Healthy Skepticism International News

Memoirs of Methods Used to Sell Drugs

March 1999

Vol 17 Issue 3/4 Memoirs of Methods Used to Sell Drugs This MaLAM edition presents the memoirs of a former drug company employee regarding the methods he saw being used to sell drugs.

Memoirs of Methods Used to Sell Drugs

Insight into the inner workings of drug companies is valuable and difficult to obtain. This MaLAM edition presents the memoirs of a former drug company employee regarding the methods he saw being used to sell drugs. He worked in the medical departments of three drug companies. We will not disclose his name or the names of the companies and countries where he worked. The amounts of money mentioned have been converted to the equivalents in US $.

I must confess to being quite amazed at the amount of information that is collected by representatives and drug companies on individual doctors. When a representative leaves employment, the diary and profile dossier is forwarded on to the successor. Doctors’ profiles will contain minutiae, from the names of their family members to their golf-handicap, to the foods they like or dislike, to the clothes that they wear!

Most companies have their own classification of the doctor’s personality type. One schema is that of the eagle-owl-dove-peacock, where the eagle is egotistical and domineering, the owl wants information and is very analytical, the dove is a friendly sort who gets on well with everyone and the peacock is a social butterfly / extrovert.

The companies hire specialised professional agencies to teach the representatives about their own personalties using the same classification. This helps the representative to plan and adapt their selling styles based both on the doctors’ styles and their own. For example, a conservative doctor and a flamboyant representative may not gel, so the representatives would modify their styles to be less flamboyant and more technically oriented so as to be in alignment with what such doctors wanted to hear. The agency providing the training would administer personality tests and then teach representatives how to modify their styles. This would be taught using video taped role-plays. The drug company that used that classification system also used it for selecting staff. They preferred to employ peacocks or eagles to be representatives.

Many doctors are also categorised according to how they prescribe. For example, A for high volume prescribers of the company products down to C for those doctors not worth targeting. This is based on the principal that 80% of the market for your product comes from 20% of prescribers. Those classified as A need to be kept on this level and so are targeted by the representatives to attend meetings etc. The B group are those targeted with a view to converting them to A types. So how does one obtain prescribing information about a particular doctor? From IMS and STATIM data, but even these methods are not that specific for a product. Representatives use the local pharmacies, or obtain the information from doctors directly using such schemes as SCRIPTRACK eg doctors are required to fill in paperwork providing information regarding their prescribing preferences etc in return for small prizes, lottery tickets, etc. The companies go to great lengths to obtain this information.

Detail aids are glossy eye-catching colourful displays of data, which are used by representatives as a selling tools. Some are designed to be left behind with the health care professional as an aide memoir. Others are not. It is the latter which are more likely to be used to convey misleading claims because doctors can not examine them carefully or compare them with other information sources or get a second opinion on them. Like any promotional item, detail aids are supposedly vetted by the company’s medical department to ensue that no misleading or false claims are made, and that the data represented is a fair reflection of the literature.

Many companies are very “marketing driven”. By this I mean to say that the structure and function of the medical department is often either token or designed to assist the marketeers in what may be construed as ‘unethical practice’. For example, some marketeers will think of an idea that will be appealing to the recipient health care professional or consumer. They will then approach the medical department to find out if there is any data to support their claim, regardless of whether that evidence is weak or unrepresentative of the current body of knowledge. For those companies that consider themselves as ‘very competitive’, the promotional items are often allowed to pass through a proverbial net of scientific scrutiny with little or none of the modifications that would be required to avoid misleading doctors.

