Drug rep largesse over!

Discussion in 'Clinical Rotations' started by Sabreman, May 15, 2002.

  1. Sabreman

    Sabreman Member
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    Bad news.

    I was helping a friend move yesterday and a Pfizer drug rep was moving stuff into a storage locker. I tried to hit him up for some free stuff since I was there. He told me that all the major drug companies had hired an independent consulting firm to assess costs, and that they had collectively agreed to END THE FREE STUFF for doctors outside of drug samples starting June 1. No more trips or golf rounds, not even free lunches or dinners. No more bagels in the morning in clinic or free books for students. From now on any free dinners will be limited to company-sponsered "talks". The free ride is over just in time for me to graduate, dammit!

    He also said they are taking this very seriously and will be monitoring the reps to make sure no one is sneaking around and providing free stuff, thus giving advantages to the cheaters. Has anyone else heard this yet?
     
  2. DrMom

    DrMom Official Mom of SDN
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    I've planned CME meetings for the past few years and have seen a HUGE change in how the pharm cos have been operating. It used to be quite simple for us to get $ (unrestricted educational grants) to cover the meeting expenses (speakers, food, golf, hotel, etc). Now it is like pulling teeth. The reps have less $ available and more strings attached. I have one rep that is no longer allowed to give educational grants at all! And this is in a big $ field (oncology).

    What really gets me is that at the same time, the pharm cos are spending big bucks on commercials & print ads to the public--the people who don't have the power (to write prescriptions) or complete information to make good drug choices! I know that the perks for Drs issue is more about *ethics* than $, but how ethical is it to make the general public think that they should hound their Dr for the new drug that they may or may not need?
     
  3. edmadison

    edmadison 1K Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by DrMom:
    <strong>
    What really gets me is that at the same time, the pharm cos are spending big bucks on commercials & print ads to the public--the people who don't have the power (to write prescriptions) or complete information to make good drug choices! I know that the perks for Drs issue is more about *ethics* than $, but how ethical is it to make the general public think that they should hound their Dr for the new drug that they may or may not need?</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Personally, I think it is much more ethical for them to use direct to consumer advertising than to bribe physicians to use their medications. And that's what it is a bribe. The research is full of studies showing that gifts to physicians have a significant impact on prescribing practices. Further, it also shows that drug education/lunches (where the rep tells you about the drug) are notoriously inaccurate and the physicians buy don't realize all the inaccuracies.

    DTC advertising also has the advantage of bringing people in that otherwise might no come into the doctor's office. Our psych department has stated that the DTC advertising has resulted in a significant number of people with previously undiagnosed depression comming forward.

    Of course, there are downsides, especially for physicians who won't stand up to their patients. Case in point is Ortho Tri-cyclin. It's company gets FDA approval for its use as an acne drug (brilliant on their part). Now everyone wants it. Our local OB/GYN's say that some women have refused to take anything else, even after being told by their doc that other OCPs have the same effect and are less expensive. You got to love a patient that will believe a television commercial over their doctor!

    Ed
     
  4. Newdoc2002

    Newdoc2002 Senior Member
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    First can anyone substatiate this "conversation". I do know that drug reps are cutting back but to this extreme?

    Direct to the consumer advertising is so vague, I don't see how it can do anything but cause grief in the doctor/patient relationship. "Ask your doc if ____ is right for you." Half the time they don't even give the indication for the medication. I had one thin old lady ask me if a new diet drug (only known to her by name) was something she needed. Talk about a waste of time.

    I'll agree that the drug rep gifts can be excessive. More often than not, a gift like lunch or dinner often provides time for the rep to detail the doc on the new drug/indications.

    If not, why should I spend 15 minutes during a office visit wasting patient time and my office's revenue to listen to some irrelevant fact from a drug rep. Leave me the samples, show me GOOD references and get out.

    This isn't absolutely the way I feel, but I can assure you that this is the way many primary docs will feel after the drug companies cut them off. And when your malpractice and overhead is creaping up while you reimbursement goes down, you will start to feel the same way too.
     
  5. carddr

    carddr Senior Member
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    All right that's it I'm going into the restaurant business... no free samples, no pens, no flashlights, no writing pads, this is an outrage.

