Drug Reps — it’s in the details

devil rep

What Are Drug Reps?

They are the sales force for drug companies called drug representatives.  They visit prescribers and hospitals and health plans or anyone perceived as having the ability to influence the use or purchase of the company medical or surgical products.  When they sell surgical products the word “drug” is changed to “device” or “equipment” or “training”.

Ecology

What is the ecology of drug reps?  What do they look like?  What is their habitat?  They seem to live in doctor’s waiting rooms.  The large briefcase, the laptop computer and the perpetual smile are the hallmarks.  They can be tracked by the trail of ballpoint pens with drug logos.  The men are rugged-looking and wear fashionable suits.  The women are good-looking with tailored short dresses.   They seem to whisk back to see the doctor no matter how busy the schedule and no matter how difficult patients have in getting an appointment.  If only patients could be so pleasant.

Friend or Foe

Are reps the patient’s friend?  Absolutely not.  Their only allegiance is to the product they sell.  The reps job is to minimize the side effects, the hazards, the opposing research, the deaths, and the cost of what they sell.  They visit prescribers as a friend, someone who admires the prescriber, and someone who thinks the prescriber is smart and sexy.  They give gifts and provide meals if the prescriber will listen to an “educational” presentation.  The reps suggest only fuddy-duddies stick with generic drugs.  Primary care providers are told the specialist the provider likes always prescribes the drug the rep sells.

No Visits, No Samples

If providers do not see reps the providers actually could get excellent  unbiased recommendations from several sources.   But, those sources (like subscription news letters) cost money and don’t come with a good-looking sales person.  Furthermore, free samples are not given to those who fail to see the company rep (no matter what the drug companies say).   Then patients gripe “why don’t you give me samples like the other doctors?’ — even the patient becomes a sales person!

Marketing Surgeons

A new device is a marketing problem.  The surgeon who might use the device does not want to travel to see the device.  So, the device comes to the operating room.  The sales person demonstrates the device and talks the surgeon through a procedure (while the patient is under anesthesia).   Or, with certain inducements the surgeon goes to a course on the device and, amazingly, they get a certificate saying they are proficient with the device — do surgeons every fail these courses?  Of course not.  And, hospitals rarely question the certificates, after all, the hospital did not pay for them.  Should patients feel comfortable with the level of training? No.

Doctors Like Reps

When doctors are asked about industry reps they say they need the information provided and like to ask questions about drugs or devices.  And, they are not influenced by the sales effort.  But, drug companies know better and continue the very successful sales technique.  So, the drug reps march on.

Free Training

Hospitals like surgeons to start using new procedures, especially if they do not have to pay for the training.  New procedures often have higher reimbursement than old procedures which are more time-consuming.  Thus, more money for less work — who approved that higher payment anyway?  The reps help surgeons inform the insurance company  about new technology “revolutionizing” treatment — denial of such an advance would not look good to regulators.  And regulators are sent fact sheets about the new procedure  insurance companies want to cover.  So the reps march on.

Hospitals Are No Match

The sales techniques for hospitals or drug suppliers are diabolical.  A one-of-a-kind drug is pared with a drug made by the same company which has lots of competition.  If the buyer purchases the two drugs together they get a discount on the high-priced item.  Another favorite tactic is to bundle a whole group of medications — the deal is if the buyer will use that group (like antibiotics) to the exclusion of competitors they get a good discount.  When a competitor invents a better medication the buyer is faced with huge losses to make a change just for one drug.   This market-basket approach undercuts the competition – often driving smaller drug companies out of business.

So Why Are They Bad?

Why are drug reps bad for patients and the U.S. health system?  Because the marketing target is the prescriber not the payor.  The prescriber does not pay for the medications or device, they don’t suffer the side effects, and they don’t die from complications.  As a group they are easy marks for sales.  The failure of adequate drug evaluation (cost-effectiveness) is extremely wasteful both in terms of the cost of care in this country and the health and financial well-being of patients.

Nobody Does It Better

In England purchasing is done by a national agency that evaluates medications for cost effectiveness.  The very reasonable English seem to have a grip on the problem.  The disorganized U.S. health system is no match for the marketing efforts.

What Can Be Done?

  • Clinics and hospitals  should not allow drug reps to visit
  • Clinics and hospitals should provide unbiased drug and device newsletters for the physicians and surgeons
  • Hospitals should pay for surgeon training for new procedures
  • Patients should be happy a doctor does not allow drug reps and accept the fact samples are actually costing money indirectly.
  • Clinics should be able to obtain (or purchase) samples of drugs needed (like for demonstration of inhalers or medication injection techniques)
  • Hospitals should participate in large purchasing organizations and follow the recommendations of third parties who advise on drugs and devices.
  • Government health plans  should have a nation-wide formulary.  The cost of drug and device evaluation is too high to allow duplication by every insurance plan or government department.
  • Market-basket sales techniques need to be stopped due to the anti-competitive effects.  One drug, one price, should be the rule.

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