GreNME:
I appreciate your perspective...a few comments on your comments.
Fair enough, and a few comments on your comments on... crap, I get confused with too much recursion!
1. You are correct, the Pharma industry does select individuals who are charismatic and good looking. I would say it is equal men and women where I work, which makes sense given the ratio of men to women presently exiting medical schools in Canada, is women about equal to men (about 52% to 48% respectively).
It's a little less even in the US, at least in sales reps, if you catch my drift.
2. I find it insulting when someone insinuates (not saying you are) that the person's looks or charm somehow plays a role in my prescribing practices. It may influence me to let them speak their piece (though I tend to listen to all of them), but I consider myself above buying the pharma line just because a cute lady is selling it.
Oh, I would say that looks and charm play a large role in the practices of carrying certain products, but it certainly isn't relegated to pretty faces.
All companies at a certain size (and upward) go to great lengths to offer very convincing presentations to prospective clients. Pharma companies happen to be one of the few, at least in the US, who actually go to such lengths as hiring former cheerleaders, beauty pageant winners, and so on for their sales teams in numbers that have at least been noted as more than coincidental (though not necessarily constituting the majority). Sure, beauty queens are people too, but I don't think Miss Virginia 1996 necessarily had hocking Provera to OB/GYNs when she answered "I want to help people" at the pageant.
Yes, I'm laying on the hyperbole there, but honestly it's not being applied as thick as you might think.
3. Perhaps honest, in the absolute broadest sense of the word, is a little too giving, but if we are to nail them for what they do as being "dishonest" then you better line them up right after car salespeople, Electronics Salespeople, and just about anybody else in sales.
I know quite a few personally, and find them to be very good people, and quite honest, both at work, and outside of work. They are also honest about their competition. Of course, mine is the perspective of the person they are making a pitch to.
Oh, I base my opinion on the perspectives of people who have been pitched to as well, both in private practices and in residencies. I somewhat disagree about the level of honesty in their pitches, at least I'm not convinced they are any more honest than most other salespeople, including those you mentioned. Those who have had a little medical study tend to be able to answer more intelligently than those who haven't, but in many cases there aren't required equivalents of medical knowledge for those in sales... not in the US, at least.
That's more reflective of sales, by the way: I'm a head of IT and many of the salespeople I have to deal with often display the same qualities as far as that goes.
4. I get a little tired about people complaining about the, heaven forbid, capitalistic attitude of the big Pharma business...what more is to be expected. If people want an altruistic provider of medicines, then increase your taxes substantially, and have it government run...oh wait, then they will be in on it right???lol
Actually, I can understand the capitalist attitude. What I don't like is when I hear about leveraging their influence on government regulatory administrations to block generic competition when their patents run out, or extending their patents past the amount of time when their drug's entrance to the market is new enough that it is meant to gain them a return on investment.
5. There is no doubt that drug companies will not invest in a product that shows little sign of sales potential. This is usually directly linked to efficacy and the seriousness/morbidity associated with the disease it treats. This is also sound business practice...like it or lump it. They will also dump a drug if data emerges that will likely result in a greater cost in litigation than they could hope to profit...cold yes, but also sound business...
There comes a point between profit and charity when the goal of healing or increasing quality of life becomes blurry and is eventually nearly non-existent. Every single doctor and nurse I have ever known (yes, every single one, and that includes family) relates this as a constant source of grief and stress in their job. In some cases, I've known doctors who have admitted the single reason they continue ongoing relationships with some sales reps is to keep a steady stream of sample packs for their... well, those for whom "healthcare" is less of a given. In those cases, I regard the doctors with a great deal of respect, not the producers from whom a single perscription can cost in the hundreds for the patients otherwise.
6. 80% of the encounters I have with reps, in the office, is in the form of....
Rep: so do you see much of illness X?
Me: A fair bit.
Rep: SO do you use much of Drug Y (their product) for illness X?
Me: I use it, as well as Drug W and Z, depends on their insurance coverage and the price, as most in that class are of equal efficacy.
Rep: Well thats fair, just keep us in mind.
and that would be the end of conversation, or at least end of Drug related convo.
I can't quote for you an alternate percentage, but I can say that the chances are that a conversation you describe signifies either a prior rapport between the salesperson and you or you have had greater experience with less pushy salespeople. I can see how that contributes to your interpretation. Here is a quote from a resident I know whose hospital has one of the more strict policies about contacts by reps:
anecdotal said:
They can invite us to dinners. I chose to go to one to see what it was like, as I was told that the speaker (an attending at my hospital) was quite good. It was at a fancy restaurant, open bar and all that. About 20 people were there, nurses/residents/docs. They prob spent about $80/person. I was disappointed in the talk. I had thought that the attending was going to present research, but all he had was a canned powerpoint from which he was not allowed to deviate. I did get to ask questions at the end about the validity of using med X versus all the other generic ones. He had a tough time answering because med X really isn't a first line choice, but he had to make it sound good for the pharm reps who were watching him.
And here is a practicing doctor's opinion of the same:
more anectodal said:
My office gets reps way too often. Internal medicine uses a lot of drugs in a wide variety of fields so we get tons of reps. For the patients's sake we sign their little forms so we can have samples of various drugs and then they leave us brochures and invite us to lectures. They actually bring us lunch several days a week. The lunch thing bugs me a lot.
I chose the more tame ones because I could copy them verbatim and because I'm not really making accusations past dubious sales practices when referring to reps.
(also, in full disclosure: it's not like I haven't taken advantage of free offers from the likes of Microsoft reps in the past)
Still, overall, I wouldn't call any of this a conspiracy, I certainly don't consider it necessarily "evil," so I still don't think many of the various wild accusations made in CTs have any extra merit just because the bigger pharma companies (like Merck) engage in somewhat monopolistic and questionable sales practices. I also have my problems with the automotive industry, also based on experiences related to me from people ranging from mechanics to those in companies who are developing some alternate-fuel vehicles, so I don't think I have quite the tenacity in my opinion as your average CT-ist might have in my negative opinion.
For this reason, we no longer buy drugs from other distributors in a second-hand manner. We now only receive drugs directly from the manufacturers.