Similarly to Detail Aids, the typical Give-Aways include such things as pens, post-it pads, torch lights, anti-stress balls, golf balls, chocolates. These are essentially brand name reminders that lead to the promoted drug being remembered more quickly than the alternatives. They are also designed to affect the subconscious mind of prescribers so that they will prefer the promoted drug. The value of any gift or give-away has to be perceived to be of relatively low monetary value eg USD $40. Consequently, companies (in association with their advertising companies) think of ingenious ways to produce materials that are appealing to the recipient without appearing expensive. For example cookie jars, which are filled up each time a company representative passes by a doctor’s surgery, are aimed primarily at the doctor’s secretarial and support staff, to assist the representative in acquiring ready access to the doctor. It must be stressed that although the final give-away product may not look expensive, the real costs involved in producing that product may vastly exceed the nominal USD $40 cited by the industry associations.

In recent years the costs of prizes have had to be reduced from the days when drug companies used to offer videos and TVs and the like. However prizes are still a useful way to attract doctors to a particular product or company. For instance, between plenary sessions at a conference, attendees were invited to partake of some “fun and games” at a trade display. The prizes on this occasion included soft toys and some good quality wines. Hundreds of attendees entered the competition which was to be drawn on the final day of the conference. Who drew the winners? I was flabbergasted to see one of the company’s product managers sit down in a quiet place and sift through all the entrants, then select three key doctors that the company wanted to influence. On challenging the ethics of such a manoeuvre I was told that it was a common practice across the industry!

Since the rise of “self-regulation” in some countries, there have been remarkably few inter-company complaints that have progressed to the stage of fines or corrective advertising. Indeed, in most countries relying on self-regulation no member company has ever been suspended or expelled. Proponents of self-regulation would argue that this is a successful formula that has a proven track record. This may be true, although I have some reservations on the matter. In 1994, whilst joining a large multi-national company’s medical department I was surprised to hear that my company and a leading competitor company had entered into an agreement whereby neither company would challenge each other’s claims. Without knowing the specific details, I can not say whether or not this agreement was unethical in this instance. However, if companies enter such agreements then perhaps misleading claims will go unchecked in the marketplace with possibly catastrophic consequences for patients. Although this is only one experience, it does make one wonder just how much of this type of thing actually occurs.

The manufacturers’ association has gone a long way to improve the professional image of the medical representative. Each representative has to undertake the association’s diploma for representatives. This involves submitting written assignments within defined time periods, in other words, distance-learning. There can be no question that the subject material and course material is pertinent to a medical representative, however, to the best of my knowledge, no studies have been undertaken to assess the effectiveness of introduction of the diploma. I have seen many representatives go through the diploma process. It is viewed by a great many as a chore, even an inconvenience. They do not see it as useful or important. They are aware that obtaining the diploma makes them more attractive and marketable as a seller of medicines. However, the nature of someone who choses to work in sales is to focus on gaining a competitive edge over rivals in the same company as well as inter-company competition. Knowledge of ethics and therapeutic areas doesn’t automatically translate into ethical selling; no such association has been established.

Representatives are given incentives, bonuses, trips etc on the basis of their market share, projected growth estimates, achieving targets, etc. They are wined and dined by the management and the marketing department, and are actively encouraged to become competitive and ‘push to the limits’ to achieve their targets. This is where ethical selling vs achieving your sales targets may clash. That’s not to say that all representatives are unethical. Many honestly convey the beliefs that their companies have given them (see indoctrination below) and have rapport established from many years of servicing health care professionals. However I did hear senior management of one company tell the representatives to say anything to the customer if it portrayed the product in a good light, but do not write it down, because it could be used against you!

Sales teams are primarily comprised of people from health care backgrounds who fundamentally care about people because such people are more effective at achieving higher sales. Selection of personnel usually involves psychometric testing, presentation skills and multiple interviews, to obtain a particular ‘type of person’ that fits with the corporate image the company wants to portray.

Sales teams are nurtured and fed positive information about the product so that they develop a strong genuine belief in the product and in the company so that they will have no problem about selling that product, which they feel will benefit patients. I remember my brief on introducing technical data to some representatives. I was not allowed to say anything negative about the product, or if I did, then I was to handle it by converting the negative into a benefit. (eg the adverse effect of sedation would be presented as “therapy for anxiety and insomnia”, nausea would be presented as “helps patients to loose weight.”)

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