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Observations on Pharmaceutical Company
(Your own doc's bribery)
January 2003 ~
(version 0.02, Jan 2003)
(slightly edited by fravia+)
With a small comment by vvf
A sound observation, from an insider, of common bribery practices. We are all so used to
them that we take them for granted. But we should not. It's our health and our kids' health
at stake. Obvious, yet underestimated.
Observations on Pharmaceutical Company selling practices.
You would expect your doctor to proscribe medication for
whatever ills you based solely on which product is
the most effective in treating your condition. You would expect
the choice of medications would be based on a
deep understanding of the drug involved, gained from years of
training and many hours of study. In fact, the
decision to prescribe one medication over the other is most often
based on an interaction that took (on average)
no more than three minutes (yes that's right, three minutes). What
I'm refering to here would be the three minutes
the doctor took between viewing patients to speak with the sales
representative from the company marketing the drug
After having spent two years supporting the field sales force
of one the world's largest pharmaco. company, you learn
a few things by osmosis. Like, for example, the average product
discussion between sales rep and MD lasts around three
minutes. You find out that sales reps often reward their top
prescribers (the doctors who are writing the most prescriptions
products that they're pushing) with invitations to "speaker
events" (Generally a brief lecture or slide presentation
followed by a free meal in one of the most prestigious restaurants
in the area, possibly followed by some form of
entertainment, show, etc.). You get an opportunity to peruse
certain "private" database entries, like the following:
"Dr enjoys basketball, make sure to get tickets to
next Lakers game". You end up meeting a cross-section
of the sales force at training events and doing on-site support,
and immediately notice that NONE of them are even the
slightest bit overweight, and the majority are female,
attractive, and between the ages of 22-28.
Buy ya a drink doc? OR legalized payola (see also late 80's music
Speaker events, industry conventions, lectures, clinical rounds,
forums, they all add up to the same thing: bribery.
Here's how it works: Joe sales rep (from now on we'll just call him
Joe) takes a look at his sales figures and notes
who's moving a lot of his product. He ALSO notes the individuals
who aren't doing so well, but are in a position to
write plenty of scrips (prescriptions for his product) and may
need a little friendly nudge. Joe confers with his manager
then begins the process of setting up an event and sending
invitations. The doctors all know that the top writers get a
free ticket to these events, and who doesn't like a night on the
town with someone else footing the bill?
A typical small event (local) would be held in
a reserved room in the most expensive restaurant available in the
area. It consists of a (very) brief lecture on a
particular disease or condition, and the effectiveness of product
X in treating it. This is followed by a free meal for
all of those who attended, and can be followed up by a trip to the
theatre, or a sporting event, or some other form of
social entertainment (yep, the pharmaco company foots the tab).
Cozy, isn't it? Reps have also been known to distribute
tickets to sporting events, concerts, etc to top prescribers as "a
friendly gesture". Larger events can include regional
conferences held at posh resort areas (guess who's paying?) and
vacation spots. In all of this, getting hard information
to the doctor in regards to the products efficacy is secondary to
Another cute ancillary benefit of a doctor's interaction with
sales reps would be samples. On any occasion that
you've been provided with a supply of a drug from the doctor's
office (as opposed to having to go get the prescription
filled immediately) what you've got is a product sample, and it
came from a sales rep. Reps call on doctors who
have more favorable prescribing habits (write more scrips for
their product) more frequently than doctors who dont,
the end result being the better writers have their sample cabinets
filled more frequently, and are able to give out
more free medication to their patients (and everyone gets a warm
fuzzy when the doctor gives out free drugs).
Reps make two kinds of calls on a doctor. Besides dropping off
samples of their products, they also make what is known as
product details. During a product detail the rep (who has
absolutely no medical background... most of these people are business majors)
will VERY briefly
discuss the efficacy of a given product, will normally
give the doctor some reading material on the subject (in the form
of pamphlets that, much like tv ads, are a masterwork
of social engineering and marketing acumen, have a look) that's heavy on
graphics and color, often presented like those ubiquitous and
useless powerpoint crap-slides), and almost worthless in regards to
concrete information on the product. In addition "promotional
items" are generally distributed. You've probably seen them.
