Wednesday, April 29, 2009

Dr Dale Console - 1960

Some drugs that are aggressively peddled by pharmaceutical manufacturers may do more harm than good, and the facts that physicians need to know about them may be concealed for commercial reasons. These charges against the industry were made last week by two outspoken physicians, one with personal experience in the business, the other a university expert on its products.

Dr. Arthur Dale Console, 46, former medical research director for E. R. Squibb & Sons, told the Senate Antitrust Subcommittee (TIME, Dec. 21), chaired by Tennessee's Democrat Estes Kefauver, that many drugs of high price but low medicinal value are being foisted on doctors and patients. Dr. Console emphasized that he was testifying about the industry as a whole and not as a witness against Squibb. (After recurrent bouts with tuberculosis, he quit the company to go into private practice in Princeton, N.J.) Then Dr. Console declared: "The incidence of disease cannot be manipulated, so increased sales volume must depend at least in part on the use of drugs . . . improperly prescribed."

The industry. Dr. Console noted, wears a cloak of "self-proclaimed virtue" for its costly research activities, stressing "that there are many failures for each successful drug." But, he charged, "the problem is that they market so many of their failures."

Under present law, a new drug may be marketed, "if it cannot be shown that it probably will kill too many people." Reluctantly, Dr. Console concluded, he is convinced that sweeping reforms dictated by federal law are the only solution, because a company that tried to live up to higher ethical standards could not survive in today's competition.

The keenness of that competition was emphasized by Ohio State University's Professor (of pharmacology) Chauncey D. Leake, 63, who is also president of the American Association for the Advancement of Science. The drug companies, said Dr. Leake, treat the nation's physicians as "simpletons" by flooding them with "flamboyant, exaggerated advertisements." And "these ads conceal for commercial reasons what is really essential for physicians to know."

The 20,000 "detail men" (salesmen who call on doctors) seldom give the physician the scientific background necessary for wise use of a new drug. "If promotional efforts were simpler and more informative," Dr. Leake contended, drug prices could be cut.

Source: Time

Insider's view: nearly half a century later what has changed?

Other than the "detail man" is now more likely to be female and there are nearly five times more of them!

Well, it could be argued that the industry has found ways of manipulating the incidence of disease. Consider "disease mongering" and diagnostic aids.

Comments welcomed!


Anonymous said...

As one who did patient care for over a decade before becoming a medical salesman, I'd like to offer these recommendations to those patient caregivers who are perhaps new to their profession:

1. Do not let those in the pharmaceutical or medical device industries, for example, interfere with or take priority over patient care.

2. Do not let the industry befriend your staff to gain access to doctors that work with them who are restoring the health of their patients.

3. Do have nurses only accept drug samples from drug reps. No literature of any kind from them. Likely, any clinical information the drug rep may have regarding the drug samples he or she may leave you is inaccurate.

4. Do let those you work with know they have a right to refuse interaction with the medical industries in their practice.

5. Do not answer questions from drug reps about what doctors prefer prescribing for their patients as it relates to their promoted products, or anything else about the health care providers at your location, for that matter.

6. Do not accept any promotional material unless it is truly beneficial for their patients, without branding on the material offered to members who work at your clinic or medical institution.

7. Do let the nurses know that drug reps. are overall not in their clinical setting to facilitate patient care, but to rather increase the volume of what they many be promoting, as this is the etiology for their interaction with you.

8. Do let others who you work wth that, if asked by medical representatives to have a disease screening day of some sort at your facility, or has invitations for such a screening for you or others to attend, consider refusing this request. Often, the screenings are conducted by front groups to expand the diagnostic boundaries of a particular disease state.

9. Do make others you may work with aware, or reiterate to them, that generic drugs are preferred over branded drugs for many reasons, including cost and experience with the medication while providing the safety and efficacy your patients need. Such drugs are listed in what is called an Orange Book.

10. Do let the nurse know that drug reps have in their possession the prescribing or buying habits of health care providers, and will tailor their interaction with them and the prescribers based on this data.

11. Do let others you may work with know that the drug reps are, overall, decent and friendly people who are just doing what they are instructed to do by their employer, and they should be aware of what they may be doing could be detrimental to the health of their patients, if such situations develop.

12. Do let those you may work with know that medical representatives who may be in your patient treatment area can question doctors about what they may choose to prescribe a patient. Yet such representatives should be aware that their time at your patient treatment area is limited.

13. Do let others you may work with know that there are doctors who receive inducements, incentives, rebates, and remuneration from particular drug reps. These gifts that are actually bribes are largely based on the prescriber's affinity for the drug. rep's promoted products or the volume of prescriptions a doctor writes compared with other health care providers. The potential consequences of accepting such bribes which the industry calls many things, including 'gifts', could have on the health of patients and the choices of treatment for them. Such bribing may cloud the judgment of the health care providers who receive such gifts..

14. Let others you may work with know that pharmaceuticals are not the answer to all symptoms or medical conditions. This is of particular importance when it comes to the issue of utilizing psychotropic drugs and antibiotics, as drugs are very over-utilized in the United States.

15. Let others who may work with you know that they should make patient care paramount when seeing patients, and should not let the industry coerce them into thinking otherwise. In other words, their idealism and passion straight out of school should be maintained, however difficult this may be at times. As a patient caregiver, you may get overwhelmed at times.

16. Let others you may work with know that, in the U.S., medical reps. have little training, education, or clinical knowledge relevant to what they may be promoting, however may have charming personalities and appear to possess quality genetic stock. What they may share with you about their promoted drugs is likely embellished or fabricated, if not fully understood by the medical representative.

17. Let others you may work with know that whatever is done for or with patients should be entirely for their benefit, and not for the benefit of a drug company or a health care provider, if such a situation develops or are noticed.

18. Speaking from the perception of the situation in the U.S., there is a shortage of nurses, and the demands on them are cumbersome and exhausting. Remind the nurses that this should not affect the treatment and care they give their patients, as difficult as this may be for the nurses. The pharma industry only amplifies this situation in various ways at certain times and locations. To say again, do not allow others to interfere with patient care.

19. Let others you may work with know that their vocations are noble and needed, and what they do for others most choose not to consider, such as drug reps., for example.

20. "Nursing would be a dream job if there were no doctors." --- Imo Philips

Dan Abshear

Anonymous said...

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.