Pharmaceutical Sales Ethics: New Reforms or Business As Usual?

By MedZilla Staff Writer

Marysville, WA - July 23, 2004--Many of the tactics used to lure physicians into prescribing medications are coming under fire. Incentives ranging from pricey vacations, front row ballpark tickets to outright financial rewards are increasingly viewed as unethical.

The pharmaceutical industry is trying to change its image and revise marketing strategies to focus more on those that educate clients about drug benefits and drawbacks and less on perks, says Jeff Trewhitt, spokesman for Pharma, the Pharmaceutical Research and Manufacturers of America (PhRMA).

While some question the reality of industry-wide adherence to voluntary guidelines, there is no question that you will have to be ethical in your marketing approach and cognizant of the growing number of sales reps competing for physicians’ time, says Frank Heasley, PhD, president and CEO of MedZilla.com, a leading Internet recruitment and professional community that serves biotechnology, pharmaceuticals, healthcare and science.

“We see the pharmaceutical rep-physician relationship as becoming much more complicated,” Dr. Heasley. “You almost have to become a partner with the doctor nowadays—establishing a trusting, credible relationship based on what you know and what you can offer as far as 24-7 access to information about the medications you sell. These crucial information exchanges might be in person, by phone or via the internet.”

What happened to the big perks?

PhRMA, the industry trade association for about 90 large pharmaceutical companies, representing about 90% of pharmaceutical sales in the U.S., implemented voluntary industry guidelines for sales that went into effect July 2002.

The pharmaceutical rep-physician relationship, Trewhitt says, is a special relationship that needs to be governed by sound guidelines.

One of the most important provisions is that any form of entertainment is inappropriate because your goal, as a technically trained sales representative, is to have a meaningful conversation about your company’s new medicine, Trewhitt says.

“This should be a serious conversation. If you’re sitting on the third baseline at Wrigley Field in Chicago, watching the Cubs play the Giants, and you’re watching Barry Bonds hit his 676th homerun, that’s inappropriate. Sporting events are inappropriate; concerts are inappropriate; golf games are inappropriate,” he says.

According to a second major provision, if you are going to take a doctor out for a meal, it should be a meal that costs no more than the prevailing local standard for a modest meal. That means, lavish lunches or dinners are out.

Yet another important provision, among others, is any gift that is given to a doctor should not exceed $100 in value, and it should be a gift that strictly helps the medical practice.

“If you buy a $75 elegant serving tray, it’s still inappropriate because it’s not a gift that helps the medical practice. If you buy a stethoscope or medical dictionary, that is definitely appropriate because it helps the medical practice,” he says.

Eric Bolesh, senior analyst at Cutting Edge Information, Research Triangle Park, NC, agrees that gone are the days when reps could treat doctors and their families to flashy vacations or nights at the ballpark.

However, according to Bolesh, not only sales tactics are changing, it is also the attitudes of doctors toward reps.

What doctors want: A real relationship

“Doctors are getting increasingly fed up with the number of reps waiting to see them. One hears or reads this line all the time now: ‘There are more sales reps in the waiting room than patients!’ Bolesh says. “In this situation, the best way for a rep to win and retain market share is to establish a real relationship with each physician in her territory. Doctors no longer look to reps as a source of trustworthy medical information, so any rep that can rekindle that kind of relationship will be miles ahead of his competitors. Reps that have been in their territories for longer -- and whom doctors actually recognize and remember -- will win more detail time than new reps. It can take several months to reach that point.”

According to Bolesh, actually speaking to a doctor is just the first part of the puzzle. After you gain access, it’s your product knowledge and objective medical knowledge that win trust.

“… the best way to capture market share, boring as this may sound, is to present compelling clinical data that proves your drug is superior to another,” he says.

Tools to back up your presentations that you might successfully use in the current sales environment include those useful items that Trewhitt mentioned, such as stethoscopes and speaker programs where doctor clients hear useful information from another respected physician.

The biggest trend in the past five to 10 years, according to Bolesh, has been the rapid expansion of the mirrored sales force. A mirrored sales force involves two or more sales divisions from a single company overlapping their territories to increase physicians' product exposure.

”This strategy of constant expansion shows signs of nearing its breaking point, when simply expanding sales headcounts will no longer yield more sales. [As I said, doctors are fed up with the flood of reps. Reps in busy territories are lucky to get a few seconds with a handful of doctors every day,” Bolesh says.

Meeting doctors’ needs

According to Bolesh, sales forces are trying a couple of different things to counter this.

One approach focuses on having specialized sales reps. To re-establish the sales rep as a source of trustworthy medical information -- not just a promotional mouthpiece -- companies are developing sales divisions that focus on particular disease areas, therapeutic areas, patient populations and medicine types. By hiring highly educated individuals into these forces, pharma companies can re-engage physicians by providing a useful service, says Bolesh.

The next step is consultative selling, where doctors trust reps enough to use them as reference points in their treatment of patients (without actually advising on patient treatment). Physicians, knowing a certain rep has enough medical and product knowledge to act as a resource, will feel comfortable engaging that rep in deeper discussions about medical challenges, product questions and more, Bolesh says.

“A second approach is e-detailing, which is still in its infancy. More and more doctors are turning to the Internet as a source of medical information. Reps that can engage doctors via the web will be able to leverage this trend -- without driving around to doctors' offices,” he says

With the time limits you face in your interactions with doctors and a sales climate that discourages using much of anything but hard evidence and knowledge to get doctors to prescribe your products, it makes sense that you should be as knowledgeable as possible and work to gain physicians’ trust, Dr. Heasley says.

“You will stand out if you’re organized, can answer the physicians' questions promptly, offer creative ways to educate doctors, and recognize that they need to have quick access to information about the medications that you sell,” Dr. Heasley says.

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