How Many Reps Visit A Doctor’s Office Each Week?
53 CommentsBy Ed Silverman // March 11th, 2010 // 9:18 am
If you guessed 20, you win a free drug company tchotchka. A recent survey found that 98 percent of physicians reported that their offices received 20 or less visits each week by sales reps, while 37 percent reported only one visit per week. This would suggest that the industry push to roll back the onslaught of visits hasn’t taken hold, although the survey, which was conducted by SK&A, doesn’t offer a breakdown on the types of meds or reps involved (register here).
Here’s another interesting finding: 73.4 percent of physicians reported their offices granted access to reps in December 2008, and that rose to 77.1 percent in December 2009. In other words, the proportion of physician offices barring access fell, which would suggest a notable reversal. However, one datapoint is in keeping with collective industry assumptions - more appointments are being required. This rose from 38.5 percent of offices in late 2008 to 49.6 percent in late 2009.
Anonymous
Now let’s compare that number to the recorded calls by reps to that office. Betcha it’s a WAY BIGGER NUMBER :-)
pharmavet
It should also be noted that approximately 80% of rep visits do NOT involve face time with the doctor, but rather to drop off samples. In fact one Big Pharma company has eliminated personal detailing altogether and only does sample drops. I don’t know what the current numbers mean, but for sure the amount of face time that the rep has for “messaging” has declined precipitously over the past few years.
pharma girl
Ed- we haven’t been able to leave a “tchotchka” behind in over a year….guess that means they just want to see us : )
Justice in MI
Vet or others–Wonder what you’d make of this.
One doc I see always meets reps in the waiting room. Since not much talk happens in waiting rooms, their conversation is heard by all pts. who are there.
Of course, someone like me finds it fascinating. But also kind of obnoxious in several directions. The doc, btw, is someone very tied into industry, does a ton of trials, speakerships, etc.
What do you think this is about?
John
As you would probably guess, I don’t see interactions with industry as intrinsically corrupting. (If nothing else,someone had to do the Provenge trials, right?)
There are lots of ways to have conflicts of interest, the biggest one I saw in academia was not financial but rather the overly zealous pursuit of self-aggrandizement and careerism. These can be pursued well enough without any help from industry.
patrons99
JiM - sounds to me like you need to find a another doc. He sounds very conflicted. Bet he’s made a Faustian bargain with pharma. And no, I have never heard of any doc meeting with drug reps in the waiting room, within earshot of patients. That is absurd, appalling, abhorent…the COIs in such behavior are too numerous to count.
David, Health Blogger
What makes this so effective is that we all believe we are impartial.
We want to believe that the free coffee mug, pen or whatever doesn’t effect our judgment. Or that the 5 minutes spent talking to a well dressed, smiling representative doesn’t impact your judgment.
But it does. And big Pharma companies are well aware of how effective their tactics are; they keep track of the relevant data and award their most effective salespeople BMW cars or similar.
NYC Rep
David, please. While we are all aware of reps using IMS data to track physician prescribing habits, give me the name of one pharma company that awards their most effective salespeople with a BMW or similar.
Love to read your health blog, sounds like a fairy tale I could read to my kids at night.
John
David, I think you just proved your own point.
M Helm, MD
JiM,
As I have understood this, in victorian era homes owned by families of sufficient wealth and importance, there was invariably a “receiving room.” This was a small room into which visitors to the house were ushered upon arrival. Depending on the visitors relative importance and the purpose of the visit this may have been the only room into which the visitor would be received. The visitor’s time in this reception room was also likely in inverse proportion to their “importance.” Gaining entry to this room did not mean that the person you intended to visit would actually see you (whether or not they were home).
French royalty (or at least the last set of kings) employed a similar system well before the victorian era. At Versailles and other palaces, there were a series of “Salons” in which and through which those wishing to approach the king were obliged to wait and (with great luck) progress.
Perhaps, meeting the drug rep in the waiting room is a sign of the level of esteem that the doctor has for the rep. Maybe there are some who are allowed greater access. Perhaps the concern is for patient confidentiality, or interuption of the back-office flow. (Though it seems to me that the doctor coming out to the waiting room is plenty disruptive.) Maybe it is a bit of narcissism.
