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Pharmaceutical companies spend more than $15 billion each year promoting prescription drugs in the United States. One-third of that amount is spent on "detailing" -- an industry term for drug company representatives' one-on-one promotion to doctors. A paper published April 24, 2007 in the Public Library of Science journal Medicine uncovers the tactics which pharmaceutical sales representatives, commonly called "drug reps," are trained to use in promoting drugs to prescribing physicians.
"It's my job to figure out what a physician's price is. For some it's dinner at the finest restaurants, for others it's enough convincing data to let them prescribe confidently and for others it's my attention and friendship... but at the most basic level, everything is for sale and everything is an exchange," stated former Eli Lilly drug rep Shahram Ahari.
Ahari, no longer a drug rep, co-wrote the paper with Adriane Fugh-Berman, associate professor of physiology and biophysics at Georgetown University Medical Center in Washington, D.C. The paper is based on conversations between Ahari and Fugh-Berman, who researches pharmaceutical marketing.
The writers report that drug reps are trained to gather as much personal information as possible about the doctors to whom they are promoting pharmaceuticals -- from birthdays and hobbies to religious affiliation. Drug reps are trained to note any detail that can be used to establish a personal relationship with a doctor. Ahari stated, "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.'"
Drug reps offer gifts, and not just mugs and pens inscribed with drug names. "The highest prescribers receive better presents," wrote Ahari. Pharmaceutical companies rank doctors according to the number of prescriptions they write -- from 1 at the low end to 10 for high prescribers. According to Ahari, "Some reps said their 10s might receive unrestricted 'educational' grants so loosely restricted that they were the equivalent of a cash gift."
The source of the 1-to-10 ranking data is prescription tracking. So-called "health information organizations" (including IMS Health, Dendrite and Verispan) purchase prescription records from pharmacies. According to the authors, IMS Health buys records of about 70 percent of prescriptions filled by community pharmacies. Pharmaceutical companies purchase the records and use them to identify high-prescribing doctors.
How the AMA earns millions by helping drug companies buy influencePrescription tracking records do not always identify doctors by name; in some cases they are identified by a state or federal license number or a pharmacy-specific identifier. To establish the identity of the prescribing doctors, pharmaceutical companies rely on the American Medical Association (AMA), which maintains a Physician Masterfile on every U.S. physician. Citing the New England Journal of Medicine, the authors wrote, "In 2005, database product sales, including an unknown amount from licensing Masterfile information, provided more than $44 million to the AMA."
Once the high prescribers are identified, the drugs reps are then directed to reward those doctors with attention and gifts. The highest prescribing doctors are the ones with whom the drug reps work hardest to build relationships. According to Ahari, "The highest prescribers (9s and 10s) are every rep's sugar mommies and daddies." Lower prescribing doctors are hardly ignored, however; Ahari explained that he was taught to "pick a handful out and make them feel special enough" and then associate increased prescribing with personal attention and a reward such as dinner at a fine restaurant.
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Monday, July 30, 2007
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