    And who said there is truth in advertising???? The general public is so gullible. More is spent on marketing than R&D. The bottom line is which drug your insurance plan will cover, so who is getting our freebies now???
     
  6. atsai3

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    Newdoc2002:

    The new industry "volungary guidelines" have been reported on extensively. Check out the following article attached at the end of my posting. About your "Leave me the samples, show me GOOD references and get out" suggestion, many clinicians in fact do this exact thing -- especially clinicians who agonize about having to accept drug rep samples for their Medicaid/uninsured patients who rely on samples because they can't pay for their meds.

    Cheers
    -a.

    <a href="http://online.wsj.com/article/0,,SB1019176543599142000.djm,00.html" target="_blank">http://online.wsj.com/article/0,,SB1019176543599142000.djm,00.html</a>

    Drug Industry Moves to Curb 'Dine and Dash' Marketing

    By SCOTT HENSLEY
    Staff Reporter of THE WALL STREET JOURNAL

    The party may be over for some of the drug industry's most controversial
    sales tactics aimed at doctors.

    The prescription-drug industry's main trade group has approved a voluntary
    code for its members that would curtail many types of entertainment and
    giveaways that salespeople use to win over doctors, people familiar with the
    matter said. The guidelines would prohibit sales reps from currying favor
    with doctors in "dine and dash" events in which doctors listen to a brief
    sales pitch while ordering meals to go, selecting gifts or even having gas
    pumped into their cars.

    Also prohibited would be token consulting arrangements that commonly
    disguise financial inducements to lure doctors to meetings.

    An entertainment arms race in the industry during the past few years has led
    to excesses that embarrassed some companies and caused sales budgets to
    balloon. The move to cut back on some of the most egregious behavior could
    save face for the industry and stave off regulation. It remains to be seen
    if the voluntary code will hold, though.

    The executive committee of the Pharmaceutical Research and Manufacturers of
    America approved the code unanimously at a meeting on Wednesday in
    Washington.

    Executives from a dozen industry heavyweights, including Pfizer Inc.,
    GlaxoSmithKline PLC, and Bristol-Myers Squibb Co. sit on the committee. All
    those who voted for the code are expected to agree to adhere to it, people
    familiar with the talks said, as are other members of the trade group.

    The guidelines take effect July 1. Although no enforcement mechanisms are
    specified, participating companies are expected to be vigilant in monitoring
    their competitors who subscribe to the code.

    The guidelines spell out that drug reps' primary duty is to educate and
    inform doctors. The guidelines still permit "modest meals as judged by local
    standards." But to keep the focus on education, a spouse or other guests who
    aren't part of the medical practice won't be allowed to tag along.

    Entertainment for its own sake is out, a person familiar with the code said.

    There will be no more golf, movies, or shows paid for by sales reps. Gone
    also are the golf balls imprinted with drug logos.

    The staff in the doctor's office can still get free pizza from the sales
    person, as long as it is delivered with an in-person educational
    presentation. Just dropping off a meal is verboten, though.

    Giveaways to doctors that are linked to patient care must be valued at $100
    or less. An anatomical model is acceptable by the code, but a VCR or CD
    player isn't. The ubiquitous pens and notepads flogging products are still
    permitted, but floral arrangements and tickets to sports events aren't.

    Write to Scott Hensley at [email protected]

    Updated April 19, 2002

    <a href="http://www.nandotimes.com/healthscience/story/369939p-2979693c.html" target="_blank">http://www.nandotimes.com/healthscience/story/369939p-2979693c.html</a>

    Drug industry tightens guidelines on marketing to doctors
    Copyright ? 2002 AP Online
    By THERESA AGOVINO, AP Business Writer

    NEW YORK (April 19, 2002 8:45 p.m. EDT) - The pharmaceutical industry, long
    criticized for its sales practices, has revised its voluntary code to govern
    marketing drugs to doctors.

    Having a sales representative spend several minutes pitching products to
    physicians as they wait to pick up a takeout meal or have their gas tank
    filled - compliments of the drug company - is no longer allowed under the
    pharmaceutical industry's revised code.