Everyone would probably be more comfortable if the office just required the rep to schedule a time for a visit - preferrably when there were no patients to be seen.
Anonymous
As a rep I have seen car company car upgrades to top performers but not quite at the BMW level…
JaT
LOL! I’d love if my doc saw reps in the waiting room, though I may not be able to keep from asking how many updates, in relation to sNDAs, they have been trained on.
Heck, I might go so far as to schedule appointments based on their visits.
Do you know what’s in that crap this month?
:D
It’s better than worshiping the pamplet shrine while my appointment is delayed.
John
Given that physicians are under no obligation to see drug reps, I can only interpret the statistics quoted in this article as meaning one of the following:
1) That nearly 80% of physicians find what drug reps have to say useful (or as pointed out by pharmavet, that they at least value the free samples of currently promoted products).
or
2) Physicians place so little value on their time that they are willing to meet with reps just to get nice pens and coffee cups.
I really hope its number 2. I have an appointment next Wednesday, and I’m going to try to use some of my extra coffee mugs to cover my insurance co-pay.
Justice in MI
Re: the waiting room, I love Doc Helm’s historical analogies. Bien fait!
There does seem to be a quality that is both demeaning (to the rep) and, yes, narcissistic for the doc. Both would be consistent with other patterns. In any event, the samples closets are always full. Going to that office is trick or treating as a kid.
The only reason I do is because of a particular piece of equipment–doc just gets paid by insurance every time a pt. uses it. I would not, and do not, rely on him as a physician.
pharmavet
The rep mentality is interesting. One of the nice thing about anonymous boards is that it gives one the opportunity to role play and see what kind of response you get. Therefore, one day, as a spoof, I posed as a rep who developed a sophisticated spreadsheet listing all of my offices, their personnel and their personal meal preferences for my catering visits. At the beginning of each month I e-mailed the sheet to each office manager, who in turn entered each persons favorite menu item. The sheets were then to be e-mailed back to me. Menu changes could be easily made electronically, so that if someone switched from French’s to Grey Poupon Mustard on their sandwich, for example, that could be easily handled. On the morning of my visit, I printed out the sheet and faxed it to the restaurant where I later picked up the order. I even said that I was working with a software developer to have password-protected software installed in my doctors’ computers with hyperlinks to the restaurants’ menus so that the whole ordering and billing process could be done electronically.
Again, this was a complete spoof, but I got a number of responses from reps who were interested in how they could get their companies to license my “software” once it hit the market.
Hence the mindset of the 2010 pharma rep. If you are further interested in rep spoofing, look up the video series entitled “Charles Charles, The Rep”. Here’e the link:
http://www.myspace.com/confarta
Doc
Not for a number of years, but Bristol-Myers had several years where reps and managers could win a BMW or Lexus for 3 years as their co car. Based on sales numbers.
Sean
How many patients benefit from the free samples usually left during these visits? Especially the Med D population. Visits done effectively, properly and ethically can create a win-win situatuion. For all the finger pointing on both sides, the drug company - physician relationship is more of a sibling relationship than either would like to admit.
Former Pharma Marketing Director
The bad news is that some doctors are so “busy” that they do not get time to search out their own information and rely on reps to deliver it all nicely packaged to them. The other bad news is that the information is always skewed in favor of the drug the rep is pushing. So, a doctor has to see all the reps from all the companies and read through all the data and hopefully somewhere in between find the truth. But even this might be too much work for some doctors.
The other obvious reason why doctors see reps, other than to get free samples, is that the rep is the first line of access to get into the organization and get noticed as a potential good speaker, influencer, key opinion leader, what ever the popular lingo is for it these days.
What I find disturbing about doctors complaining that they do not have enough time to research the information they need to stay on top of things is that they would if they were:
1.) traveling less on company sponsored trips
2.) seeing less reps
Isn’t getting paid really well for the work you do bonus enough?
