Tuesday, May 15, 2007

Blog Readers' Opinions on Physician Marketing & Education Practices

According to a Government Accounting Office (GAO) report, pharmaceutical companies spend approximately 70% more money marketing to physicians than they do to consumers (see chart; click to enlarge).

The physician promotional data includes estimated spending on office and hospital-based promotion to physicians and journal advertising. These estimates do not include other spending, such as drug company spending on meetings and events (eg, CME and advertising at CME events, which could be as much as $1.5 billion). It also does not include fees paid to physicians for participating in post-marketing studies or for "consulting." As I pointed out previously (see "Dollars for Docs: More Scrutiny Needed"), some of these fees can be substantial.

Regular readers of Pharma Marketing Blog know that from time to time I host little opinion polls on various topics. In case you missed these polls, I have placed them in the column on the left. A new poll is reloaded every time to refresh the page.

Several polls on this blog addressed pharmaceutical physician marketing and education practices and the results to date are shown in the figure below.

Whoops! Wrong figure. That's the infamous bikini-clad sales rep (see here for that story).
See chart below for poll results.
The Necessity of Sales Reps
A big slice of the physician promotion pie goes towards supporting field-based sales reps. The average cost of a sales call by a rep may range from $200 to $500 (see "What Is Average Cost of Sales Call?").

What absolutely essential need does the rep fulfill? I originally asked this question back in January (see "Are Sales Reps Necessary?"). This got me banned from Cafe Pharma (see "Banned from CafePharma!"), but it was worth it to raise the issue and get feedback from readers (see poll results at top of chart above).

Surprisingly, almost twice as many votes were cast agreeing that pharma sales reps are unnecessary for any of the listed functions than votes agreeing that they were needed for all the listed functions (14% vs. 8%).

While "Source of Practical Information for Docs" got the most votes, I think this is not an "essential" function of sales reps. After all, physicians have multiple ways of getting drug information, including the Internet. However, I do see the utility of getting right in front of the doc and shoving the information in his/her face.

Free Lunches
Only 9% of the votes cast agreed that reps served an essential function by serving free lunches to physicians. In another poll (second from top in the chart above), a clear majority (62%) of respondents agreed that pharma should STOP serving free lunches altogether.

If pharma can't stop the lunches, then I suggest they serve healthy lunches instead of pizza and cupcakes. What kind of message does that menu send, especially to patients who see the food being rolled by them in the waiting room?

Soon, I expect pharma to start serving lunches to patients as well (see "Free lunch for patients! Why not?").

Consultant Fees
While pharma is being pressured to reveal who gets continuing medical education (CME) grants, a lot more money may be going to physicians as paid "consultants" (see "Dollars for Docs: More Scrutiny Needed").

A very large majority (71%) of respondents to a poll agree that the public has a right to see which physicians get consultant fees, for what and how much they get (see poll results at the bottom of the chart above).

To sum up, if reader opinion means anything, pharmaceutical companies should stop giving physicians free lunches and they should make public the consulting fees they pay to docs.

I respectfully await your rants!


  1. Interesting poll, no doubt. But as a former statistician, I have to remind you to point out that this is not a statistically sampled study. The poll is good for exploring the attitudes of some of your readers, and for bringing up issues for further discussion. It would be interesting to know some demographics on your readers/poll-takers. Just who are they?

  2. Sarah,

    Thanks for your comments.

    To be sure, nothing I do these days is scientific and it would be good to know more about the demographics of people who take these polls.

    My experience with other surveys that collect that type of info, suggests that about 30% of survey respondents are employed inside pharma/biotech.

    In any case, I am just cleaning house here and trying to get the results of these little polls out there and use them to start a discussion or continue one.

    BTW, I like the "pharmagather" feature of Cafe Pharma. But Pharmalot really dominates the list because of the number of # posts that Ed Silverman makes,not that there's anything wrong with hat ;-)

  3. Anonymous12:23 PM

    I would just like to say that as a former intern and resident working 100-hour weeks while making less than $30K a year, a free lunch now and then was a godsend and brightened up otherwise long and dreary days.