    Most of the gifts, entertainment and consulting arrangements drug companies
    have used to ingratiate their products to doctors will be prohibited or
    curtailed under the new guidelines, which take effect July 1.

    The new code comes as a shortage of new drugs on the market has intensified
    competition in the industry to sell existing medications. Critics charge
    that hefty marketing expenses are driving up the cost of medicines and are
    focused on buying doctors' loyalty rather than education.

    Last year, the industry spent $13.2 billion promoting products to doctors.
    Nearly $5 billion of that was spent on the industry's sales force and its
    activities, according to the Kaiser Family Foundation. The nonprofit health
    policy research group said 61 percent of doctors say they have received free
    meals, event tickets or free travel from a drug company representative.

    "We think there are some very valid concerns and as an industry we are
    looking at ways to address concerns while still continuing the very
    important work of educating and communicating to physicians information
    about new products," said Jeff Trewitt, a spokesman for the Pharmaceutical
    Research and Manufacturers of America, the industry's trade organization
    based in Washington D.C.

    The organization has no way to force its members to abide by the new
    guidelines and critics charge sales representatives have ignored previous
    industry codes as well as their own company rules.

    "It is a move in the right direction certainly. But I'm a bit skeptical. It
    sounds like it could be just a lot of public relations," said Dr. Robert
    Goodman, founder of No Free Lunch, an organization which lobbies doctors to
    reject industry freebies. "Whether anyone will abide by it or whether it can
    be enforced are big questions."

    The industry and the American Medical Association use essentially the same
    code to govern the interaction between doctors and pharmaceutical sales
    representatives. Last August, the AMA announced a new campaign to promote
    the guidelines but it was sharply rebuked after it was discovered the
    industry was funding the effort.

    Pharmaceutical executives say the new code is stronger than one adopted in
    1990. For example, the new guidelines strictly forbid sales reps from
    treating doctors to the theater, concerts or sporting events. Gifts such as
    golf balls, gym bags, flowers and VCRs are off-limits.

    The previous industry code left more leeway because gifts of nominal value
    were tolerated and very broadly defined, drug executives said. It was also
    OK to explain new treatments to doctors over a round of golf or drinks. Now
    the venue is supposed to be "conducive to providing scientific or
    educational information."

    Pens, pads and textbooks are still considered OK, as is a reasonably priced
    meal.

    Drug Industry Adopts Guidelines on Giveaways to Doctors
    <a href="http://www.washingtonpost.com/wp-dyn/articles/A18058-2002Apr19.html" target="_blank">http://www.washingtonpost.com/wp-dyn/articles/A18058-2002Apr19.html</a>

    By Bill Brubaker
    Washington Post Staff Writer
    Saturday, April 20, 2002; Page E03

    Free steak and lobster dinners are out. But pizza is okay.

    Sports tickets are forbidden. So are tickets to Broadway plays.

    After increasing criticism from health-care watchdog groups, pharmaceutical
    industry executives yesterday announced new voluntary ethical guidelines to
    govern the relationship between drug sales representatives and physicians.

    Beginning July 1, drug companies said, their sales reps no longer will woo
    doctors -- the men and women who prescribe the firms' medications to
    patients -- with expensive meals and other perks.

    The Pharmaceutical Research and Manufacturers of America will leave it to
    the drug companies to enforce the guidelines.

    "We didn't like some of the things that some companies and sales
    representatives did in the past," said Hank McKinnell, chairman and chief
    executive of Pfizer Inc. "Doctors were being entertained [by sales reps]
    when there was no educational element involved."

    The new guidelines will still allow drug companies to hire doctors as
    "consultants." Some doctors have said consultancy contracts provide a
    loophole that has enabled them to take all-expenses-paid trips to resorts,
    where some scientific conferences are held.

    Scott Willoughby, a lawyer for the drug-industry trade group, said the new
    guidelines "clarify" existing policies and ban gifts such as "floral
    arrangements . . . music CDs or tickets to a sporting event" that are now
    acceptable.

