Justinian Lane

The “Ethical” Pharmaceutical Sector

I saw an interesting article at Pharmalot about the sales tactics pharmaceutical sales reps use to push products onto doctors.  We strictly regulate how lawyers may solicit for clients, but we allow people with no medical degree - and sometimes not even a Bachelor's degree - to recommend which medicines a doctor should prescribe.

"During training, I was told, when you’re out to dinner with a doctor, 'The physician is eating with a friend. You are eating with a client.' " - Shahram Ahari...

Reps may be genuinely friendly, but they are not genuine friends. Drug reps are selected for their presentability and outgoing natures, and are trained to be observant and personable...Personal information may be more important than prescribing prefernces... A photo on a desk presents an opportunity to inquire about family members and memorize whatever tidbits they are offering...Reps scour a doctor's office for objects - a tennis racquet, Russian novels, seventies rock music, fashion magainze, travel mementos, or cultural or religious symbols - that can be used to establish a personal connection with the doctor.

They then list eight different types of doctors: friendly and outgoing; aloof and skeptical; mercenary; high prescribers; prefers a competing drug; acquiescent; no-see, no-time, and finally, the thought leader. And they provide insights into all the methods a sales rep may use to wear down each one in hopes of getting more scrips written.

For instance, with the 'friendly and outgoing doc,' Ahari (that's him to the right) says that he would 'frame everything as a gesture of friendship. I give them free samples not because it's my job, but because I like them so much. I provide office lunches because visiting them is such a pleasant relief from all the other docs. My drugs rarely get mentioned by me during our dinners.

Just being friends with most of my docs seemed to have some natural basic effect on their prescribing habits. When the time is ripe, I lean on my 'friendship' to leverage more patients to my drugs...say, because it'll help me meet quota or it will impress my manager, or its crucial for my career. Outgoing, friendly physicians are every rep's favoriate, because cultivating friendship is a mutual aim. While this may be genuine behavior on the doctor's side, it is usually caclulated on the part of the rep." (Emphasis added.)

Source: Pharmalot: The Doctor Is Not Your Friend!

I wonder how many victims defective drugs were given their prescription just to help a sales rep "meet quota." 

Perhaps Congress should introduce legislation to prohibit pharmaceuticals from giving gifts to physicians - something similar to the crackdown on lobbyists, for example.  They could even require them to register as "medical lobbyists." 

Cross-posted to

Justinian Lane: Author Bio | Other Posts
Posted at 9:10 PM, Apr 23, 2007 in Health Care
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Justinian: Like a child. I suggest you check with your doctor, an adult, if you ever find one willing to take new patients, after what the lawyers have done to the doctors. The second suggestion is to start a counterpoint section to every one of your postings. Your blog will benefit from having an adult present the facts on whatever left wing, pro-lawyer, biased fantasy of the day you choose to entertain.

When the patient does well, the doctor's life is paradise. No hassles, no screaming families, no threats, no frequent, repeat phone calls, no parsing, second guessing, and public commentary by peers, by staff, down to janitors cleaning hospital rooms, lots of money for no real indoor work, lots of immediate word of mouth renown among patients and neighbors, lots of referrals for more of the same by the patient's referring doctor.

When the patient does not do well, substitute the word, "lots" for the word, "no," above, and substitute the word, "no" for "lots.".

What doctor could dinner could overcome the above pressures to serve the patient? None.

This is what happens. For 5 minutes of time, the doctor gets $100's in samples, if not $1000's, for his uninsured patients. Many patients have no insurance because of its cost, from defensive medicine, lawyer frivolous lawsuits, lawyer rent seeking worthless government regulation of the doctor, down to the minute, far greater than if the doc were a lettuce picker in a field. The doctor is the most over-regulated activity in our econimy. All clinical achievement has been despite this anchor and obstructionism by the criminal cult enterprise.

When there is a drug company dinner, other docs are present. The rep may enjoy the merciless bashing of the product, and the animus of the clinician toward the company. These remarks are worth $millions in free consulting value, all on behalf of advocacy by docs for clinical care. As a result of such feedback from the real world, companies have put new delivery systems, changed available doses of their medication. They have been motivated to invest in getting new FDA approved indications, long after well established in the clinical grapevine. Why can't doctors talk on the internet or in the lounge or take each other to dinner? They do. The dinner is to informally send a message to the drug company. The customer of the drug company is the doctor.

Naturally, the docs talk mostly to each other, after polite acknowledgment of their hosts. These informal conversations are the real cutting edge of clinical care. The literature in medicine is mere verification of what everyone was doing 5 years ago by government dependent academic researchers. The medical literature represents the long gone past in medicine. It is those dinners where word spreads of what works and what doesn't in real patients.

