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How effective are physician-pharma interaction?

Very effective for the drugmakers

Based on the Congressional testimony of  Michael Wilkes, M.D., Ph.D. Vice Dean, Medical Education Professor of Medicine and Public Health, University of California, Davis in front of the Committee on Government Reform with respect to safety of Vioxx.

In chemistry class when we study chemical reactions the step, in a multistep reaction, that limits the speed of the reaction is called the “rate-limiting step”. In medicine, the rate-limiting step leading to increased drugs sales is the doctor who, after all, writes the prescription. Pharma currently employs an army of 88,000 sales reps who are on the front lines with doctors convincing them to write prescriptions for expensive drugs, occasionally dangerous drugs, and often drugs that are far less effective than alternatives.   (Related article:  Vioxx was often overprescribed or prescribed to patients who were unlikely to benefit)

There is one drug rep for every six physicians, or thought of in economic terms, Pharma spends about $9,000 per doctor per year. Perhaps more appropriate for Congressional consideration is whether prescription drug costs would be substantially lower if we did away with this costly promotion. Lower drug costs would almost certainly translate in to more people getting the drugs they really need.

Drug reps (detailers) are usually gregarious, young, and attractive. And they are well schooled in persuasion. Written manuals, videos, and simulation exercises are just a few of the trench warfare tools used to teach detailers how to engage doctors in the field.  Detailers are usually found roaming hospital hallways or paying visits to doctors’ offices.  Dressed in their conservative business attire they almost always come with gifts including free samples, flowers for the front office staff (who are crucial in helping to arrange for the doctor to meet the rep), lunches, books, loads of pens, and invitations to dinners, sporting events and trips. There are even examples of drug companies actually paying doctors to prescribe their drug.

As a child, my mother told me I couldn’t buy anything advertised on TV. She explained that if the product was really that good the manufacturer wouldn’t need to spend all that money telling everyone how good it was. The same is true for drugs. Very few drugs being advertised are any great shakes. In fact, most medical professors tell our students to avoid prescribing any new drugs until its use can be tested and established in the real world of medical practice as opposed to pharmaceutically sponsored drug studies.  Advertising is meant to sell drugs and the less effective the drug the more marketing it takes to sell it.

Related articles:    Impact on prescription behavior due to marketing by pharma companies   Extraordinary Measures movie review

How to doctors come to know about new drugs?    Why should drug promotion be different?   How to avoid prescription drugs

Vioxx recall and direct to consumer advertising   Ethics of marketing new drugs to doctors

Vioxx and Celebrex advertising to blame for personal injuries   FDA warns Pfizer on misleading Celebrex and Bextra ads

Direct to consumer advertising unchanged despite Vioxx controversy

Vioxx patients misled by Merck advertising  Relationship of pharmaceutical companies and doctors

Responsibility for Vioxx related deaths lies with doctors too     Celebrex attorneys also use advertisements to seek plaintiffs

Impact of drug promotions on doctors' prescription decisions Overall impact of drug promotion and advertising on pharma industry

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