The money that pharma uses for these enticements comes from the health care premiums and taxes collected from all of us.
Drug reps should have a B.Sc. as a minimum and report directly to the medical department. Their salary and bonuses should not be tied to drug sales. It should be tied to the amount of information they provide to doctors.
Marketing departments should be completely disbanded and replaced with business strategy and research. They should be completely separated from the medical department. The medical department should have the final say on issues directly related to the use and sales of the drug and or device.
And yes, I am aware that reps in some companies were offered the use of luxury cars for a year as part of the incentive plan….
patrons99
Sean -
I respectfully disagree. It’s the physician who took the oath, a promise to do no harm, not the drug company. I don’t see “free” drug samples as win-win, either. Nor do I think it is wise for physicians to have ANY “relationship” whatsoever with drug companies.
I don’t believe drug reps should ever make it past the front door. I know that sounds harsh. But how many patients died as a result, at least in part, of “free” samples of Vioxx, just casually left (promoted) by the drug reps? This is just one example. There are hundreds of similar examples.
The big drug and insurance companies have no business meddling in the doctor-patient relationship. There has been a steady erosion of trust. This, in substantial measure, is what’s wrong with medicine and with healthcare today.
harpy
I think it’s instructive to look at pharma company rules on their employees receiving gifts.
NoBama
As a physician I can tell you that a visit with a rep is pretty much a waste of time. It does not matter how good the product is; if the insurance won’t cover it I won’t prescribe it. Healthcare, my friends, is an industry being choked to death by a combination of insurance companies plus government regulations.
Tripod
NoBama,
Healthcare, in its current form, NEEDS TO BE choked to death.
Whistler
AMEN!!!!!!!
Finally, NOBama makes sense. All this other BS about Reps and Docs doesn’t make any difference if the Physicians cannot take care of their Patients properly!
Insurance Companies, Government Regulations, Pharmaceutical Companies, etcetcetc. Should Not be involved in the decisions that the physicians have been hired to do.
It always amazes me how the insurance companies, government bs, pharma, med companies think they should be able to run my life. Only in healthcare does this happen.
My friends go golfing, dinners, conventions, etcetcetc. with their clients and nobody says a thing.Only in Pharma! In fact it is part of doing business. They’re in chemical sales, aviation, food, automotive ,etc. All run by the government and they continually make decisions about our life’s that only cost us more money and cause us problems.
Insurance Companies and Government needs to stay out of our lives!
I’m sure there are going to be those who are going to reply “Well if you don’t have insurance/govt you can’t live” My reply can’t be posted here!
Lisa Van Syckel
NoBama,
I thought all Physicians were in favor of Obamacare.
Former Pharma Marketing Director
NoBama, I am for Obama and health care reform and government needs to get more involved in health care otherwise health care because a private for profit business that only the wealthy can afford. Which, wait a minute, yup, is pretty much what we have now and it stinks…
So, Pharma and insurance should get out of the business of getting between the doctor and the patient. The doctor should make only clinical decisions on how best to treat/care for the patients and should not be induced by incentives, bonuses or other schemes to exploit the vulnerability of the patient.
If this wasn’t such a serious matter I would laugh and your remarks about how government should get out of helping to secure the safety of the public. If there was no government involved were would we all be?
Free an open access to health care is the only way to go. Treated should never be delivered base don cost and finance considerations.
Lisa, NoBama can’t be a real physician….
pharmavet
If I were advising a prospective medical student today, I would advise him/her to do plastic surgery, because:
1) reconstructive plastic surgery rates are highly reimburseable.
2) cosmetic plastic surgery patients pay up front.
3) there is a never-ending supply of vanity in this country.
4) plastic surgeons in my state average $650,000/year pre-tax.
JaT
I think doctors are being fed so much garbage that they don’t stand a chance. And pharma wants you to think that they have a disadvantage online-
but then explain this from Pharmacist’s Letter:
RUMOR: The new Dilantin 100 mg capsules aren’t the same as the original Dilantin Kapseals.
