I share the posters’ here frustration with reps who go off-label (we are dealing with that in my class of drugs, and it is an instance where going off-label could literally be fatal for patients). I think there is a huge difference between saying an SSRI that works for GAD and panic will probably also work for “social phobia” (whatever that is) versus telling a doc to use a drug first-line that the FDA regulates closely and insists must only be used as a last resort.

I also share the frustration with reps who while they may stay on label, just regurgitate the same message over and over, like a Bud commercial (actually, they are not as entertaining as a beer commercial). When we sold Zoloft, we would get apoplectic because we were using approved clinicals (that at least attempt to be scientific) and our competition simply bombarded offices with reps and having no clinicals to speak of, just gave the same 30-second blurb over and over. (They also were not members of PhRMA and gave give baskets, etc.)

Ultimately, I agree with Monyonyo–we need fewer, better educated reps, probably concentrated on the specialties. I think that is happening now–I would not be surprised to see radical changes in the way companies approach primary care in the very near future.

The biased perception study produced makes a good attempt to neutralize the arguments of late. Intelligent people out there can see through the smoke screen.

The bottom line is the reps “filter” the information just as much as the published studies and the “rigged” CME events.

There’s been so much in the news lately about massaged trial data and misinterpretations. We are all to blame, we all want one block buster after another. Everybody wants to “fast track” the earnings and get just as rich as the other guy.

Anyway, my experience is Docs speak to reps more about drug access issues. Smart docs go straight to the medical affairs directors for information on drug to drug interactions, side effects problems and SE management and in my opinion that is the way it should be. H C all due respect, there are very few sales reps with PhD’s..

In my observation from being a pharma rep for the past 23 years, the physician’s who take time to listen to reps, read journel articles, and attend CME programs are usually the most well informed and caring physician. One that comes to mind is an internal medicine physician from North Carolina that absolutely enjoyed bantering back and forth with pharma reps. His office door was usually open and he delighted in “grilling the reps” across from his desk. He was thirsty when it came to knowledge, reading journel articles that were piled high in every corner of his office. He frequented the internet on his lap top or palm held. In other words he used every source of information that was available to him and was always curious about EVERYTHING that had anything to do with the possibility of helping his patients. Pharma reps would reccommend him to their friends who were looking for a good caring physician that would spend time with them. I selected him as my personal physician as most reps did.

It’s the physician’s that close the door to reps or any other source that are not well informed enough to come up with sound clinical decisions. I know that type well after years in this industry. They refuse to see any representatives, they hate the invention of the computer and they think they know it all. You hear patients complain about the lack of sympathy or the lack of time this “dollar chaser” takes.

I do admit that the pharma industry has misbehaved over the past 15 years or so. I believe that there are too many reps in numbers and too many that have no business being in health care. However, this source should not become extinct….the pharma companies just need to reduce the size of their forces, be more careful in selecting the people who represent the products and get back to the premise of DETAILING and NOT SELLING.
Companies owe it to the public to deliver the good, the bad and the ugly of these compounds.

We mail information to physicians now, Ginger. They throw it away. Important information, like rare side effects that show up only after you have a million prescriptions. And the PI is a vast wealth of information that physicians don’t read.

In the past two days, I have had three physicians ask me questions to which they couldn’t get the answers on the internet, in the literature or from other physicians. Specifically, how to get past a costly co-pay problem. I fielded a dosing question from a doc who admitted he didn’t know the dosing of my drug or any of its competitors (they all involve paperwork and my nurse does that), a physician who wanted to know about pharmacokinetics (that would be in the PI, BTW), pregnancy and my drug and the current state of the pregnancy registries for the whole class of drugs (oh, that was information I had because I attended an all-day Saturday seminar, where I DIDN’T see this doctor)…I could go on an on.

This bizarre adulation of physicians, that somehow they are more moral, more curious and more diligent than normal folks (and therefore don’t need reps), combined with the polar opposite view that somehow they are gullible idiots who will believe anything as long as it comes from a rep, just makes my head explode.

A good physician gets information from a variety of sources, including reps, measures it against his clinical experience (hello? who could claim they didn’t know Zyprexa causes weight gain??), and prescribes the best medication for the patient–taking in formulary considerations and patient preference. I believe that a physician who asserts that he believed a rep about the absence of a side effect or the unbelievable efficacy of a drug (i.e., weight gain and Zyprexa) simply is retrospectively trying to get himself off the hook for making what he thought at the time was the best presribing decision.

I’ll take a doc who sees reps over a no-see doc anytime. The best docs I know (and I know A LOT of them) get as much information as they can from as many sources as possible. They may not see reps during clinic, but they make time before, after or at lunch. The most hard-core anti-pharma, no-see offices I have are the patient mills, busy running patients through triple-booked and giving 4-5 minutes of the docs’ precious time to the patient. They don’t see reps because they don’t let anything interfere with the billing factory–including the patients’ needs.

1.) In light of the massive off-label fines paid in recent years and the fact that there are several hundred such cases still under investigation, what better way to try and neutralize the arguement that legions of sales reps promoting off-label have any effect on MD prescribing habits.

2.) The companies need to cut the number of reps, 100,000 is about 2-3X what is actually needed to do the job effectively.

Now as we move forward in time it will be interesting to watch the ‘no effect’ argument used in future off-label cases.

However, to the points made above - if reps have little to no effect, it is a foolish strategy to pay them $100K+ per year (with all benefits).

As the wise one said, “Watch what they DO, not what they say”.