NY Governor To Limit Pharma Influence Over Docs
44 CommentsBy Ed Silverman // January 25th, 2010 // 1:00 pm
New York Governor David Paterson is proposing new rules that would restrict drugmakers from giving gifts and certain product info to doctors, the Associated Press reports. “This will benefit patient care and reduce costs in the Medicaid program, as more expensive drugs will not be prescribed for the wrong reasons,” Paterson said, according to the AP.
Under his proposal, drugmakers that violate the law would be fined between $15,000 and $250,000 per violation, and health care professionals would be fined between $5,000 and $10,000 per violation. The state Department of Health would be responsible for enforcement, but would rely on complaints to identify violators. The Paterson administration estimates the change will generate little money for the state through cutting the spending on prescription drugs, but argues it’s important for New Yorkers to know they are being prescribed meds for the right reasons, the AP writes.
“Cracking down on the gifts that the drug industry gives to doctors could lead to more independent prescribing by physicians,” said Bill Ferris, a lobbyist for AARP, tells the AP. “Doctors are constantly being solicited to prescribe high-cost brand name drugs when equally effective less expensive drugs may be available.”
The Paterson administration estimates the change will generate little money for the state through cutting the spending on drugs, but argues it’s important for New Yorkers to know they are being prescribed meds for the right reasons. Drugmakers argue Paterson’s measures go beyond the current voluntary code by interfering with the relationships between doctors and experts who act as consultants for the companies.
“This proposal calls for unneeded government intrusion into a competitive private marketplace that is already working well,” Jan Faiks, a PhRMA vp, tells the AP, adding the move is unnecessary because the industry already has a voluntary code of conduct. tion’s Division of Drug Marketing, Advertising and Communications already regulates their marketing practices
“That code is voluntary, not all of the companies have adopted the code and there are no enforcement standards,” Lisa Ullman, assistant counsel to the governor, counters, adding that Paterson’s plan makes mandatory most of the things already included in the voluntary guidelines and creates new oversight.
M. Black
It sends a message, but can’t see how this will make a noticeable difference. If reports of $250k fines become a trend, again, it will send a message, but that’s chump change for pharma. Execs will cackle in laughter as they send fine money.
And what if the generic alternative IS NOT the equivalent of the brand name drug, which is purportedly prescribed because sales reps (oh, I’m sorry… “expert consultants”) give hand outs, etc? These reps may have no clue or understanding about the regulations re: generic efficacy, potency, etc., but that tub of Drug X pens for the office staff and patients used to market the product may be actually causing doctors to prescribe the more effective drug which may ultimately benefit the patient.
Information about the pharmacology of brand and generics must be accurately provided to patients. Then let them decide: You will pay less for this generic, but it may be 15% - 20% less potent and / or effective than the brand name.
And if that patient is living out of a large cardboard box, the generic will be acceptable. If they have good insurance, they’ll take the brand. Also, there may be four companies that make a generic of one brand name drug. What are the differences from a pharmacology perspective?
And really, not to knock sales reps, but until pharma puts more scientists in suits or pretty dresses, please don’t insult the public with that “expert consultant” BS. Cheerleaders in suits, do not experts in pharmacology make.
Lisa Van Syckel
Pushing the envelope just before an electon,.. How Unique.
Tito Santana
If enforcement depends upon complaints to identify violators, exactly who is expected to complain? It’s a self serving system.
Tito
Josh
M. Black….actually a brand name drug can also be +/- 25% for content uniformity, and typically about ~5% for assay….not just generic.
M. Black
I know Josh. I was being conservative. There are some who read these posts who flame the numbers. For certain conditions, a sudden 20% drop in medication when switching from brand to generic could be lethal.
You are correct. 20% + or - 5%.
And Content Uniformity tests aren’t worth a squirrels turd in the spring when the data is churned by an unvalidated version of Excel, and in blissful happiness signed off for release.
M. Black
Brand name drugs are also audited more rigorously than generic.
Josh
You may be missing the point. The “sudden 20% drop in medication” can happen in brand drugs as well as it is within QC range.
If data is not put out by a validated system (whether it be Excel or a chromatography system), then the data has to be hand calculated in our company…not sure how it is done elsewhere.
As an auditor for both brand and generic drugs….we honestly don’t treat any one drug higher than another. Typically audits are done by “systems” (same way FDA does it) and not by individual drugs. Not sure about clinicals as I don’t handle that section of our company.