TRUTH: Pfizer stopped making the original Dilantin Kapseals 100 mg when they updated their manufacturing process. The ingredients inside the new capsules are exactly the same…just the capsule shell has changed. read entire truth…
http://www.pharmacistsletter.com/(S(pqownmqv2pszsb55iwkfvy55))/pl/Rumor.aspx?li=1&st=1
(if the link doesn’t work Google pharmacy/ rumor v truth/ Dilantin)
This is the sort of thing that contributed to consumers to losing long term relationships with their doctors and allowed those consumers to continue to be put in danger.
(consternation and non-compliance?)
Then ask yourselves where Pharmacist’s Letter got that information.
Then ask yourselves why that site’s incorrect information still remains- despite the change in AUC.
Then ask yourselves how a doctor or pharmacists is supposed to know better.
JaT
This is not so easy to explain:
FDA/CDER is determined to set “markers” for safety, which sounds a lot like setting “minimum standards” (QbD style). They have to change existing products to test and accomplish that.
I think we’d be better to insist that drug makers not change their product quality so that doctors and pharmacists know precisely what they are dispensing. So that previous FDA approved applications and labeling don’t become inadequate. And so, if drug makers alter products, they alone are accountable. Because, despite all of the evidence in the world, no suits will be brought if FDA is involved in those changes. And if FDA is involved in those changes then government suggested “Best Practices” are not neccessarily going to provide consumers with the best quality treatments.
Think about lobbyists and major manufacturers moving to Branded Generics. What hospital won’t go with a major brand over the product of a smaller company- even in using a generic?
_________________________
Look at it like this- If FDA is requesting and setting the markers then we already have FDA preemption.
Pfizer told me that FDA made them do it. No suit and no attention from DoJ.
_________________________
In my experience with Dilantin, FDA is not insisting that generics move closer to the innovator, but rather, is allowing the innovator to move toward generic criteria. And seriously, anyone willing to pay for a branded product after this is throwing money out the window.
Major manufacturers must know this. It would go a long way toward explaining their partnerships with (and accuisitions of) generic drug companies. Are they even claiming that their branded products are superior anymore? Instead they appear to be rolling with the changes and cornering the new market.
So is “setting markers” to the benefit of the consumer or the drug companies? Because, frankly, I don’t want my medications to be of the minimal quality acceptable by FDA.
Doc
Reps are seen almost exclusively for free samples
Free samples are for the patent protected newer drugs that cost many times more than numnerous alternatives
Reps have a biased presentation
Mds lose money for the time they soend with reps
Reps can offer nothing that is not in the PI, you need medical for out of label questions
Reps are poorly trained beyond their marketing message, very shallow understanding of concommitant disease states and complicated patient profiles
Reps offer little true value
Reps increase the cost of drugs
But reps play on human nature, emotion and psychology. Millions of dollars and thousands of hours are spent on tewaking every word, phrase and statement to increase sales, not to benefit patients.
This method of “selling docs” is doomed. MDs will eventually wake up and realize they and their patients are being gamed, more than they realize.
Codes R not us.
Another side of this question: “How many reps of the SAME bigpharma co visit SAME doctors per month? Earlier I written about the MSFoMP (Multiple Sales Forces of Mass Promotion), your friendly bigpharma Cos’ equivalece to WMD’s.You know, the several sales forces they have in each and every territory across USA and Canada*.At least they had them for good part of decade but now they are reducing the numbers.AstraZeneca after the merger had 10 sales reps in every territory.Pfizer about 8, Novartis 6 and so on. These are GP reps who do the real mass promotion of their key drugs. Viagra and Lipitor were promoted by at least 6 reps. Diovan by Novartis by 6 reps. What that means every rep whenever calls on doc must push the promoted drug. On top of this, they are asked to see top quality docs (some cos call them super targets) 20-30 times per year. That is all six of them. Do the math.The individual territories were small sometines only 150-200GPs per rep.Of course this is one of the main reasons many docs stopped seeing reps, so they drop off samples, fake visits etc. etc.The pharma sales job used to be a really good one and even had good dose of dignity and prestige. Not any more. The only good thing about it still is good pay for what you do. Will it last for long. Maybe but numbers will come down dramatically. Some 35 years ago, the famous and really excellent co from Swissland Sandoz, had a one day think-tank where the question re need for sales reps was discussed. They concluded that eventually the need will diminish or completely end.Perhaps we are entering that territory after all these years.
