Tension between two bills that affect the life sciences industry may come to a head this week. One bill that details a one billion dollar investment in life sciences is expected to be released from a conference committee any day now. The other, a health care cost containment bill, has become increasingly controversial because it would ban gifts to doctors from sales reps for pharmaceutical and device manufacturing firms. W-B-U-R’S Martha Bebinger explains what’s at stake.
BEBINGER: The gift ban includes pens and water bottles stamped with a drug name you can’t pronounce. It would also end the platters of sandwiches and the tens of thousands of dollars that fund continuing medical education for physicians in Massachusetts.
RICHARD MOORE: If their products require very generous gifts just to sell them, then there must be a deficiency in the product.
BEBINGER: Senator Richard Moore is a co-sponsor of the bill that would ban gifts to physicians as part of package of health care cost control measures.
MOORE: The drug companies have to re-evaluate how they push their product. It has a significant impact on prescribing practices and on the cost of health care. So I think whether they consider it friendly or not, it’s friendly to the patients and the taxpayers and that’s our primary concern.
BEBINGER: The pharmaceutical industry says it’s insulting to suggest that a meal or a pen push doctors to prescribe one drug over another. But Massachusetts Biotechnology Council Vice President John Heffernan says there’s no disagreement about how his members feel about a gift ban.
JOHN HEFFERNAN: This legislation would make MA the least friendly state to the bio-pharmaceutical industry in the country.
BEBINGER: How does banning a lunch or a pen, how does that make us the least friendly state in the country?
HEFFERNAN: It’s really not that simple. The legislation is extremely far reaching and it’s very hurtful to the industry.
MARK LEUCHTENBERGER: What could come next out of legislature that has such a level of distrust of biotech and PhRMA that they won’t let federal legislation and won’t let the PhRMA code speak for itself as we do.
BEBINGER: Mark Leuchtenberger chairs the Biotech Council and is CEO at Targanta Therapeutics. He says industry leaders, especially those outside Massachusetts, are asking that what’s could be next question at the same time State House leaders finalize a 1 billion dollar life sciences bill they hope to parade at a major conference.
LEUCHTENBERGER: It is a dichotomy. And believe me with BIO, the national convention, in San Diego next week. Knowing my California colleagues, they are watching this and waiting to crow about it. It will be a classic California vs. Massachusetts and they will have the upper hand in this argument as they try to encourage investment out there as opposed to here.
BEBINGER: In the Senate, where the bill that includes the gift ban passed unanimously, leaders say it’s foolish to suggest that it undermines the one billion dollar life science investment. But the Patrick administration and the House, are taking the industry’s frustration seriously. Housing and Economic Development Secretary Dan O’Connell says the state must make sure there is no conflict.
DAN O’CONNELL: I think how the gift ban is crafted is most important. The goal is a laudable one, but we also must be sensitive to bio-pharma and their sales needs and making users familiar with their products.
BEBINGER: House Speaker Sal DiMasi says he too wants to make sure that the ban does not interfere with doctors learning about the latest drugs or medical devices. He’s appointed 5 committee chairs, including Representative Michael Rodrigues, to look at ways to exclude educational materials from the ban.
MICHAEL RODRIGUES: Many times anatomical models that are very expensive are presented to physicians so that physicians can instruct patients on the effects of a particular disease or how to implement a medical device. That’s all stuff that we don’t want to prevent happening, we should encourage.
BEBINGER: Minnesota is the only state that already restricts gifts. It does not apply to journals or tools about the specific drug or medical device…(textbooks, PDAs, online subscriptions ior other gifts not directly related to the product are not allowed). In Massachusetts, lawmakers say this gift ban is the only piece of the broad health care cost containment bill they are hearing about. And they aren’t just hearing from the doctors and drug reps in their district…it’s also the catering companies and customized trinket makers who might lose significant accounts. Another part of the bill aimed at limiting the pharmaceutical industry’s influence has been largely ignored. It would set up a team of “academic detailers.” They are independent drug and medical device researchers, paid by the state who would travel the physician circuit just like sales reps. Jerry Avorn, a professor at Harvard Medical School, started this as an alternative to the pharmaceutical sales force 25 years ago.