Posted by: Supremacy Claus | April 23, 2007 10:51 PM

In regard to the above comment. I see a large number of patients who are uninsured and pharmacy reps provide samples to care for these patients. In fact, I do not even see the reps.

The general way the medications are marketed to physicians is to get physicians to try the medications. If they work, you prescribe them, if they don't, you dont.

Posted by: Chris | April 24, 2007 8:29 AM

Funny, I've had no problem getting a new physician, and I had to just recently because my pcp dropped out of my insurer's plan... so you're obviously overestimating the impact of trial lawyers.

Maybe some doctors give away tons of free samples to uninsured patients, but there are more than a few doctors who won't even see uninsured patients. (At least, not without payment up front.)

For as irritated as this post seems to have made you, I'm guessing you must work as a pharmaceutical sales rep.

Posted by: Justinian Lane | April 24, 2007 9:28 AM

Maybe some doctors give away tons of free samples to uninsured patients, but there are more than a few doctors who won't even see uninsured patients. (At least, not without payment up front.)

you 've any problem with that ?

Posted by: Anirban | April 24, 2007 3:59 PM

"you 've any problem with that ?"

Nope, none whatsoever, unless it's a life threatening emergency. Otherwise, who a doctor does or doesn't see should be the doctor's decision. I think they're jerks, but I support the rights of those doctors who refuse to treat trial lawyers.

Posted by: Justinian Lane | April 24, 2007 6:38 PM

Justinian: I am irritated by your left wing misrepresentation, and lyin' lawyer propaganda. You have no thought of your own past the ATLA talking points. Try entertaining a thought. It hurts only at first.

The damaging effects of drug regulation are reviewed in greater depth and candor in, Overdose: How Excessive Government Regulation Stifles Pharmaceutical Innovation, by Richard A. Epstein, 2006.

According to this research, the biggest loss of life from the regulation of medicine by the criminal cult enterprise is from the slowing of application of approved medicines to off label use. Little investment is needed in finding new uses for approved medication. Even innovative uses of generics has yet to be exhausted. The criminal cult in total control of clinical care crushes such innovation. They make it cost $100's millions to test drugs with no profit potential, by their rent seeking over-reaching, lawyer self-dealing regulations.

The little clinical underground of doctors meeting to compare experience notes helps a little, but not systematically.

Posted by: Supremacy Claus | April 24, 2007 8:35 PM

Justinian: I call for a boycott of all lawyers by all service and product providers. The lawyer is a bigger threat to them than to the doctor. Productive people must stop the lawyer.

No police shows up. No fire rescue shows up to any lawyer address on a lawyer database. It is the Supreme Court that held six times the police and fire department have no duty to the inidividual. Give these cult criminal hierarchy members a taste of their own medicine.

Grocery store security escorts the lawyer to the door without his purchases, once identified as a lawyer from a national database at the cash register. Let the louspeaker announce, "Security to register four. Security to register four. Code CCE." ("criminal cult enterprise").

Such discretion is for the safety of the lawyer, to avoid attacks by mobs of angry employees and shoppers.

Posted by: Supremacy Claus | April 24, 2007 8:58 PM

If it can be shown off label use helped people, this case should be dismissed on policy grounds. The fine of the government represents the cost of getting a new FDA indication. It should be returned on condition the company will use the money to conduct the test of the off label use.

The suit violates the Commerce Clause, not to mention the First Amendment.

If I were a cancer patient I would be taking direct action against the plaintiffs. We have yet to hear from the victims of lawyer tyranny and over-reaching, the patients. When they wake up, I pity the lawyer.

Posted by: Supremacy Claus | April 25, 2007 6:21 AM

"Grocery store security escorts the lawyer to the door without his purchases, once identified as a lawyer from a national database at the cash register. Let the louspeaker announce, "Security to register four. Security to register four. Code CCE." ("criminal cult enterprise"). "

Doesn't sound like now is a good time to ask you to donate to the John Edwards campaign.

Posted by: Justinian Lane | April 25, 2007 10:53 AM

Justinian: I also believe in the immutable Law of Hilarious Political Irony, and am prepared to out trick myself.

George Bush in a debate: There will be no nation building under my administration. That immediately signaled anyone who wanted an orgy of nation building to vote for Bush.

Those who wanted to crush people on welfare and to explode the gap between rich and poor? Best vote: Bill Clinton.

Anyone wishing to nuke Iran? Best bet: Hillary.

Anyone wishes to help minorities? Elect Trent Lott.

Anyone wishing to crush the legal profession, best vote is for ...? Correct. Edwards.

Posted by: Supremacy Claus | April 26, 2007 7:47 AM