Question: How many drug reps it takes to sell one/same drug to the same doctor?
Answer: As many as the drug Co can afford and manage.
pharmavet
Doc, I tell you what sells among your peers. I recently attended a focus group of surgeons to get their take on a new pre-op sedative hypnotic. The last question was: what would compel you to listen to a 15 minute detail on this product versus a competitor? Somewhat sheepishly, the doctors agreed that the prettiest rep was likely to have the advantage over the other candidates.
I guess that some of your brethren see alternative value in the art of the detail rep.
Jack Friday
To answer your question Ed - too many!
Just say “no free lunch”!
http://www.nofreelunch-uk.org/
http://www.nofreelunch.org/aboutus.htm
http://www.nograziepagoio.it/
And for those addicted to sexy drug reps - it can be hard to say “no”!
http://www.timemastermd.com/?p=173
John
96,000 US deaths per year due to medical errors by MDs and those under their direct supervision. 12,000 of these due to unnecessary procedures.
Autopsy based studies show that deaths due to medical malpractice are commonly attributed to other causes on death certificates.
99,000 US deaths per year due to hospital acquired infections. A recently published review of hospital sanitation procedures concluded that fewer than 50% of medical doctors consistently wash their hands between hospitalized patients.
Venture capitalists will not fund new medical technology that potentially reduces physician income. Pharma companies avoid developing oral drugs that will compete with existing drugs that oncologists get reimbursed for infusing. History has shown that such products rarely achieve market acceptance.
The median salary of an orthopedic surgeon in the US is $460,000.
Yup, all we need to do to fix the US healthcare system is get rid of the pharma reps.
patrons99
John - “Yup, all we need to do to fix the US healthcare system is get rid of the pharma reps.”
You are wrong. Pharma reps are just a microcosm of far greater problems. “Get[ting] rid of the pharma reps” is the very LEAST that we can do to fix this mess. It’s much more than just the pharma reps. The biopharma reps have become VERY aggressive of late, in pushing their toxic cocktails.
Here’s an interesting intellectual exercise: simply juxtapose three recent articles side by side: Jack Friday’s link [highly recommended] to the article “Bikini Babes Bringing the Goods to the Doctor’s Office”, next to the vactruth article of March 1, 2010, by Paul Watson titled “Bill Gates: Use Vaccines to Lower Population”, next to the article of March 11, 2010, by Robert F. Kennedy, Jr. titled _Central Figure in CDC Vaccine Cover-Up Absconds With $2M_
http://www.huffingtonpost.com/robert-f-kennedy-jr/central-figure-in-cdc-vac_b_494303.html
http://www.timemastermd.com/?p=173
http://vactruth.com/2010/03/02/bill-gates-use-vaccines-to-lower-population/
What’s the common thread, you might ask. Greed. The pharma/biopharma cartel is using every page in their playbook, including appealing to both our personal financial and sexual appetites.
AdMan
Sex, and good looks, sell…that’s true in virtually all sales jobs, restaurants, airlines, etc.. Almost certainly, the human condition.
So, rather than bemoan it, maybe you can recruit some hotties (no gender intended) for counter-detailing.
patrons99
AdMan - your complacency borders on complicity. You seem to accept no responsibility for your actions. Pharma reps have “crossed the line”. They must accept some personal responsibility for all of the hospitalizations and deaths related to the waves of dangerous drugs (and biologicals) in the marketplace.
pharmavet
Patrons, I say this somewhat facetiously, but if a woman (and I know some) spent $50,000 on breast implants, cheekbone implants, Botox, Restylane, collagen lip injections, ankle liposuction and a Brazilian butt lift in order to become a drug rep, that she shouldn’t be entitled to an ROI in terms of promotions and bonuses? It’s all about face time with the docs, and it’s sadly true that the “Barbies” are edging out the older male reps in my generation, despite their greater knowledge of science and medicine.