AVORN: Somebody comes into your office and says if you have 15-20 mins. I will summarize the best available information on how to manage hypertension, cholesterol, diabetes. It’s a real service that doctors would have to spend hundreds of hours in the library to get that same quality of information.
BEBINGER: With lunch or without?
AVORN: Well, we actually had a soul searching about the lunch. We originally started out by saying, we’re not going to do any bribes, we’re not going to give any freebies. And then some of the doctors said, I’d really love to talk to you but the only time I have is during my lunch hour, can you bring me a sandwich. So we crossed the line and said yes, we’ll spring for a pizza or a sub sandwich but not for a meal at Anthony’s Pier 4.
BEBINGER: Avorn says his program, in other states, either breaks even or saves a dollar for every one spent. Supporters of the gift ban say it would also save money. Former Health Care for All Director John McDonough says gifts help drug reps buy good will and persuade physicians to try a newer, more expensive drug.
JOHN MCDONOUGH: The gifts end up inflating the cost of health care. They’re not the only culprit, they are many, many culprits. It’s hard to imagine if we can’t face up to this one, how we will face up to some of the more difficult ones down the road.
BEBINGER: Pharmaceutical industry leaders say a ban would raise costs because physicians would be less likely to take time to learn about new, effective treatments. Regulators in Minnesota says there is no hard evidence that their gift restrictions have either saved money or changed the way doctors prescribe drugs.
A Brief Manifesto Offered For Drug Reps.
The word, ‘Manifesto’ is one of Latin origin, and means ‘to make public’. It’s an open statement of standards related to good behavior based on principles.
What will follow are not in any way intended to be absolute directives or rules you should adopt in order to be successful. Nor am I, as a veteran ex-big pharmaceutical representative, suggesting the contents are an outline of what is an ideal pharmaceutical representative.
So, these are some simple, yet possibly preferred, ideas I wish to offer to those who are pharmaceutical representatives regarding the nature of their vocation, and the image of your industry as it exists today that needs to be improved:
Never park your free company car closest to the entrance of a doctor’s office or clinic. Obviously, both places treat sick people- some worse than others. Aim for the back of the parking lot. Exercise is good for you. Others need that ideal parking space more than you do. Show some consideration.
Upon entering a medical location, such as a doctor’s office, if you happen to notice more than one pharmaceutical representative sitting in what may be a small waiting room, leave immediately and return at another time. Don’t be so insistent or persistent that you disrupt those in that waiting room who need to see the doctor much more than you do.
Conversely, a similar suggestion is that if you enter a waiting room of a doctor’s clinic, and there are no other drug representatives, and only a few patients waiting to be seen by the health care provider, consider striking up a conversation with one of these patients as you both wait to see the health care provider. This rarely if ever happens- drug reps having a nice conversation with a patient in such a manner. You know, they are not Lepers, and you might provide some public relations for the industry that employs you.
Make an effort not to become vexed if you are unable to see one of your targeted prescribers that you desperately feel a need to speak with, or else you will view yourself to be a complete failure at your vocation.
More importantly, if such a health care provider accepts your promoted drug samples from you without you interacting with them, this in itself will influence their prescribing habits more than you may realize. So I suggest you visit such offices, regardless if you see the prescriber or not. You still will or may have a positive effect on what you feel you need to do with your job.
However, if you have an opportunity to be invited into the medical office to ‘check samples’, which means an opportunity to speak with the health care provider, make an effort to read the environment in this patient treatment area you are a guest in at this time.
For example, are staff members in this patient treatment area moving quickly? Do they appear overwhelmed? Are you not receiving any eye contact or dialogue from such staff members? Does the health care provider seem less than jovial? If so, don’t discuss any business issues at such times. The doctor and his or her staff have more concerning issues than your presence there, and certainly more concerning than any needs you feel you may have. Likely, you will visit this same location again and again.