M. Black
Josh,
Gee, you’re absolutely correct.
Did I mention there is a new generic for a commonly prescribed ADHD product?
Case in point.
M. Black
Doc
Day late, dollar short.
Robert
It’s disgusting that big pharma has any influence over doctors. The idea that money is dictating care is unthinkable.
Natalie @ Avail
Great thread! Lots of great opinions!
Natalie
M. Black
Josh,
Purely brainstorming… Studies show that in most instances generic alternatives prove to be noticeably less effective / potent then its brand analog.
We both apparently have auditing experience. (Trust me, I do). From one auditor to another, and in genuinely wanting to know the reason why, what reason or reasons could you think of that attributes to brand name drugs being noticeably more potent than its brand?
I know of at least one company in the past who made lucrative business deals with the brand manufacturer to purchase the actual finished brand name product from the original manufacturer. Great idea, except for the fact that they knowingly purchased product from an apparently overproduced stockpile of expired product. They just put a fresh coat of paint on the pills, packaged, and sent them to market with their own new expiration date. That’s one instance I know of for certain. Do you have any other explainations from your end? Of course, CU and assay testing alone doesn’t always account for end-user potency (You could use that term, Ed). Dissolution rate plays a key role. Impurities another (both individual and total). Then there’s identity by TLC and HPLC. If it’s an XR product, there’s efficacy of release rates. Then some marginal characteristics such as residual solvents, and any other detritus that may or may not be attributed to the cleanroom (or “dirty room” if it falls in the “cosmetic” category - which is a whole other can of worms in itsef).
The world of drug manufacture and testing just got a bit larger.
As for data, if it’s done by hand, your calculators should be validated if used. No, I’m not kidding. If that’s the case, a second person must sign for the accuracy of the calculation upon completion.
Or just buy a prevalidated 21 CFR Part 11 compliant out of the box software, and no worries.
Your thoughts?
JaT
M. Black,
“Brand name drugs are also audited more rigorously than generic.” ?
By who?
______________________
“However, the criteria Pfizer used was not requested by the FDA to show bioequivalence and was different from the FDA criteria, according to an FDA spokeswoman. She adds that the FDA was unable to review the study protocols before Pfizer proceeded and the agency doesn’t know why Pfizer chose different acceptance criteria. Nonetheless, the agency did approve the new Dilantin.”
http://www.pharmalot.com/2008/05/a-new-version-of-dilantin-is-giving-pfizer-fits/
_________________________
“Brand-name drugs are subject to the same bioequivalence tests as generics upon reformulation.”
http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/AbbreviatedNewDrugApplicationANDAGenerics/default.htm
I don’t know how to shorten that link. Sorry.
__________________________
In late 2007:
“There is a need within the regulatory community and the pharmaceutical industry for case studies that put these principles into action and test these approaches.
Research Approach: This research project has focused on pilot-scale manufacturing of Dilantin capsules as a CRADA with Pfizer.”
http://www.fda.gov/AboutFDA/CentersOffices/CDER/ucm142591.htm
And using that same CDER link from 2007:
“Pharmaceutical product quality is very sensitive to small changes in the concentration or properties of magnesium stearate. Recently a major manufacturer of magnesium stearate has switched the starting raw material for the magnesium stearate synthesis from a bovine-based material to materials of vegetable origin. This will mean that most manufacturers will have to substitute the bovine sourced magnesium stearate with that of the vegetable source.”
MM
Obviously Gov. Paterson wants people to think he is taking an aggresive step in healthcare. Jan Fieks is absolutely correct in her comments about PhRMA Guidelines. It would serve Peterson well to read these guidelines before making his “BOLD” move. As a pharmaceutical sales representative, I no longer am allowed to even give a pen to a doctor, let alone spend $1000’s of on them. All the major pharmaceutical companies adhere to these guidelines already. Hardly an original move.
Brett Nafziger
What most people don’t realize is the pharma industry began policing itself vigorously about two years ago. Companies are no longer allowed to even hand out a promotional ink pen let alone anything of value.
I’m not saying these new rules followed by 98% of pharma and 100% of big pharma are a bad thing. The public is still under the perception that pharma is showering doctors with gifts and it’s just not the case.