John
Patrons, I see three types of criticism of pharma on this thread. 1) criticisms that have some validity. 2) those that are true but overblown. 3) those that are based on completely unsound premises, such as the idea that it is possible to design a drug that is completely safe.
I put the criticism that pharma is “greedy” in the second category. My response is “greedy compared to what?”. MD’s pulling down half a million a year? Buying a new car when the same amount of money given to UNICEF could provide several thousand children with clean drinking water? I find the criticism overblown because few of the folks on this board score higher than the people they are criticising on this measure, especially when seen through the eyes of a third world mom.
Pharma Reserach
The average physician spends 8 hours online per week engaged in medical information and less than 2.5 hours with reps each week. They don’t have the time even if they wanted to as PCPs need to see a patient every 8 minutes.
Large practices are more likely to block physician access as they see them as interruptions in practice oprations and more physicians are becoming employees/contractors as the economics of small practices becomes increasingly more challenging. More physicians “punch the clock,” more retiring creating a physician shortage. Add increasing patients loads (ObamaCare) and the drug rep will become a relic like the travel agent, the bookseller, record store owner, the stock broker, etc.
patrons99
Vet- also somewhat facetiously, thank you for your assurance that you “know some” women, presumably augmented pharma reps. I’m also quite impressed as to your detailed knowledge of their cosmetic procedures. I’m sure this topic must have just come up as casual talk between “professionals”. Surely there were no “strings attached” to their samples.
John - you seem to be justifying one wrong by simply citing other wrongs. I generally support philanthropy, when it’s well intended and not driven an ulterior motive. Once in a rare while, well intended philanthropy can have a very detrimental effect, e.g. the third world.
pharmavet
Pharma Research, you are so right about today’s physicians “punching the clock”. My dad is a semi-retired surgeon. When he was a surgical resident, it was pretty much standard procedure to be on call every other night. Even at that, his boss said that when you’re “only” on call every other night, you still miss 50% of the pathology coming through the door. He had to get special permission to take an extra day off to get married, and was still expected to be back on the wards by 5:30 AM Monday morning to start rounds.
When he was in active practice, his average work week ran 75-80 hours, seven days/week. He didn’t want to take time away from his office patients to talk with the drug rep; therefore he saw all reps between 5-6PM, by appointment only. Not only that, but HE bought coffee for the reps (not the other way around), because the reps in those days usually provided good information. One of the reps knew that he was an amateur photographer, so the only thing of “value” that he received in his 40 year career was a Hasselblad camera as thanks for about 50 hours of lectures on behalf of the company. Believe me, he easily outspent that much buying coffee for the reps over the years.
Most of today’s clock punching doctors I wouldn’t let cut my toe nails. But that’s the world we live in.
orphandrugrep
I agree that most physicians don’t need to hear a message about a drug that has been around for a decade or longer. For newer drugs that treat rare conditions about which OUR doctors know very little, it is extremely importnat to get some face time. In most cases I educate, in many cases I help the office find the source of a patient’s problems. I wish the phsyicians I call on knew as much about the disease that my drug treats as they think they do. Bottom line, fewer reps is better but we still need some. Finally, having been in this industry for over a decade it is truley scary how it works (or doesn’t work. Everyone - the best thing you can do is your own homework. The doc doesn’t have time to do the research and most of the staff don’t care.
John
Patrons, I think “defending” is too strong a word. To make myself better understood, I’ll offer the following analogy.
You are sitting in a public park, and there are a bunch of teenagers nearby, drinking beer. For the last three hours they have been gossiping mercilessly about a classmate who smokes cigarettes, and going on endlessly about how disgusting they think this behavior is. The smoking and drinking are both bad, but after a while you may begin to find the self righteousness of the drinkers and their transparent need to have someone to feel morally superior to more irritating than either the drinking or the smoking.