    "Previously a physician could attend a baseball game with a sales
    representative," Willoughby said. "That was something that was [under the
    guidelines] 'less than substantial value.' And the sales rep was to provide
    [educational] information to them [at the game]. We feel that is not the
    type of venue where it's . . . even believable that you're providing good
    information.

    "A round of golf with a physician may only cost $50. But under the new code
    that's not acceptable," Willoughby said.

    Under the new guidelines, a sales rep can still buy a doctor a "modest" meal
    at a function that has a scientific or educational component. What's
    "modest" is left to each drug company to decide.

    "In downtown D.C., I'd consider $50 a modest meal," Willoughby said.

    McKinnell said "modest" to him is a pizza -- not dinner at the Palm in
    midtown Manhattan.

    The American Medical Association called the pharmaceutical trade group's
    plan "a positive step" that addresses "inappropriate . . . marketing
    practices aimed at physicians."

    Last summer, the AMA launched a campaign to increase awareness of its own
    gift guidelines, which were established in 1990. Some doctors say the AMA
    guidelines are vague and have been ignored.

    The new drug-industry guidelines were criticized yesterday by a consumer
    group. "This is a thinly disguised public relations campaign," said Sidney
    M. Wolfe, a physician who heads the health research group at
    Washington-based Public Citizen. "I don't trust the pharmaceutical industry
    or the AMA to practice what they preach because they have articulated
    similar guidelines for 11 1/2 years. And in the last couple of years alone
    we have found large numbers of violations of these."

    ? 2002 The Washington Post Company

    ** Drug industry curbs dine and dash marketing **
    Drug makers approved a voluntary code to curb many types of entertainment
    and gifts that salespeople use to win over doctors.

    <a href="http://www.msnbc.com/modules/exports/ct_email.asp?/news/740920.asp" target="_blank">http://www.msnbc.com/modules/exports/ct_email.asp?/news/740920.asp</a>

    Drug industry curbs
    'dine and dash' marketing

    By Scott Hensley
    THE WALL STREET JOURNAL

    April 19 - The party may be over for some of the drug industry's most
    controversial sales tactics aimed at doctors.

    THE PRESCRIPTION-DRUG industry's main trade group has approved a
    voluntary code for its members that would curtail many types of
    entertainment and giveaways that salespeople use to win over doctors, people
    familiar with the matter said. The guidelines would prohibit sales reps from
    currying favor with doctors in "dine and dash" events in which doctors
    listen to a brief sales pitch while ordering meals to go, selecting gifts or
    even having gas pumped into their cars.
    Also prohibited would be token consulting arrangements that
    commonly disguise financial inducements to lure doctors to meetings.
    An entertainment arms race in the industry during the past few years
    has led to excesses that embarrassed some companies and caused sales budgets
    to balloon. The move to cut back on some of the most egregious behavior
    could save face for the industry and stave off regulation. It remains to be
    seen if the voluntary code will hold, though.
    The executive committee of the Pharmaceutical Research and
    Manufacturers of America approved the code unanimously at a meeting on
    Wednesday in Washington.
    Executives from a dozen industry heavyweights, including Pfizer
    Inc., GlaxoSmithKline PLC, and Bristol-Myers Squibb Co. sit on the
    committee. All those who voted for the code are expected to agree to adhere
    to it, people familiar with the talks said, as are other members of the
    trade group.
    The guidelines take effect July 1. Although no enforcement mechanisms
    are specified, participating companies are expected to be vigilant in
    monitoring their competitors who subscribe to the code.
    The guidelines spell out that drug reps' primary duty is to educate
    and inform doctors. The guidelines still permit "modest meals as judged by
    local standards." But to keep the focus on education, a spouse or other
    guests who aren't part of the medical practice won't be allowed to tag
    along.
    Entertainment for its own sake is out, a person familiar with the
    code said.
    There will be no more golf, movies, or shows paid for by sales reps.
    Gone also are the golf balls imprinted with drug logos.
    The staff in the doctor's office can still get free pizza from the
    sales person, as long as it is delivered with an in-person educational
    presentation. Just dropping off a meal is verboten, though.
    Giveaways to doctors that are linked to patient care must be valued
    at $100 or less. An anatomical model is acceptable by the code, but a VCR or
    CD player isn't. The ubiquitous pens and notepads flogging products are
    still permitted, but floral arrangements and tickets to sports events
    aren't.

