Drug sales calls wear on doctors

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DRUG SALES CALLS WEAR ON DOCTORS

Surge prompts some to limit, end access; skepticism grows

 

 

http://www.chicagotribune.com/features/health/chi-0505080304may08,1,1154248.stor\

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By Bruce Japsen, Chicago Tribune staff reporter

 

May 8, 2005

 

By the time Dr. Jeffrey Kopin finally closed his office doors to visits from

drug industry sales representatives last fall, he was getting up to five visits

a week from multiple salespeople working for the same company, encouraging him

to prescribe the same drug.

 

The Chicago internist became overwhelmed by the sheer number of visits and felt

that what came from them--biased marketing pitches, some drug samples and the

occasional free Subway sandwich lunch--was not anything he needed or wanted.

 

Increasingly, doctors like Kopin are shutting out drug representatives or

dramatically reducing access, believing the visits are more about sales

relationships than prescribing a product that's best for patients.

 

" There is no reason for doctors to make room in their schedules for visits from

salespeople, whether they're selling refrigerators, cars or drugs, " said Dr.

Marcia Angell, a Harvard University lecturer and former editor of the New

England Journal of Medicine.

 

" In fact, it's worse to see drug reps, since their purpose is to influence

doctors' professional judgment to make sales, " she said.

 

Yet doctors never have faced so many drug reps.

 

The army of drug sales reps in the United States last year mushroomed to more

than 100,000, or at least one for every seven practicing physicians. That's

nearly triple the number compared to just a decade ago, according to market

research firm Verispan.

 

Despite the rapid growth in the number of reps, doctors are starting to carve

out less time for the drug companies.

 

The average amount of time spent with a doctor and the number of times doctors

actually agree to meet with sales reps has been flat or falling for the last

three years, according to national drug marketing research firm Impact Rx Inc.

 

" The additional reps haven't been seen by doctors or they aren't getting in, "

said Fred Nelson, senior vice president at Impact Rx. " There is just no more

capacity for rep visits. "

 

Some major drugmakers have taken note and begun a retreat. Two of the nation's

largest drugmakers in the last month said they plan to cut back on their

representatives' visits to doctors.

 

New York-based Pfizer Inc., which has the nation's largest drug sales force at

11,000, said in April it will curtail the number of reps calling on doctors to

two or three per product, down from what has been as high as five. Pfizer reps

sell the cholesterol-lowering drug Lipitor, the impotency pill Viagra and

controversial arthritis drugs Celebrex and Bextra.

 

" This is in response to our customers' feedback, " said Pfizer spokeswoman

Mariann Caprino.

 

Merck & Co., the maker of Vioxx and the popular cholesterol drug Zocor, said it,

too, is concerned about physician feedback.

 

" Merck representatives will call on fewer physicians and handle fewer products

to help them become more specialized in their knowledge of both their products

and their doctor customers, " the company said.

 

Scaling back on office visits could be a risky move for the industry, in effect

dulling its most effective sales tool. Drugmakers spent more than $7 billion

last year to send ambassadors to physicians' offices, according to IMS Health.

 

That's far more than the $4 billion the pharmaceutical industry spends on

marketing to consumers through television and print ads.

 

Drugmakers say their reps also provide useful information on the latest studies

and assistance in administering medications safely.

 

Jeff Trewhitt, spokesman for industry lobbyist Pharmaceutical Research and

Manufacturers of America, said sales reps, many of whom are nurses or

pharmacists, are technically trained to talk with doctors about the medicines.

 

Safety issues raise concerns

 

Doctors may also be growing more skeptical of sales relationships in the wake of

recent safety controversies involving heavily promoted brand names like

painkillers Vioxx and Bextra, which were pulled from the market after being

linked to heart problems.

 

" Our office decided that in order to make informed decisions on our patient's

behalf about the risks and benefits of a certain drug, we would rely solely on

drug information published by independent journals and Web sites, " said Kopin,

who also is medical director of Northwestern Memorial Physicians Group. " It is

our strong feeling that these people are not educators. "

 

Congress is examining the role of drug reps. On Thursday, a U.S. House committee

issued a report stating that Merck " sent more than 3,000 highly trained

representatives into doctor's offices and hospitals armed with misleading

information about Vioxx's risks. "

 

The information is part of a larger congressional examination into whether the

structure of the Food and Drug Administration's Center for Drug Evaluation

should be changed following Merck's withdrawal of Vioxx.

