| Ilena Rose 2005-07-25, 11:53 pm |
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http://slate.msn.com/id/2119712/
May 31, 2005
Spin Doctored
How drug companies keep tabs on physicians.
By Shannon Brownlee and Jeanne Lenzer
Doctors have long maintained that they are immune to the blandishments
of drug companies. The lucrative consulting contracts, fancy meals,
trips to exotic locales, free pens, flashlights, coffee mugs, and
sticky notepads emblazoned with prescription-drug brand names - none
of these are supposed to cloud a physician's clinical judgment.
Doctors
like to think they decide which treatments to order and which drugs to
prescribe because of scientific evidence, not marketing.
But the companies think they know otherwise. Last week, five
whistle-blowers from government and industry gathered in Washington,
D.C., at a meeting sponsored by the online scientific journal PLoS and
the Government Accountability Project to discuss the pharmaceutical
industry. Among the attendees were Kathleen Slattery-Moschkau, a
former
drug company representative and independent filmmaker, and an unnamed
drug company researcher. They detailed for the group how the companies
and the reps know - right down to the pill - whether or not their
sales pitches are working and how to improve them. The industry's
semi-secret weapon is prescriber reports, weekly lists of every
prescription written by each of the 600,000 doctors in the United
States. Relatively few physicians know about prescriber reports, also
known as prescriber profiles. But their existence makes it far more
difficult to imagine that pharmaceutical marketing has no effect on
the
doctors it targets.
Prescriber reports became possible in the early 1990s. First,
pharmacies began processing insurance claims by computer and peddling
the data to the pharmaceutical industry and to clearinghouses, like
IMS
Health, which then sells information about the drug market. The
pharmacy records don't include the names of patients or doctors: They
are coded with physician ID numbers, which are issued by the Drug
Enforcement Administration so that it can track controlled substances,
like morphine. But drug companies and IMS can buy lists that match the
DEA numbers to doctors' names from the federal government or the
American Medical Association, which earns about $20 million a year
selling its "physician master file" database. The master file contains
personal and professional information about every doctor in the
country, including their DEA numbers.
By putting together all of this information, the weekly prescriber
reports can show the names of the doctors in a rep's territory and
what
each doctor prescribed and how much of it. Reports provide reps with
up-to-date feedback on just how effective they've been in persuading
their doctors to prescribe the two or three drugs each rep pitches.
The
reps are schooled for weeks in a variety of sales techniques. They
memorize tightly crafted speeches and volumes of data on their
products, and some are even trained in personality profiling, to help
them guess whether a physician is more likely to respond to reams of
scientific research or to schmoozing. Prescriber reports play a key
role in helping reps boost sales - they're like weekly focus groups
that help reps shape their pitches to individual doctors. If Doctor A
increased her prescriptions after being treated to a facial and
full-body massage, more expense-paid spa excursions are in order for
her. If Doctor B didn't respond to a courtesy five-course meal, then
maybe it's time to try football tickets, or up the free drug samples,
or plug clinical research that touts the proffered drug's benefits.
Prescriber reports also allow reps to identify and target their top
prescribers. The reports rank doctors into four tiers, based on how
many scripts they write. Reps focus most of their energy on the upper
ranks - the doctors who write hundreds of prescriptions per month.
That's because a rep's bonus depends on increasing market share, the
sales of his drugs in his territory compared with competing
medications. Getting top prescribers to increase their prescriptions
by
even a few percentage points can give the rep that needed boost.
>From the companies' perspective, hard-sell tactics are simply good
business. Pharmaceutical manufacturers spend hundreds of millions of
dollars getting a single drug to market. Once it's there, they try to
move as much product as possible before the drug reaches the end of
its
patent life, usually within a decade.
What's harder to understand is doctors' insistence that they're
unmoved
by the approximately $15 billion that drug companies spend annually on
marketing (compared with $33 billion a year on research and
development). Plenty of evidence shows that they're easy marks.
Several
published studies have found that doctors who rely on reps for their
information have more expensive prescribing habits than those who
stick
to the medical journals. Besides raising costs, taking a company at
its
word about the merits of a drug can hurt patients. One study published
in the New England Journal of Medicine in 2001 revealed that patients
who used the painkiller Vioxx were five times more likely to suffer a
heart attack than users of the generic drug, naproxyn. Yet that year,
Merck & Co., Vioxx's manufacturer, managed to make the drug's sales
rise faster than the top 10 drugs in the industry, with revenues
topping $2.6 billion. How did that happen? Merck documents submitted
to
Congress after Vioxx was withdrawn from the market last fall show that
the company taught sales reps how to deflect doctors' questions about
the painkiller's safety. The reps handed out "cardiology cards,"
pamphlets that used studies less powerful than the one in NEJM to make
it look as if Vioxx was associated with fewer heart attacks rather
than
more. Merck code-named its marketing blitz "Offense" and
"XXceleration."
Most physicians make "I'm OK, you're not" assumptions about their
profession's susceptibility to such tactics. In one survey, 61 percent
of the residents at the university of California, San Francisco
Medical
Center reported that they themselves are unmoved by drug company
gifts.
But when asked if they thought their colleagues were swayed, 84
percent
said yes.
Perhaps revelations about prescriber reports will persuade doctors
that
they should think seriously about how hard they're being spun.
Physicians who find out about the reports by word-of-mouth at medical
conferences, or in the occasional medical journal article, often say
they feel their privacy is being invaded. They worry that the
pharmaceutical industry's extensive data collection violates
doctor-patient confidentiality (though they can't say precisely how,
since patient names are not included in the reports). Some have booted
drug reps from their offices when they've learned of the reports.
"Telling your doctors how much you really know can be the kiss of
death," said Slattery-Moshkau, the former drug rep whose indie film
Side Effects is about her decade in the business. Maybe what's most
disturbing to physicians is that the prescriber reports make it hard
to
go on pretending that science always trumps marketing.
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Shannon Brownlee is a Schwartz senior fellow at the New America
Foundation. Jeanne Lenzer is a freelancer whose work appears regularly
in the medical journal BMJ.
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