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How effective are physician-pharma interaction?
Very effective for the drugmakers
Based on the Congressional
testimony of Michael Wilkes, M.D., Ph.D. Vice Dean, Medical Education
Professor of Medicine and Public Health, University of California,
Davis in front of the Committee on Government Reform with respect to
safety of Vioxx.
| In chemistry class when we study chemical reactions the step, in a multistep
reaction, that limits the speed of the reaction is called the “rate-limiting step”. In
medicine, the rate-limiting step leading to increased drugs sales is the doctor who, after
all, writes the prescription. Pharma currently employs an army of 88,000 sales reps who
are on the front lines with doctors convincing them to write prescriptions for expensive
drugs, occasionally dangerous drugs, and often drugs that are far less effective than
alternatives. (Related article: Vioxx
was often overprescribed or prescribed to patients
who were unlikely to benefit) |
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There is one drug rep for every six physicians,
or thought of in economic terms, Pharma spends about
$9,000 per doctor per year. Perhaps more appropriate for
Congressional consideration is whether prescription drug costs would be substantially
lower if we did away with this costly promotion. Lower drug costs would almost
certainly translate in to more people getting the drugs they really need.
Drug reps (detailers) are usually gregarious, young, and attractive. And they are well
schooled in persuasion. Written manuals, videos, and simulation exercises are just a few
of the trench warfare tools used to teach detailers how to engage doctors in the field.
Detailers are usually found roaming hospital hallways or paying visits to doctors’ offices.
Dressed in their conservative business attire they almost always come with gifts including
free samples, flowers for the front office staff (who are crucial in helping to arrange for
the doctor to meet the rep), lunches, books, loads of pens, and invitations to dinners,
sporting events and trips. There are even examples of drug companies actually paying
doctors to prescribe their drug.
As a child, my mother told me I couldn’t buy anything advertised on TV. She explained
that if the product was really that good the manufacturer wouldn’t need to spend all that
money telling everyone how good it was. The same is true for drugs. Very few drugs
being advertised are any great shakes. In fact, most medical professors tell our students
to avoid prescribing any new drugs until its use can be tested and established in the real
world of medical practice as opposed to pharmaceutically sponsored drug studies.
Advertising is meant to sell drugs and the less effective the drug the more marketing it
takes to sell it.
Related articles:
How
to doctors come to know about new drugs?
Why
should drug promotion be different?
Vioxx
recall and direct to consumer advertising
Ethics
of marketing new drugs to doctors
Vioxx
and Celebrex advertising to blame for personal injuries
Direct
to consumer advertising unchanged despite Vioxx
controversy
Vioxx
patients misled by Merck advertising Relationship
of pharmaceutical companies and doctors
FDA
warns Pfizer on misleading Celebrex and Bextra ads
Responsibility
for Vioxx related deaths lies with doctors too
Celebrex
attorneys also use advertisements to seek plaintiffs
Impact
of drug promotions on doctors' prescription decisions
Impact
on prescription behavior due to marketing by pharma
companies
Overall
impact of drug promotion and advertising on pharma
industry |
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