“Confessions of a Former Drug Rep”

Shahram Ahari, former Eli Lilly drug “detailer,” shared the tricks of the trade on NECN this week (two parts):

Shahram, who now travels the country testifying to legislatures considering measures to regulate pharmaceutical marketing and speaking to doctors and medical students, provided an insider view to the manipulative tactics that drug companies use to sell their products.

According to Ahari, drug reps are hired based on good looks and congeniality – no science background required. They are then encouraged to exploit sexual tension and to ply docs with gifts to foster a friendship and sense of reciprocity. Dr. Dale Magee, President of the Massachusetts Medical Society, echoed Ahari’s concerns over the industry’s sales practices – and gift-giving in particular:

Recognizing the cost and quality implications of these practices, Senate President Murray has taken these concerns head-on. Her cost control legislation, released this month, would prohibit pharmaceutical companies from giving gifts to doctors and would create an educational outreach program to provide doctors with an unbiased source of information about drugs. The Massachusetts Prescription Reform Coalition strongly supports this legislation.

In related news, a University of Chicago study found that consumers who get free drug samples actually face higher drug costs. On the heels of another study that found that samples rarely go to the uninsured and low-income, this once again raises the question of whether samples are charity or just another marketing ploy. What do you think?
Lisa Kaplan Howe

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3 Responses to “Confessions of a Former Drug Rep”

  1. Dan says:

    Are Drug Reps Really Necessary?

    One of the main functions of pharmaceutical representatives is to provide free samples to doctor’s offices presently instead of authentic persuasion, and these samples in themselves cost billions to the pharmaceutical industry. Yet arguably, samples are the most influential tool in influencing the prescribing habit of a health care provider. Let me be clear on that point: Its samples, not a representative, who may be the top influencer of prescribing habits.

    Yet considering that drug promotion cost overall is approaching 20 billion a year, combined with about 5 billion spent on drug reps themselves, what if there is another way for doctors to get free drug samples, which is what they desire for their patients to initiate various treatment regimens? What if prescribers could with great elation avoid drug reps entirely?

    There is, actually, a way to do this, but it is limited. With some select, smaller pharma companies, doctors have the ability to order samples by printing order forms on line for certain medications through certain web sites associated with the manufacturers of these samples. Some examples are such medications that can be ordered in this way are keflex, extendryl, and allerx. Possibly several more can or are available to prescribers in this way. Others, however, cannot be acquired by this method.

    So in some situations, a doctor can go on line, print off a sample order form, fax it into a designated fax number after completion of the form, and the samples are shipped directly to the doctor’s office with some products thanks to their manufacturers who provide this avenue. There is no review of the doctor’s prescribing habits. No embellishments from reps actually sounds pretty good.

    Usually, this system is available for those smaller companies with very small sales forces to compensate for what may be vacant territories, but can be applied to any pharmaceutical company who, upon discretion, could implement such a system.
    Now, why is this not done more often?

    Apparently, it is legal to obtain samples in this manner. If samples are the number one influencer of prescribing habits, why spend all the money on reps to deliver samples personally? It’s worth exploring, possibly, since the drug rep profession has evolved into those who become UPS in a nice suit.

    Think of the money that could be saved if more pharma companies offered samples to doctors in this manner. Furthermore, additional benefits with this ideal system are that there is no interruption of the doctor’s practice. And again, there is no risk of bias presented to the doctor by a rep, as they would avoid contact with reps if they order samples through this way- to have the samples directly to be shipped to their office.

    When samples are shipped to doctors’ offices in this manner, prescribing information of the particular med is included with the samples shipped. Doctors can order and utilize samples according to their discretion, and would be free of interference from the marketing elements of pharmaceutical corporations. Patients benefit when this occurs.

    Considering the high costs associated with the pharmaceutical industry, having samples shipped directly to doctor’s offices should be utilized more than it is presently- regardless of the size of the pharmaceutical company.
    Something to think about as one ponders cost savings regarding this issue.

    “The new source of power is not money in the hands of a few but information in the hands of many.”
    —- John Naisbitt

    Dan Abshear

  2. Samples aren’t intended to be charity care, or sources of free medicines to the poor or uninsured. Rather, that is the point of the industry’s patient assistance programs – which are specifically designed to ensure a steady supply of medicines for chronic conditions to these patients. Although these programs are not perfect, they have both greatly improved and expanded in recent years. When I was a volunteer doctor at a free clinic in Washington DC in the early 1990s, the medicine room (i.e. dispensary) was loaded up with big bottles of generics, and generally disorganized shelves of samples – so finding the best medicines for the patients was often a challenge, and starting someone on samples for chronic condition represented a gamble that there would be more samples when they came back to refill their medicines. However, by the late 1990s, those shelves of samples, had been replaced by much larger shelves of medicines (labeled for individual patients) that were supplied by patient assistance programs.

    Compared to samples, patient assistance programs are much better since physicians can run out of samples, and then the low-income uninsured patients face either paying for the medicine or switching to another medicine – either a generic or something that their physician does have samples of. Therefore assessing the value of samples by how many go to low-income or uninsured patients is misleading.

    It should also be recognized that the other financial crunch which can occur for insured patients is if they find that their deductible or co-payment presents a real hardship. (Or in the case of Medicare Part D plans, the donut hole which is mid-benefit deductible before they reach catastrophic coverage.) Addressing these financial challenges for insured patients won’t be solved by samples either (and because of anti-kickback laws can’t be solved with patient assistance programs), but rather needs to be confronted as part of the problem of the structure of the US health insurance system – and its financing which is often regressive.

  3. Mandatory Health Insurance is a tax says:

    Let’s not forget how ethical Senate President Therese Murray is.

    http://www.boston.com/news/local/articles/2007/12/30/law_put_candidate_atop_fire_dept_list/?page=1

    How much will this law that fast tracked thru 2 committees and the senate back in September cost the taxpayers over time?

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