Physician Education vs. Promotion

Pharmaceutical meetings and events have become an integral component of the drug industry's promotional efforts used to gain face time with physicians. According to a Verispan Sales Force Effectiveness audit in 2004, 63% of physicians surveyed considered rep-arranged meetings and events to be more or much more effective than a traditional detail. Only 12% characterized events as less or much less effective. Versipan Press Release.

An article in today's Wall Street Journal ("To Sell Their Drugs, Companies Increasingly Rely on Doctors") offers an explanation of why physicians might consider pharma-sponsored meetings more effective than traditional details: it's the money! Also, the free food.

Hiring a doctor as a speaker and providing a free meal for the attendees is still acceptable -- and, data suggest, highly effective. An internal study done by Merck & Co. several years ago calculated the "return on investment" from doctor-led discussion groups was almost double the return on meetings led by the company's own sales force. WSJ.

According to Merck documents cited in the article, the "return on investment" of doctor-led discussion groups is 3.66 times the investment, versus 1.96 times for a meeting with a sales representative.

According to the document, doctors who attended a lecture by another doctor wrote an additional $623.55 worth of prescriptions for the painkiller Vioxx over a 12-month period compared with doctors who didn't attend. Doctors who participated in the more intimate discussions wrote an additional $717.53 worth of prescriptions for Vioxx, which Merck pulled from the market last year over concerns about cardiovascular side effects. That compared to an increase of only $165.87 in Vioxx prescriptions by doctors who attended a meeting with a salesperson. WSJ.

Return on Education
These meetings are supposed to be educational and non-promotional. One doc who often speaks at such meetings was quoted as saying to his pharma sponsor: "Your job is to sell the drug and my job is to educate."

Measuring ROI of educational meetings is considered unacceptable by continuing medical education standards and may indicate a breakdown in the "firewall" that many pharma companies have erected between promotion and education.

If the budget for education no longer comes from the marketing team but from professional services, then there should be no measurement of "return on investment" in the traditional sense: i.e., in which new prescriptions written are tracked after physicians receive education.

Some physician education professionals prefer to talk about ROE or return on education (see, for example, "A Strategic Approach to CME Offers High Return on Education Investment").

"However, many pharma companies lack interest in the return on education investment or ROE data our programs are able to provide," says Jan Heybroek, Vice President at Imedex, Inc., an accredited worldwide CME provider located in Alpharetta, Georgia.

Training vs. Promotion
Aside from the ROI issue, the article touches on another sensitive issue regarding education vs. promotion: paying physicians as "consultants" to attend meetings, the purpose of which is to "train" them as speakers.

Pharma companies may pay physicians $750 to attend such meetings in exchange for agreeing to be speakers. It is claimed that many attend, but few are called upon to fulfill their obligation to speak.

A Pfizer spokeswoman -- why are pharma spokepeople invariably women and not men? -- was quoted as saying: "We would never knowingly train them and not use them."

Yes, because to do so would violate the "PhRMA Code on Interactions with Healthcare Professionals" (also see "PhRMA Code Helps Re-define Roles of Medical Affairs and Marketing") as well as risk running afoul of the HHS' Office of Inspector General (OIG), which can fine you big time!

Are Docs Naive?
Critics claim that many docs naively believe that pharma-sponsored meetings are non-promotional:

"An awful lot of the doctors in the audience are naive about the fact that these are really sales talks," says Jerry Avorn, a professor of medicine at Harvard Medical School and author of a recent book that criticized drug companies' marketing.

Please excuse me while I LOL.

I haven't read Avorn's book, which has gotten good reviews on Amazon.com, but it's difficult to believe that intelligent, professional people with over 20 years of schooling would confuse promotion with education.