 

Merck said the allegations in the document were " completely without merit, "

adding that the company's " longstanding policy is to communicate the benefits

and limitations of its products in a fair and balanced manner. "

 

Too much attention, some say

 

Some who have been on the front lines say drug sales are indeed about

relationships and agree it's become a game with too many players.

 

Former Pfizer and Eli Lilly & Co. drug rep Jamie Reidy boasts in a new book

" Hard Sell: The Evolution of a Viagra Salesman " about his life as a drug rep

that he easily charmed his way into doctors' offices with lunches, M & Ms and

other goodies when he sold drugs for Pfizer in the late 1990s. But even then, he

said, he could see the backlash coming.

 

" There are way too many reps ... doctors hate it, " Reidy said in an interview.

 

Reidy said it was not uncommon during the late 1990s for six different Pfizer

sales representatives to call on the same doctor in the same week to talk about

Viagra.

 

Cathie Holt Wood, a former sales rep for TAP Pharmaceutical Products Inc.,

agreed.

 

" With all of the reps out there, companies are just making it harder for the

reps to be seen, " said Holt, who left TAP in September 2001. " We were all sort

of on top of each other. "

 

Holt said the Lake Forest drugmaker added a second representative to her sales

territory in 1998, about three years after the company launched its heartburn

drug Prevacid in a tactic called " mirroring. "

 

TAP wouldn't discuss the size of its sales force but said it believes regular

drug rep visits with doctors are important.

 

" TAP and our sales force continually evaluate and refine our approach to

providing important product information to physicians, " the company said in a

statement.

 

Crowd can interrupt practice

 

But some office managers say salespeople can get in the way of a busy doctor's

ability to provide patient care.

 

" I have had physicians trying to get by reps as a bunch of them stood in the

hallways, " said Sarah Gibbert, who manages a gastroenterology practice in Macon,

Ga., and assists eight other doctor groups with running their offices. " There is

sometimes no respect that these doctors are seeing patients. "

 

Reidy said flirting with office staff was common, too. While sales reps in many

industries can be handsome people, the drug industry " takes it to another

level, " he said in an interview. Pfizer had no comment on Reidy's book.

 

Sales representatives from other companies, who would not comment in print

because they feared it would endanger their jobs, said it's not uncommon for a

rep to have a budget of $20,000 a year to buy lunches and other goodies for

doctors and their office staffs.

 

Drugmakers, though, are sensitive to the behavior of their sales force in the

field, especially with the ongoing scrutiny.

 

Lilly, which hired Reidy in 2000 after he left Pfizer, fired him in March after

learning of his book. The company said he was terminated because the " book

advocates acts we find inappropriate and in violation of our policies " but would

not specify the acts it found inappropriate.

 

Reidy worked first as a Lilly salesman and was a sales rep trainer until he was

fired.

 

Doctors decide, AMA says

 

Beyond ethics guidelines limiting the value gifts that should be accepted, the

American Medical Association has left decisions to individual physicians.

 

" Our philosophy is that everybody has a right to make a living, " Dr. Edward

Langston, a member of the American Medical Association board, said of his

Lafayette, Ind., practice.

 

And not all doctors are barring reps. Among fellow physicians at the 11 sites

under the Northwestern Memorial Physicians Group umbrella, doctors' access for

reps varies, said Dr. Daniel Derman, president of the group. Most have at least

curtailed access and are evaluating additional restrictions, he adds.

 

" The good side of [rep visits] is that doctors are busy and the reps provide a

good service of presenting data about new information and proper usage of

drugs, " Derman said. It's unclear just how far drugmakers will go to reduce

sales reps because reps say the current strategy works. During the 10-year

period that the number of sales representatives tripled, so too, did U.S. drug

sales that now generate about $240 billion in annual sales.

 

" It's all noise, " Reidy says. " The more often doctors hear [about the

antibiotic] Zithromax, the more they are going to prescribe it. And so if the

others want to compete, they have to hire more reps. "