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Curbing corruption in medicine PDF Print E-mail
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Written by Roman Bystrianyk   
Tuesday, 04 April 2006 00:00

Pharmaceutical companies spend between $12 and $18 billion every year marketing to physicians and residents. This amount of money includes approximately 60 million annual visits by pharmaceutical representatives as well as most of the $1.5 billion spent annually on continuing medical education. 

In the January 25th issue of Journal of the American Medical Association (JAMA), 11 authors of a paper call for a reexamination of health industry practices that create conflicts of interest throughout the medical field. Financial conflicts of interest occur when doctors deviate from their professional obligations for economic or other personal gain. 

“Approximately 90% of 21 billion marketing budget of the pharmaceutical industry continues to be directed at physicians, despite a dramatic increase in direct-to consumer advertising.” In 2000, the pharmaceutical and medical device industry sponsored over 300,000 events specifically for physicians. Industry also contracts with many doctors to serve on advisory boards. The obvious purpose of all these actions is clearly for drug companies to promote the use of their products. 

It’s long been assumed by many that doctors can remain objective if the cost of the gifts is small. However, social science research shows that the desire to reciprocate for even low cost gifts is a powerful force on behavior. “Individuals receiving gifts are often unable to remain objective; they reweigh information and choices in light of the gift. The rate of drug prescriptions by physicians increases substantially after they see sales representatives, attend company-supported symposia, or accept samples.” Unfortunately, studies show that the overwhelming majority of these influences “had negative results on clinical care.”

The authors call for a major reform in the way business and medicine is conducted. 

1. A complete ban on all gifts of any value, free meals, payment for traveling to and time spent at meetings, and in addition to payment for participation for CME [Continuing Medical Education] from drug and medical device companies. 

2. Providing drug samples directly to doctors needs to be prohibited. This should be replaced with a system that distances the company and its products from doctors. 

3. Groups overseeing the purchase of drugs and medical devices should exclude all doctors with any financial relationships with companies. 

4. More stringent regulation on companies that provide continuing medical education. 

5. Faculty at academic medical centers should not be members of speaker bureaus for medical device or drug companies. “Speaker bureaus are an extension of manufacturers’ marketing apparatus.” 

The authors conclude that if these measures are put into place that, “decisions by physicians on which prescriptions to write and which device to use might become more evidence-based; medical societies’ practice guidelines might become less subject to bias. A greater reliance on objective sources for accurate up-to-date information would also promote better patient outcomes and total expenditures on prescription drugs might decline.” 

“Ultimately, the implementation of these proposals will substantially reduce the need for external regulation to safeguard against market-driven conflicts of interest, and the medical profession will reaffirm very publicly its commitment to put the interests of patients first.”


Source: JAMA, January 25, 2006
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A Brief Manifesto Offered For Pharmaceutical Representatives

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 related to the intention of the author.

What will follow is not in any way to be interpreted by the reader as being 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 considered an ideal pharmaceutical representative, and what is needed for your own success as you define this as a pharmaceutical representative.

So, these are some simple, yet possibly preferred, ideas I wish to offer to those who are pharmaceutical representatives related to the nature of their vocation, as well as the image of the industry of your employer, and how this can 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. Do not 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, for example, and there are no other drug representatives at such a location, do not necessarily be in a hurry. There may be 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, and certainly for the company 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 as dictated by your employer. Do not view yourself to be a complete failure at your vocation if this occurs.

More importantly, if a health care provider accepts your promoted drug samples from you, yet refuses to see or speak with you, you still have accomplished something positive for your employer. The samples in themselves 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, which is to increase the market share of your promoted medications.

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, do not discuss any business or promoted product issues at such times. The doctor and his or her staff have more concerning tasks at hand than your presence there, likely, if this occurs. Their needs are always more important than your own.

Likely, you will visit this same location again and again that is in your territory assigned to you by your employer. So you will not receive immediate results- both with your business, and your relationships with those in the medical community for which you serve.
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 as you interact with others who are clinicians and patient care providers with great knowledge, often, of what I am suggesting to you as a pharmaceutical representative.

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. This paradigm is in large part the apex of the profession in which you dialogue with during the course of your day.

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’- based on the clinical trials your employer gives you to persuade prescribers in fact often contain data that is largely embellished, incomplete, or completely fabricated. You are not told this because your employer wishes you to believe that your promoted drug is in fact superior, and safe.

Find avenues 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 stance of credibility, but for the benefits of patients who may be prescribed your promoted drugs as well.

I can assure you that such authenticity will not ruin your life, and will be appreciated by those who may prescribe the drugs you promote.

Furthermore, and as with so many other pharmaceutical representatives, I’ve read those aggressive and brutally 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, or the BMW you may be driving.

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 your misperceived creative or innovative acts. 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.

Yet often, you may be directed to implement such activities by your manager, and those above your manager on the corporate ladder.

It happens often at times, and it is not a good thing for many others, these activities that are simply not the right thing to do.


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, kickbacks, off-label promotion, and disease mongering as well, for example.

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

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.

For example, do not ever engage in what is called quid pro quo. This is Latin as well, and means, ‘this for that’.

Just because you or those from your employer has bought the staff of a medical office lunch often, or leave the health care providers samples of your promoted products in great amounts, or placed a fancy TV in their medical clinic, since the prescribers in such a clinic are ‘top’ prescribers- 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. You have no right to remind a prescriber of the inducements that you have provided a particular prescriber.


To be clear, this scenario of potential wrongdoing is possible, yet not always. In summary on this topic, exercise caution on what you may be directed to do by your employer, and your manager. If it is in fact illegal, or potentially illegal, you do not want to do such actions, of course.

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 am not suggesting that you consider you adopt such moral and ethical concepts if they are of no importance to you. I'm suggesting these concepts because they appear to be absent from your industry as an entire entity.
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 life span and your career.
Thank you for your time, and good selling,

Dan Abshear

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Last Updated on Wednesday, 09 September 2009 02:12