The Kid
It’s funny how fast the politicians are ready to police an industry and the doctors who wouldn’t exist without it (many of them). But when is the disclosure going to come into their realm. How many politicians are ready to have the monies they receive from special interest and lobbyist revealed to the public. Better yet when are they going to close the door on the people buying their influence…….hypocrites. It should always be the doctors decision what to write not a half wit in Albany.
M. Black
By you JaT. By you.
M. Black
M. Black
<>
You infer that this is a minor change and the system is so robust as to not allow such a minute change without a big to-do.
Au contraire, mon frere. A “simple” change as you suggest could render a product “non-kosher” (literally), and could prevent distribution to a significant part of the world.
Think global. Achtung!!!
M. Black
BMF
Ummmm….if the governor wants to ensure that drug spending is cut on Medicaid, why don’t they just create a formulary that leaves off expensive brand name meds? They should be doing that by now anyway…no reason people with government health care should be getting better meds than some people on private plans.
Josh
M. Black,
A lot of things affect how well the drug actually works when comparing brand vs. generic. The ingredients that generics will use differ a lot of times in fillers, binders, lubes, etc., as does the manufacturer of the API. The manufacturing process (bin blending, fluid bed, etc.) can also add to differences. Differences in people’s own chemistry can also change that effectiveness. The same can be said for brand though…one ACE may not work for someone as well as another. All these reasons are why a lot of generics companies work for years on brand formulations. Sometimes the generic actually works better, like in the case of one of our controlled release drugs that is in formulation (our numbers look way better for clinical efficacy and during assay, CU, and disso). A good generics company will also run bigger clinicals than are what is standard in an ANDA.
Sounds like you worked in the 80’s during the generics scandal. I have yet to hear of a company in recent years that has tried this.
As far as calculations…you don’t have to validate your calculator if you buy a NIST certified one… And most companies do buy out of the box for Part 11 software, takes a whole lot less time getting it out on the floor.
Robert
Another clown. Another uneducated politician thinking that giving a doctor a pen or a pad will make him/her to write a presecription. Wow.
tom lesterson
You have got to be kidding me, especially you Mr. Black. The drug industry has been handcuffed for the last several years. There haven’t been ANY gifts, pens, pads, for over a year now. You know, you are all hypocrites!! You say, monitor the drug companies, cut the high priced drugs yet if any one of you gets cancer….are you really going to take a generic..or are you going to want the latest and best treatment. Also, these physicians have had more education then anyone on this board, spent more money getting there, and spend more money on insurance to protect themselves from idiots like you! Do you seriously think, people with this kind of training would throw it all away for a pen??!! You should be ashamed of yourselves. Why don’t we do something about insurance companies and the need for better reimbursement….why…I will tell you why, because we can’t. But we sure can take away the pens….how embarrassing!!
M. Black
I’m flattered Josh. Not quite that old, but I truly care, and “find things out” by any means necessary. These hands have been in piles of mulch. I’ve audited and / or overseen at least 10 manufacturing processes and have consent decree experience.
This post is about what the hell to do about either putting non scientists through military style scientific training such that the top 25% of those actually get those sales jobs. My friends are MD’s. My doctors and I talk about this stuff. When I meet my buddies in Manhattan for a drink on a Saturday night, they spend half their time mocking the he’ll out of drug reps. I almost feel bad, but they are right. Now, device reps (for knee / hip replacements, etc) are very well respected and are often in that mix. These guys are NEEDED by surgeons in the OR. If every sample and pen toting drug rep got sucked into the pit of the earth, the doctors will surely (and easily) find a way to do their jobs just as well. Some may do it better because they’d not have a scapegoat / life raft in a pinch…
The same way you can’t be a patent attorney without a science degree or a mind numbing exam that rivals the BAR itself, this same philosophy should apply to drug reps. The minds that are coming into their own and that will be the ones influencing the profession certainly don’t have any respect whatsoever for sales reps. I’m sure some are brilliant, scientific, and do some homework on the side because they truly care and are interested, but business types just see that promise of an early retirement, which does the medical profession a grave injustice.
It’s not going to be like this forever.
M. Black
NYC Rep
Typical political grandstanding by Paterson in an attempt to swing voters. We have not given out “freebies” in over two years, dinner programs have ended and financial payments to doctors and institutions have been listed on-line by the major pharma companies.