Obviously it would not be fair to apply this to everyone here. But I think there is an awful lot of it. And I do genuinely believe that the average American’s indifference to the plight of those who did not have the wisdom and foresight to be born here is a much bigger moral issue than “its nice to give money to charity”.
patrons99
Yes, John, we do agree that this is not a USA-centric problem. Technology transfer to the third world as philanthropic initiatives is fraught with risks, particularly when the so-called innovations that we try to transfer cause more harm than good. For example, vaccines have never been proven to be either safe or effective. As another example, indiscriminate use of antibiotics appears to have caused more multi-drug resistant infections than ever before in history.
Former Pharma Marketing Director
Orphan drug rep, you’ve got it right. After so many years in Pharma marketing that was exactly my conclusion.
Caveat Emptor - patients are led like lambs to the slaughter in many cases. Doctors who do their own research and are innovative leaders are few and far between.
Do you homework, the only one who really cares whether you ever recover is you.
pharmavet
Orphandrugrep, I’ll stipulate that you probably know more than the doctor about the one or two rare disease states that you have boned up on compared to the vast storehouse of medical knowledge that the doctor has to carry around in his head. How do you answer the non-medical questions which are foremost, i.e., why are your company’s drugs so expensive? Why does my patient have to practically declare bankruptcy before being eligible for payment assistance? Why, for example, has the cost of Cerezyme increased from $180,000/year to $300,000/year despite improvements in manufacturing efficiency.
The doctor doesn’t need your expertise to find the medical information he needs. I think that four years of med school, four years of residency and two years of fellowship have equipped him on how to use a medical library or do a medline search. The questions I have posed above are those that he/she is more likely to be interested in.
JaT
“I help the office find the source of a patient’s problems.”
Egads!
Trust your patients. No one knows better what they are experiencing and no one will do more research than those looking out for their own welfare. This relationship is a partnership. Doctors are advisors long before they are healers. Whether or not your advice is taken depends on trust. Condecension is a huge mistake. One that drug companies make regularly.
M Helm, MD
Pharmavet and Orphandrugrep,
As a physician, I see danger in doctors treating conditions about which they know less than the drug rep. I do not believe that it is a service to train primary care doctors on how to prescribe anti-TNF drugs (just for example) or other specialty/orphan drugs. There are many medications/ treatments which should be left to the specialists. (For the anti-TNF drugs, it is not entirely clear that these offer a significant benefit over “standard treatments” in rheumatoid arthritis. As usual, adherence to treatment is more likely a greater factor in outcomes than the actual choice of treatment. Nevertheless, it seems that anti-TNF treatment is being positioned - in the US anyway - as the first-line treatment.)
As a pediatrician, I may understand the indications, value and mechanics of a ventricular-peroteneal shunt, but I’m an idiot if think I can put one in. Similarly, if a newborn screen indicates an inborn error of metabolism, I make the appropriate referral. I know the folks to whom I refer these patients have a greater understanding of the disease and treatments than I. I’m also confident that they know more than the drug reps. I also accept that the patient families affected by a few specific, rare conditions will likely know more than I do about it, even if I have read everything I can find. In other words, I hope that both of you are wrong about the MD knowing less than the rep. I would advise any patient being treated by such an MD to find a smarter doctor.
I was taught that there are key concepts to practicing good medicine. Among others, these include to: 1) know what you know you know, and know where to find (or - not as good - who to ask for) the answer when you don’t know, 2) remember that half of what we think we know about medicine today is utterly wrong, 3)never be afraid to say “I don’t know,” but whenever possible follow this with “But I will find out.”
I agree that pharmavet’s question about the cost of Cerezyme would be an appropriate question for a drug rep, but if the doc needs a pathophysiology/molecular biology lecture, they’ve got no business trying to treat. Another possibly appropriate question for the drug rep in this situation might be “who treats this condition more in this area than anyone else?” Though even that answer will likely be skewed if there is more than one treatment for a condition.
JaT
That I cannot spell has nothing to do with my ability to participate in my own care.