    Copyright ? 2002 Dow Jones & Company, Inc.
    All Rights Reserved.
     
  7. Smoke This

    Smoke This Sweet cuppin' cakes!
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    Come on, no drug logo golf balls? I don't see how that could bias me any more than free pens and stuff.

    I say we boycott the pharmaceutical companies and prescribe only homeopathic remedies.
     
  8. migraineboy

    migraineboy Member
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    I don't know what you guys are talking about. I got this totally wicked Prozac pen the other day. Here's the best part...there's a laser pointer built into the end of it!!! All I do now is point, write, point, write, point...until I point it in my eye, which slows my ability to write.
     
  9. EidolonSix

    EidolonSix Member
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    Seems so strange to me that the public is working to prevent doctors from enjoying some of the perks of the profession while lobbyists in Washington D.C. and state capitols around the nation can wine and dine politicians with lavish meals and vacations for the sake of passing corporation friendly legislation.

    Oh the hypocrisy....I'm afraid it may never end....
     
  10. atsai3

    10+ Year Member

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    Lexchin J. What information do physicians receive from pharmaceutical representatives? Can Fam Phys 1997;43:941-945.

    Lexchin J. Interactions between physicians and the pharmaceutical industry: what does the literature say? CMAJ. 1993; 149:1401-7.

    Wazana, A. Physicians and the Pharmaceutical Industry: Is a gift ever just a gift? JAMA. 2000; 283, No 3.

    Chren MM, Landefeld CS. Physicians' behavior and their interaction with drug companies. JAMA. 1994;271:684-689.

    Orlowski JP and Wateska L. The effects of pharmaceutical firm enticements on physician prescribing patterns. Chest. 1992; 102:270-273.
     
  11. Fanconi

    Fanconi Senior Member
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    Yeah, I've got a friend who is a Pfizer rep. She told me this was coming a while back. I think that they'll still do meals at grand rounds, sponsor speakers, etc., but meals with spouses, golf outings, etc. are gonna stop as of July 1st.

    Two drug companies are not changing their wining and dining policies, however. Abbott and some other one that starts with an F. Or Ph? Can't remember the name.

    Anyway, is this really so awful? I think it's a step in the right direction. EVEN BETTER if they would knock off some of those stupid television commercials. If I see another patient demand Celebrex because they saw it on a commercial and ibuprofen isn't strong enough, I'm probably gonna freak out.
     
  12. PACmatthew

    PACmatthew Senior Member
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    Here is a fresh perspective from someone who has been in the trenches with these people for four years after PA grad school. I am generally the sacrificial lamb at our office so that we can get free lunch daily. The docs come in for about 3 minutes, just long enough to get their food. I stay for about 30 minutes and listen to the speeches and read the company sponsored studies and master visual aids. After doing this for so long, I can tell you that it is high time that we change the way these guys are allowed to market us. I admit, it was nice getting my annual free Christmas Tree, kid's pictures with Santa at the Christmas Tree Farm, trip to play golf in NC for the weekend, donations or our Christmas party, 2-3 three takeout dinners per week at the "Dine and Dash" (until they stopped these about a year ago), Wax and Dashes for my Truck (detailed,,,no pun intended), golf once weekly, and many more things. But, I am ready to stop enjoying these things (well I have to anyway because I am starting med school in August), because someone other than myself is paying for them. They are no more than leagalized bribes, and you cannot tell from looking at company literature whether the product is worth a damn or not. Any company can market a product to look good from certain angles where it may not be worth a flip. And reps are more and more discounting our personal experience with meds and our patients only to show us some study that says our personal experiences must be wrong! My wish for the industry would be that we only allow reps into our offices when they are accompanied by their competitors, that way we can hear the good and the bad from both all at the same time, and that would be quite entertaining as well. Get rid of half the drug reps, make their positions more useful, and get back to practicing medicine. By the way, if you think this is the end of perks, just wait about 3 years. It is purely cyclical.
     

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