Friday, March 6, 2009

Sales Tactics in the Drug Industry: Plus Ca Change

Not a week goes by without news of the growing concern -- among consumer advocates, medical students and Congressional watchdogs -- about the financial conflicts of interest that bind doctors to the pharmaceutical industry and may bias their judgment about new drugs. Several drug companies, hoping to forestall federal legislation, have announced their intention of disclosing these conflicts of interest -- which take the form of lucrative personal payments to prominent doctors and researchers (key opinion leaders or KOLs in the industry vernacular) who are in a position to influence other doctors.

But within the industry itself, status quo reigns.

One need only glance at the flyer for an upcoming conference targeting the industry's army of salesmen and women. Dubbed "the premier event in pharma sales," the May sales force effectiveness summit in Princeton, New Jersey, features several seminars on how sales agents can improve their access to physicians and "connect directly" with them, in order to promote new products. Five "key opinion leader physicians" will be on hand to lead one seminar (highlighted in bright yellow) and instruct attendees on what works the best with their busy medical colleagues. (I'm sure these KOLs are being paid handsomely to attend; I'm equally sure that KOLs who are currently under Congressional investigation such as Charles Nemeroff, Martin Keller and Alan Schatzberg will probably not be in attendance, but I could be wrong).

Attendees can also learn how to maximize the use of software to sort through doctors' prescribing practices to determine which doctors to hit on and how best to capitalize on all this lovely data for sales. In the conference organizers' own words: "Enhance your [sales] reps' interpretation of patient-level data to ensure increased success with physicians." Why do I have the feeling that patient privacy is not going to be high on the agenda here?

In sum, the two-day conference boasts a virtual smorgasbord of tips for getting close to doctors in order to maximize drug sales. The price of entry may be a bit steep -- fees range from $1,795 to $2,895 depending on whether you buy a platinum, gold or just a silver pass -- but don't worry: if you're a hard-hitting pharmaceutical sales rep, your company will no doubt pick up the tab.

Hat tip to Marilyn Mann for spotting this brochure and sending it my way.


Dan said...

A Brief Manifesto Offered For Drug Reps.

The word, ‘Manifesto’ is one of Latin origin, and means ‘to make public’. It’s an open statement of standards related to good behavior based on principles.
What will follow are not in any way intended to be absolute directives or rules you should adopt in order to be successful. Nor am I, as a veteran ex-big pharmaceutical representative, suggesting the contents are an outline of what is an ideal pharmaceutical representative.
So, these are some simple, yet possibly preferred, ideas I wish to offer to those who are pharmaceutical representatives regarding the nature of their vocation, and the image of your industry as it exists today that needs to be improved:
Never park your free company car closest to the entrance of a doctor’s office or clinic. Obviously, both places treat sick people- some worse than others. Aim for the back of the parking lot. Exercise is good for you. Others need that ideal parking space more than you do. Show some consideration.
Upon entering a medical location, such as a doctor’s office, if you happen to notice more than one pharmaceutical representative sitting in what may be a small waiting room, leave immediately and return at another time. Don’t be so insistent or persistent that you disrupt those in that waiting room who need to see the doctor much more than you do.
Conversely, a similar suggestion is that if you enter a waiting room of a doctor’s clinic, and there are no other drug representatives, and only a few patients waiting to be seen by the health care provider, consider striking up a conversation with one of these patients as you both wait to see the health care provider. This rarely if ever happens- drug reps having a nice conversation with a patient in such a manner. You know, they are not Lepers, and you might provide some public relations for the industry that employs you.
Make an effort not to become vexed if you are unable to see one of your targeted prescribers that you desperately feel a need to speak with, or else you will view yourself to be a complete failure at your vocation.
More importantly, if such a health care provider accepts your promoted drug samples from you without you interacting with them, this in itself will influence their prescribing habits more than you may realize. So I suggest you visit such offices, regardless if you see the prescriber or not. You still will or may have a positive effect on what you feel you need to do with your job.
However, if you have an opportunity to be invited into the medical office to ‘check samples’, which means an opportunity to speak with the health care provider, make an effort to read the environment in this patient treatment area you are a guest in at this time.
For example, are staff members in this patient treatment area moving quickly? Do they appear overwhelmed? Are you not receiving any eye contact or dialogue from such staff members? Does the health care provider seem less than jovial? If so, don’t discuss any business issues at such times. The doctor and his or her staff have more concerning issues than your presence there, and certainly more concerning than any needs you feel you may have. Likely, you will visit this same location again and again.
As you continue with your career, strive to learn as much as you can about not only the benefits of the medications you promote, but also the disease states for which they treat. You are, or should be, viewed as somewhat of an expert with both.
So many others in your profession are a bit apathetic regarding any interest with medical issues, and the importance of restoring the health of others. Quite frankly, if you have no interest in the importance and complexities involved with medicine or health care, you should consider another job.
Keep in mind the ‘detail pieces’ and clinical trials your employer gives you to persuade prescribers contain data that is largely embellished, incomplete, or completely fabricated. Find sources of information on the drugs you promote from legitimate sources you can easily find on the internet. You should do this not only from a paradigm of credibility, but for the benefits of patients who may be prescribed your promoted drugs as well.
Furthermore, and as with so many other pharmaceutical representatives, I’ve read those aggressive and clearly subjective commentaries if not essays from other pharmaceutical representatives on the ever so popular Cafepharma website- that great bathroom wall where others express their anger in the written word. I know your concerns as a pharmaceutical representative, as well as the ridiculous activities you are required to do by your employer at times that either appear or in fact are pointless and absurd, if not unethical and/or illegal.