If the governor and politicians really wanted to control health-care spending they should examine Medicaid / Medicare fraud, which is absolutely rampant in NYC. I love to see patients pull up in their BMWs and Benzs and give the receptionists a government sponsored medical benefit card.
Seth
Politicians in the past have said that Physicians, not insurance “bean counters” should make decisions. Now Politicians are all for formulary when it comes to Medicare & Medicaid. Maybe the insurance companies aren’t so evil after all?
You can eliminate every drug rep and it won’t drop the price of drugs by a nickle. All it’s doing is eliminating good jobs.
I am all for generics, but there are appropriate places for some drugs that haven’t went generic yet. When they do, no problem with the generic version of them.
Pharma has drastically cut spending on research. Keep beating pharma down though.
Also a rep
I am so sick of the double standards by the anti-pharma folks
They are the first to line up for a life changing/saving medicine when THEY or their family are in need, but if anyone else needs a new medicine to save someone….well that same med is a luxury medicine.
These so called luxury meds saved MY LIFE in a cancer battle. My wife, my 2 children and I owe this industry everything. Would you want your family member to fight cancer with a 30 year old chemo or would you want the one with better results and tolerability? Yeah, I thought so..
Pharma, medicinal research and investment in this process SAVES AND IMPROVES LIVES. Period
NYC Rep
Funny thing is I’ve been around long enough to recognize that our industry AND our customers created the current situation we’re in. But anti-pharma folks you’d be amazed at the greed of some “doctors” who have no shame in laying out exactly what it will take to prescribe a medication. The press would have you believe that kick-backs and pay for scripts is a one way street with pharma driving…absolutely untrue. Just as with some pharma companies who bend the rules, there are plenty of docs who do the same thing. Let’s see the major media outlets run a story on that.
M. Black
Easy Tommy Testosterone,
If every rep does what you say you do, then I suppose marketing “swag” would never be distributed. If you are so naieve to think that you speak for the world, then I truly am sorry for you. My own doctors still get this stuff, such as the simple marketing pen. They get so much, they leave 8 of them out by their sign in sheets in hopes of patients signing in, and forgetting to put it back. Reps leave free samples which are desired by doctors. Reps leave those “get your first prescription free ‘credit cards’ “. But don’t blow smoke up this heiny telling me that your hands are tied, unless they are tied with imaginary rope. If your hands were tied (really tied, not this voluntary moral understood ABSOLUTE BS you guys are puffing your chests out over), then the actions by the governor would not have needed to add oversight and enforcement.
Let me ask you something Tommy Tutone, what happens when you give a stack of ‘get your first prescription free (get all after that for the rest of your life because now you’re addicted)’ cards to doctors? What happens if you were to leave some marketing swag for the staff and patients? What are the CONSEQUENCES for you? Are the strings that tie your hands made of barbed wire? If they are, then you bleed voluntarily. My doctors still get this stuff, which should not be central to this issue in the big picture.
I recommend an SSRI.
M. (not Mr.) Black
M. Black
“Also a rep”,
When my mother was diagnosed with cancer over a decade ago, she was given a product that hadn’t been proven yet. 9 months later she became a statistic.
A very dead, cold statistic.
Cry me a river.
M. Black
harpy
I’m happy to see that fines against doctors are being proposed. Why should industry have all the fun?
And, if it’s just giving the PhRMA Code some teeth, that Code you’ve been diligently following for years (nope, wait, went into effect 01/09), what the hell are you bitchin’ about? Follow the industry standard, toe the line, and you’ll have no problems. Easy-peasy.
And be thankful you’re not in Massachusetts or Vermont. And pray the Sunshine reforms don’t go through. ‘cos then you’ll really be crying.
RA
NYS has no money. Huge budget deficit caused by trying to run a welfare state. Welfare states cannot work, as there is too little people in the workforce and too many on the dole. If you want to restrict medicaid costs simply restrict the formulary. NY has had open medicaid formulary up until about 2 years ago. Yet still so many BS line extention products still remain on formulary. I guess Patterson doesnt want to limit choice for Medicaid recipients because they represent too much of a voting block. News flash blindy, your not getting re-elected anyway. And there is no way I am willing to pay higher taxes for any of this shit.
M. Black
There is no room in pharma to let rats voluntarily guard the cheese.
