks were eliminated, except drug sampling, and resulted in a cost reduction of medications, then ban the PharmaPerks! Fine the doctors and the companies. Use the fines to assist those who are unable to afford much needed medications to enhance their quality of life and/or to prolong it.
Copyright © 2007 by Avis Ward of AWard Consulting, LLC
Source: New England Journal of Medicine | Special Article - A National Survey of Physician-Industry Relationships
