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Observations on Pharmaceutical Company selling practices
(Your own doc's bribery)

by Phaedrus, 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 in question.
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 for the 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 industry scandal)

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 entertainment.

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 exposure.

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' websites 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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