Yes, insurance needs to be addressed too.
Undoubtedly, the doctors know exactly what they are doing, and do not prescribe drugs because of pens. A patient may subconsciously be swayed to “ask” (i.e. “demand”) a product because of any of a variety of product swag. That’s it’s intent. Doctors do however have their own retirement portfolios.
Doctors can have their own agendas by prescribing products biased toward a select two or three firms in which they are heavily invested. They will not prescribe anything that will harm their patient, but may overlook a couple of viable treatment options to keep the karma flowing into certain firms. And if the patient asks to change treatment, then it’s changed.
This issue is bigger than marketing swag. I’d like to see some debate on reps leaving “get your first month free and your second and third month at a $25 discount” for products such as SSRI’s that are widely known to cause physical withdrawal symptoms when treatment is discontinued. If they couldn’t afford the first three months, they sure as hell will find a way to afford it after taking it for a chunk of time, else they feel as if electricity is running through their brains and vomiting. That’s borderline criminal in my book. It’s like a heroin dealer giving out some product for free knowing their clientele will be back after feeling like crap when they run out.
Not good practice. Absolutely piss poor practice.
Oh yeah, but your hands are tied. You’ve got to be kidding me and ashamed at YOURSELVES if you feel they are. Perhaps a side effect of relatively moot limitations (you can keep your damn pens) are replaced by these neat little ‘credit cards’ that viably is sinister in nature, and ultimately has negative physical effects while ensuring future purchases via “encouraged addiction”.
This needs further looking into and discussion because some posting here have their heads up a place not intended for heads to be.
M. Black
M. Black
Perhaps “facilitated addiction” is a more accurate terminology.
also a rep
Hey Black
First, sorry about your mom.
But last time I checked there isn’t a road map to curing cancer, only trial and error.
The medicine that saved my life was in (very expensive) trials 10 years ago. I am sorry that the people trying to develop an effective chemo for your mothers carcinoma were unsuccessful. I truly am.
However
Maybe if you were told you have 6-9 months to live and pharma is working this new approach to treating your disease you might get your head out of your butt long enough to say “sure…worth a shot”
If I follow your (deeply flawed) logic we should stop trying to cure disease, eat generic medicine, throw our hands in the air in defeat and look on at our dead relatives as “statistics”.
I would love to cry you a river if it would bring morons like you far out to sea.
M. Black
Hi Also,
Thanks.
I have no idea how your read on my “logic” inferred:
1) We should throw our hands in the air and stop trying to cure disease.
2) We should eat generics
3) We should all look at our dead relatives as statistics.
First off, your ignorance is blinding. The incident brought up about my mother was done so to illustrate a case study that nullifies your apparently strong opinion that we should believe what we hear without perhaps informing ourselves better with regard to new treatments with the promise that they will do what we are told they will do. You’re a jackass for assuming she was given 6-9 months. She was given at worst 2-3 years. In this case, believing what the doctor provided (which was provided to him by “expert consultant” idiot cheerleaders in business suits like yourself) may have done more harm than good. He was a bit off in her life expectancy with the data that (let’s assume YOU, since you reps are all generic, irrelevant, replaceable cogs) convinced my doctor of. Good job!
If I’m a moron, then I have no idea what that would make you.
M. Black
Mark
You’re welcome
I hope to someday sell the chemo that cures idiocy …I will talk to your doctor on that very day and get you started right away.
I should make enough to by another new suit with your commission alone
By the way…
You’re still a moron
M. Black
You want a solution? This country is in shambles. SOS. In distress.
You want a new regime? Enough of this bullshit.
At min a 50% ELIMINATION of way overpaid travelling drug reps. The UPS solution goes into effect.
Take all that money and put it back into research.
Sales reps out of jobs could go sell something else. Most of them have no business communicating information that they do not have the background or proper training to communicate.
Wait a year or two, then initiate Phase II. Another 50% across the board Elimination of travelling drug reps. Samples, etc, sent by UPS, infusing the shipping business with income.
And so on. Only reps that have solid scientific knowledge are left, mostly coordinate shipping efforts internally, and on an as needed basis, and/or for special curcumstances, deploy these “Jedi” reps to actually provide info when it’s needed. I mean when it’s REALLY needed.
That’s all. Don’t like it? Waaaaaaaaaah.
You’re looking at ground zero.