With this said, I suggest you not be in a constant state of understandable anger or unhappiness as you work during the day visiting those in the medical community. People, including pharmaceutical representatives, are more transparent that you may realize (psychopaths are an exception). Those in the medical community that you interrupt (and you do) would rather not view you as upset or joyless if you are fortunate enough to visit them at their medical facilities. Attempt to make yourself in a presentable mood before entering such medical location. Who knows? You might actually make another’s day. Try gently to make medical staff laugh appropriately, for example. This may be more important than the 1000 dollar suit you may be wearing.

Also of particular note, and this applies in particular to rather large pharmaceutical corporations, there seems to be a constant theme with their sales forces: Members of these sales teams are always striving to make a favorable impression for their employer- specifically their manager. This in itself is understandable and not necessarily a bad thing to do in the corporate world to ensure employment security.

Yet do not ever confuse creative or innovative acts that may be misperceived by you as being these things. Such acts possibly could be unethical if not criminal activities you may engage in upon your own discretion, or upon a recommendation from another employee you work with at your pharmaceutical company, or most often, your manager.

It happens often at times, and it is not a good thing for many others. So I suggest that you learn about laws relevant to your profession as a pharmaceutical representative. There are many, and you are likely not told these legal statutes and acts mandated by lawmakers by your employer at all. Learn about the terms associated with such laws, such as misbranding, kickback, and disease mongering as well.

Why do pharmaceutical representatives follow at times directions of this nature by their superiors, as uncomfortable as it may be for them at times?

This happens for two reasons: First, it’s understandable with a pharmaceutical representative that if their superior directs them to implement certain activities related to their employer’s objectives, the directives are appropriate and necessary. It is also reasonable to conclude that such acts planned deliberately could in fact ethical and legal. So rarely do pharmaceutical representatives ever question what they are told to do by their employers and managers. To be clear, this scenario of potential wrongdoing is possible, yet not always. In summary, exercise caution on what you may be directed to do by your employer.

For example, do not ever engage in what is called quid pro quo. This is Latin as well, and means, ‘this for that’. For example, just because you buy the staff of a medical office lunch, or leave the health care providers samples of your promoted products, or placed a fancy TV in their medical clinic- these gifts do not mean in any situation that the doctor owes you prescriptions for the medications that you promote to such doctors. If your sales numbers are down, do not blame the medical professionals in your territory in such a way, and it happens at times.

Finally, there are certain intrinsic human traits that others rarely discussed or examined, and I believe they should be acknowledged. Examples include qualities such as character, integrity, or kindness- as well as honesty. I’m not suggesting that you consider such moral and ethical concepts if they are of no importance to you.

What I am suggesting is that you discover the meaning of such words and at least consider the possibility of acquiring such traits within you if they are absent. At the very least, consider the value of such traits, and this may be for your benefit as you continue through your lifespan and your career.