The receptionist's coffee mug with Paxil on it, note pads, pens,
(one company even has microwave popcorn and lollipops
with drug logos printed on them) etc. The next time you go to your
doctor's office, take a close look at the pad he uses
to write your prescription on. Odds are, it'll have a pharmaco
company lable and drug promo on it (that way doc gets
the product message reinforced every single time he writes a
scrip). Everywhere you turn in a doctor's office you can
usually spot some little item or another that has some company's
logo and/or drug brand on it. All this crap functions
the same way as banner ads do on the internet. Reinforcing brand
recognition and subliminal programming through constant
Last but certainly not least would be the pharmaco's approach to
using sex to sell. As I mentioned before, the majority
of pharmaco representatives are female, (and I can attest that almost all
the ones I've seen where VERY attractive) and
ALL of them are generally in good shape, to say the least. They all have cutting edge
wardrobes, they're provided with stylish new cars to make calls
in, and all of them are carrying aprox $1700 - $2000 in hi-tech
gadgets at all times (laptop, cellphone, pda, etc). Why?
Simple: new cars and good clothes are a (THE) sign of success in
our conditioned countries and "success is sexy"... Hi-tech is sexy.
Beautiful young people fresh out of college and here to make
their mark on the world! Who wouldn't be enticed? You're
talking about people who look (and act, for the most part) like
they just stepped out of a GAP or Calvin Klein ad. I personally
know of at least two occasions where the company hired former
strippers to work as field sales reps, but that's a different
story. Believe me, this is only the tip of the iceberg.
You could spend years analyzing the tactics used in the various companies'
and/or the promotional materials alone. I haven't even MENTIONED the
echelons of doctors these companies have hired SOLELY for
the purpose of speaking with other doctors about various aspects
of their products. Why? To circumvent the laws regarding
discussion of "off label" uses of a product, among other things.
Laws that prohibit sales reps from giving information
to a doctor regarding the useage of a product that isn't what the
FDA approved it for. Sales reps can't talk about that
stuff, but no law says two doctors can't have a "discussion among
peers" regarding off-label useage. I also haven't mentioned
the doctors and executives on the payroll whose sole purpose is to
politic hospital and insurance formulary boards to insure
the company's product is allowed by the insurance company and
stocked by the hospital (this is a HUGE deal... unfortunately
too much outside the bounds of this little essay to go into in detail...
Suffice to say this is such a realm of backroom deals and
backscratching that would blow your mind).
In any event, put what I've told you to the test. The next time
you go to the doctor's office, ask to see the sample cabinet.
Ask your doctor if he allows sales reps into his office. Keep your
eyes peeled for promo items that have a drug company or
brand on them. You might also want to keep this in mind: last year,
in the United States,
the pharmaco industry as a whole spent well over 60
billion dollars, on advertising alone. And people wonder why
prescription medication is prohibitively expensive.
A comment by Vvf, 26/01/2003
Excellent essay, making one wish it were even more detailed.
Thanks to an insider friend in the advert business, I have
recently seen with my own eyes the docs of a promo campaign
for a pain killer drug, and I can confirm what Phaedrus described.
The campaign I've seen was aimed at drugstores and pharmacists
and didn't feel right at all, rather looking like "direct
marketing" to me. The pharmacists were basically told to
push the product in priority before any similar stuff, even
before generic and therefore much less expensive pills.
How do you sell some lousy aspirin clone for 5-10 times
the cost of the no frills kind? They did it using advertisements
targeted at women with children of a specific level of income,
conveying the idea that the kids "deserve" good care,
blah blah blah (subtext: the generic drug is ineffective
because it is cheap. If it were effective it would be like
our stuff: expensive. Choose health, choose life etc.).
The usual brain conditioning crap you well know.
That's one side of the campaign. The other side of the
campaign was targeted at pharmacists. Lots of brainwashing
for them too; a strategy in steps involving contact and
discussion, convincing the persons to buy as much of the
drug as possible. How? Little gifts. You got a present
depending on the quantity sold: a watch, a gold-tipped
pen, an invitation to a confertainment event...
If I remember well, there was also some kind of raffle
involved in the end. The sales reps (0% medical, 100%
marketing) also furnished the drugstores with promotional
items and displays, posters and the like. They also took
good care that the pharmacists learned their lesson well,
feeding them the exact words that they should say to any
prospective buyer. In the end (and forget _anything_ about
the extra cost) what you get is pharmacists that push the
drug of the highest bidder/druglord, impervious to any
concern that a drug might or might not be suited to a
specific individual. Sorry, but I can't trust them any
Hell, who am I to complain, after all it makes perfect
economic sense :-(
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