;-)
condescention
By the way- It seems that there used to be this little form which patients had to fill out and sign before their cases were discussed with an outside party. Avoiding a name and speaking in generalities is not enough. The reason being that it is not in the best interest of the patient for a drug company to have someone’s records to try to dispute a problem with a product. Electronic records are going to be a huge problem in this area. As it is- FDA cherry picks info out of reports- reducing the complexities of a situation.
We really need our doctors to protect our information. And it is their information too, as everything they have done may be equally scrutinized.
doc
The average doctor knows 100x what the average rep knows. Even for their own drugs, reps knowledge is generally shallow and marketing message oriented. If you ask them about concomitant medical issues that complicate the use of their drug, most are lost.
Suzanne
M Helm MD wrote,
“As a physician, I see danger in doctors treating conditions about which they know less than the drug rep. I do not believe that it is a service to train primary care doctors on how to prescribe anti-TNF drugs (just for example) or other specialty/orphan drugs. There are many medications/ treatments which should be left to the specialists. (For the anti-TNF drugs, it is not entirely clear that these offer a significant benefit over “standard treatments” in rheumatoid arthritis. As usual, adherence to treatment is more likely a greater factor in outcomes than the actual choice of treatment. Nevertheless, it seems that anti-TNF treatment is being positioned - in the US anyway - as the first-line treatment.)”
Wow. I have been puzzled all week over the “Arthritis” patient/caregiver educational material piled on all the tables in our ped’s waiting room. It seemed so out of place, I took one so I could identify the source later.
They might not be training the peds to rx the drugs, but parents who have them recommended by a specialist will ask the advice of their ped or other physicians. As a parent who has been told, “I would not give this to my child”, I can see ped rheums wanting/needing peds to be on board.
M Helm, MD
Suzanne,
“They might not be training the peds to rx the drugs, but parents who have them recommended by a specialist will ask the advice of their ped or other physicians. As a parent who has been told, “I would not give this to my child”, I can see ped rheums wanting/needing peds to be on board.”
I think you are correct that kids with rheumatologic conditions need their PCPs to be on board with the rheumatologist. I have exactly two pediatric rheumatologist who I trust - they are also the only two PEDIARIC rheumatologists for several hundred miles (fortunately, they travel to satellite clinics).
I know that if one of ‘my’ rheumatologists has prescribed an anti-TNF drug, they believe this child has severe/aggressive enough disease to warrant the use of these medicines. That is because I know how conservative these two are. If the child is treated by an adult rheumatologist, MY reaction is more likely to be “why don’t we get a second opinion?”
Another principle from medical school (and life) is that “a little knowledge is a dangerous thing.” Pharmaceutical marketing (and sales) is geared to deliver just enough information to make doctors (staff and patients) FEEL that they have sufficient understanding to confidently prescribe medicines.
The newer medicines in particular (ie the ones subject to the most promotional push) are generally not well-studied enough to justify the degree of confidence placed in them. This also applies to new indications (such as for pediatric patients)for older, but still “on patent” medications. FDA approval doesn’t generally mean that you can stop worrying about individual risk-benefit factors, and which of several choices should be the first-line approach. Nevertheless, the presence of educational pamplets for arthiritis treatments in your pediatrician’s office is evidence of a marketing push to make anti-TNF agents a “first-line” choice even in pediatrics.
The marketing problem of “confidence,” and the “little knowledge” issue, in my opinion, are the reasons there are still (and likely always to be) drug reps. There is too profit potential which would be lost if drug adoption was dictated by clinical experience and good science.
no name
I work in a doctors office, one rep that comes in is very, very pushy. She works for a Home Health Care agency. She has done everything to get patients referred to her. She has offered services to the doctor including being his nurse at the hospital to oversee patients there, overseeing his staff in the office to see what we are and aren’t doing, doing his health fairs, she has asked me several times to go in to the system so she can look at our patients charts to see who she can take on as a home health case to make the doctor extra money. I told her no, I am too busy right now to help you. I know that this violates hippa rules, she is not an employee there and why is she being so overly nice to this doctor? Is she offering services like this to other offices? What can I do to make her stop? Should I call her supervisor or boss to let them know what she is doing?