As you continue with your career, strive to learn as much as you can about not only the benefits of the medications you promote, but also the disease states for which they treat. You are, or should be, viewed as somewhat of an expert with both.
So many others in your profession are a bit apathetic regarding any interest with medical issues, and the importance of restoring the health of others. Quite frankly, if you have no interest in the importance and complexities involved with medicine or health care, you should consider another job.
Keep in mind the ‘detail pieces’ and clinical trials your employer gives you to persuade prescribers contain data that is largely embellished, incomplete, or completely fabricated. Find sources of information on the drugs you promote from legitimate sources you can easily find on the internet. You should do this not only from a paradigm of credibility, but for the benefits of patients who may be prescribed your promoted drugs as well.
Furthermore, and as with so many other pharmaceutical representatives, I’ve read those aggressive and clearly subjective commentaries if not essays from other pharmaceutical representatives on the ever so popular Cafepharma website- that great bathroom wall where others express their anger in the written word. I know your concerns as a pharmaceutical representative, as well as the ridiculous activities you are required to do by your employer at times that either appear or in fact are pointless and absurd, if not unethical and/or illegal.
With this said, I suggest you not be in a constant state of understandable anger or unhappiness as you work during the day visiting those in the medical community. People, including pharmaceutical representatives, are more transparent that you may realize (psychopaths are an exception). Those in the medical community that you interrupt (and you do) would rather not view you as upset or joyless if you are fortunate enough to visit them at their medical facilities. Attempt to make yourself in a presentable mood before entering such medical location. Who knows? You might actually make another’s day. Try gently to make medical staff laugh appropriately, for example. This may be more important than the 1000 dollar suit you may be wearing.
Also of particular note, and this applies in particular to rather large pharmaceutical corporations, there seems to be a constant theme with their sales forces: Members of these sales teams are always striving to make a favorable impression for their employer- specifically their manager. This in itself is understandable and not necessarily a bad thing to do in the corporate world to ensure employment security.
Yet do not ever confuse creative or innovative acts that may be misperceived by you as being these things. Such acts possibly could be unethical if not criminal activities you may engage in upon your own discretion, or upon a recommendation from another employee you work with at your pharmaceutical company, or most often, your manager.
It happens often at times, and it is not a good thing for many others. So I suggest that you learn about laws relevant to your profession as a pharmaceutical representative. There are many, and you are likely not told these legal statutes and acts mandated by lawmakers by your employer at all. Learn about the terms associated with such laws, such as misbranding, kickback, and disease mongering as well.
Why do pharmaceutical representatives follow at times directions of this nature by their superiors, as uncomfortable as it may be for them at times?
This happens for two reasons: First, it’s understandable with a pharmaceutical representative that if their superior directs them to implement certain activities related to their employer’s objectives, the directives are appropriate and necessary. It is also reasonable to conclude that such acts planned deliberately could in fact ethical and legal. So rarely do pharmaceutical representatives ever question what they are told to do by their employers and managers. To be clear, this scenario of potential wrongdoing is possible, yet not always. In summary, exercise caution on what you may be directed to do by your employer.
For example, do not ever engage in what is called quid pro quo. This is Latin as well, and means, ‘this for that’. For example, just because you buy the staff of a medical office lunch, or leave the health care providers samples of your promoted products, or placed a fancy TV in their medical clinic- these gifts do not mean in any situation that the doctor owes you prescriptions for the medications that you promote to such doctors. If your sales numbers are down, do not blame the medical professionals in your territory in such a way, and it happens at times.
Finally, there are certain intrinsic human traits that others rarely discussed or examined, and I believe they should be acknowledged. Examples include qualities such as character, integrity, or kindness- as well as honesty. I’m not suggesting that you consider such moral and ethical concepts if they are of no importance to you.
What I am suggesting is that you discover the meaning of such words and at least consider the possibility of acquiring such traits within you if they are absent. At the very least, consider the value of such traits, and this may be for your benefit as you continue through your lifespan and your career.
Thank you for your time,
A seasoned pharmaceutical representative.