Thank you for your time,

A seasoned pharmaceutical representative.

Dan said...

A Bribe Is A Bribe

Violating the anti-kickback statute, 42 U.S.C. & 1320a-7b (b) of 1987

Managed by the DHHS (
Regulated by the OIG (Daniel Levinson
Drug companies violate the F.C.A. with pricing or marketing. Kickbacks are marketing that can result in the submission of false claims to federally-funded programs, which violates the F.C.A.
The company knowingly causes to be presented to the Fed. Govt. false/fraudulent claims for payment/approval. Or the company knowingly causes to be made or used a false premise to get a false or fraudulent claim approved or paid by the Federal Government. Drug companies pay doctors to have them write more prescriptions for their promoted products.
Fed. Health care programs will not pay claims that were induced by kickbacks. This is knowingly and willfully paying of remuneration to induce others to refer or arrange for a health care item that is reimbursable under federal health care programs. It is a prerequisite to payment of federal health care funds, so kickbacks are F.C.A.s
The company, by violating the anti-kickback statute, knowingly and willfully acts with deliberate ignorance and reckless disregard of the truth. Evidence shows that the company was reckless and deliberately ignorant in engaging in offending marketing conduct.
Sales reps. constantly try to make health care providers to favor and utilize their drugs for their patients, and these drug reps are often told by their employers that bribing them is the most effective tool in making this happen.
A useful prosecutorial tool is this anti-kickback statute, yet it is not a deterring statute, so it seems. Whoever knowingly and willingly offers or pays remuneration directly or indirectly, overtly or covertly, in cash or in kind to another in order to induce the receiver, is now guilty of a felony. This crime could lead to a fine of 25,000 dollars, and less than 5 years in prison.
It is illegal criminal commercial bribery that prevents health care providers from fully acting in the best interest of public health. Sales reps. From drug companies are often required to pay doctors or bribe them in some way to those prescribers with a high prescription volume. Hiring one for research is one form of inducement.
2-09: Forest Pharmaceuticals-
Paid kickbacks to induce health care providers to prescribe their drugs by providing these prescribers with various forms of illegal remuneration, such as high cash payments and valuable goods and services.
Sept. 2007: BMS- 515 million
“Knowingly and willfully paid illegal remuneration to physicians and other health care providers to induce them to purchase BMS drugs. BMS paid the illegal remuneration in the form of consulting fees and expenses to physicians and other health care providers to participate in various consulting programs, advisory boards, and preceptorships. By paying this illegal remuneration, BMS knowingly caused the submission of false and fraudulent claims to the federal health care programs.
“Illegal drug marketing schemes will be vigorously persued by OIG- Daniel Levinson, HHS Inspector General. “We are committed to ensuring that others are not taken advantage of by those engaging in unscrupulous practices.
90 percent of new health care fraud enforcement actions were initiated by whistleblowers. Less than 10 percent are sales representatives. One third of prosecuted schemes were illegal marketing, inappropriate financial relationships, and kickbacks.

11-08: Bayer- 100 million
Paid others to use their products. “Those who pay illegal kickbacks should expect to be held -accountable.” --- Daniel Levinson
8—06: S Plough 435 million. Kickbacks to insurers. “health care corruption erodes public confidence and affects both patients and doctors.
2008: Biovail 25 million for paying thousands of doctors 1000 dollars each to enroll 13 patients to place on their drug cardizem.
Merck 650 million:
Paid illegal remuneration to health care providers to induce them to prescribe merck’s products. Multiple programs were implemented by their sales reps. To induce health care providers to prescribe their products. This included excess fees to health care providers that were illegal kickbacks intended to induce the purchase of merck products.
2-09: Forest Pharmaceuticals-
Paid kickbacks to induce health care providers to prescribe their drugs by providing these prescribers with various forms of illegal remuneration, such as high cash payments and valuable goods and services.
Novartis pays about 50 million for eluding and impeding federal audits, as well as violating the fed. Anti-kickback statute by giving free medical equipment to potential clients. DOJ never did a press release. St. Louis Post Dispatch, and Bloomberg were only sources that reported this event.
I recently had my qui tam unsealed against my will that had quid pro quo written all over it. Prosecutors are rather selective with what they investigate, it seems,

Dan Abshear

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