M. Black
M. Black
Mark,
By the way, you’re still just another arrogant cheerleader in a business suit. Must be fulfilling.
M. Black
M. Black
Will you “by” me a suit too?
Moron.
M. Black
And Gov Patterson is a weiner. If you vote for him, you’re a weiner too.
This post has been exhausted.
A new regime will be lobbied.
M. Black
microbio
M. Black,
You, obviously, have way too much time on your hands. Maybe you should dedicate some of it to learning PIs and clinical studies for branded products in and out, back and forth. Perhaps undertaking the intense, ongoing training pharmaceutical representatives endure in a highly scrutinized industry would provide you a different perspective. You have very strong opinions which classify a group of professionals into one bucket. Other than the data you’ve provided on generic drug manufacturing, your comments are opinions, not facts, based on your mislead, ignorant arrogance. I hope, for your sake, you never need any of our branded or investigational products - and if you do, I would expect you to deny their use inturn drowning in your ignorance. Cheers!
M. Black
What? You’re going to “by” me a new suit too?
M. Black
http://www.youtube.com/watch?v=sqy2CMDl7U0&feature=youtube_gdata
Since dissecting the crap you just spewed and providing references from this post alone showing that just about everything you said except “I have a lot of time on my hands” is riddled with holes, and since you waited way too long to get in on this discussion, and since your only contribution was an attempt to undermine my posts, I refer you to the above video.
I frankly am not all that interested in PI’s nor clinicals, bur was required to learn about them as part of my Pharma Management Graduate Program. I’m a certified auditor on the manufacturing, QA, and QC side. I’ve said far more than your nose in the air conviction that almost everything I said was arrogant opinion. I’m still waiting for the answer to my simple question, being, what would be the consequences for leaving a Flomax pen at a providers office.
You got in way too late my friend to just blanket attack everything in a neat little text box. And if I didn’t have time on my hands, I wouldn’t be dignifying your post with this one.
Show up next time. Earlier. This post has been beaten like a dead horse. And I put reps into a large generic bunch for a reason. An informed reason, with enough empirical observation to justify my “opinion”. Of course there are exceptions. However, funds are being wasted on your salaries and commissions. The pool of reps across the board should be distilled down to the best and brightest 20% of you, and the monies saved put back into research. The UPS solution will fill the gap. My friends are MD’s (again, if you joined earlier or actually read my posts you would see. I trust their experiences as well as the experiences and judgements of their colleagues as true. They have no motive to lie. I’ve known at least one for nearly 30 years.
Jump over to the Quality or Manufacturing side, mate. Come over and perform a full Computer System Validation one day, and find out exactly where mold contamination is coming from the next. If all you’ve done in your life is “sales”, you’d be either shredded alive or crying within 6 months to a year if you think that the training reps get is anywhere near as rigorous. You assume I don’t know how reps are trained. That makes you an ass.
I’m finished with this post. Watch the video. It will really give you some insight as to what I mean.
M. Black
SAM
M Black I know you deemed this post “finished”, but I just wanted to chime in..
pharma rep here (with a solid scientific education) my friends are MD’s too, and so is my brother and so is my husband.
60% of my customers openly admit to “splitting the business” between the product I sell and the other 2 competitive products in the same class. Their reasons are that “we really like all 3 of you (reps) and we know you are all trying to make a living”, “we want to be fair”. And man, are they good at splitting it three ways. Almost to the script. They have systems in place to rotate meds evenly. Though when asked which drug they would choose for a family member, there is often a clear first choice. The medications are coke and pepsi, but the delivery systems are like night and day-one is much easier, less pain, more compliance, though similar cost.
Not all reps are evil as M Black makes us out to be. And not all docs are saints. I am trying to focus on getting the drug I sell to the patient that can benefit from it and no other patient. It sickens me that being likable is all that I sometimes need to be.
Regarding the product and disease state training, well, that used to be quite rigorous. That has gone to the wayside and all that is provided is just enough to make reps dangerous! Some of us do more on our own, seek the training of non-company sponsored physicians etc.
Finally, M Black, if you’ve never done “sales” in your life or put up with the nonsensical bs from physicians, pharmacy directors etc. and the bs fed from upper level sales managers and their managers’ expectations, then you should attempt it. You might not be shredded alive or crying within 6 months, but you surely will have a new perspective.