    The very thought of changing lunches from pizza to something healthy is heresy.

    I think it's fine to let the public see what type of paid consultancies physicians offer so long as they're not all painted with the same brush. Are there physician shills out there. Undoubtedly. However, what about the opinion leaders out there who are helping design and run trials for every company in a given therapeutic area? Will people understand that money doesn't mean tainted, and that some of these people actually, you know, get paid for being experts. For example, there was a meta-analysis in JACC last year by Chris Cannon and Eugene Braunwald that showed that intensive statin therapy was significantly more effective in preventing CV events than moderate therapy. On a well-known cardiology site, the very first message on the board regarding these results was, "what are the industry ties of the authors?" And I'm thinking, "are you kidding me? You're questioning the integrity of Cannon and Braunwald?" And that's from a cardiologist, not some random layperson.

    I agree that there are issues with Pharma industry, but sometimes I feel like people lose perspective of how industry, medicine, and scientific progress work, and certainly the Cannons and Nissens of the world should be paid for their time and expertise, just like any other professional in any other industry.

    p.s., Neither I, nor anyone I trained with was ever even remotely influenced by a drug lunch (N = at least 100)

    p.p.s, Seriously, though, I do understand why institutions are moving toward these "No Free Lunch" things, but really, cut the scut workers a break every now and then. If you've been there, you know how it sucked and how a free lunch was like having recess.

  4. Thanks for your comments.

    It appears that a lunch is not just a lunch, but, in some cases, it's like recess at school or a "godsend."

    This really puts into perspective the true value of a lunch, which is many times the monetary value.

    From that perspective, it's more likely than ever that free lunches can unduly influence physicians, regardless of the fact that dozens of these lunches have not influenced you.

  5. Anonymous4:24 PM

    I think you took a lot of liberty in reading into my comments. Geez, it was hyperbole for crying out loud! Your level of suspicion and disbelief is bordering on staggering.

    It's free pizza, no more, no less. I probably couldn't have told you who sponsored the lunch at the time, let alone an hour later or a year later. Besides, it's less about the pizza and more about having 15 or 30 minutes to rest. I can assure you that I was not somehow subtly and unconsciously brainwashed by the diabolical drug rep because I had some time to relax and have a couple slices.

    How do I know that my friends weren't influenced? I don't know, maybe by talking to them?

    Really, if you think I/we can be bought by some pizza and a Bic, you must have very little faith in people. Or just entirely anti-Pharma, which I know you say you're not, but I'm not convinced.

    To paraphrase Freud, sometimes pizza is just pizza. Really.

  6. Anonymous6:24 PM

    You must've posted your comment as I was responding. I also meant to post it into the new topic, in which you got all Woodward and Bernstein over my comments like you got the scoop of a lifetime, but I guess I'll just continue it here.

    I seriously think the level to which you're reading into this is lunch thing is ridiculous -- oh, it's not monetary, it's worth even more than that! The pizza is worth its weight in gold! It's bordering on parody.

    My comments, which I stand by on general substance, were made with considerable tongue-in-cheek. I think any doctor with a decent sense of humor would've sensed that. I'll chalk your enthusiasm up to inexperience ;-)

    Is it really heresy to substitute pizza. Well, no, not literally. But I don't want steamed vegetables when I go to a baseball game. It's context. Was it really like recess? No, because I'd been up for 36 hours surviving on instant coffee, just finished writing notes on 15 patients, and smelled like, well, a hospital. But was it nice to have a lunch provided where we could sit and, god forbid, relax? You bet. I know that gives you people the vapors, but get over it - it means nothing. A one-lunch stand, if you will.

    Let me ask: You must know some doctors personally, I'm sure. Perhaps even as friends. And given what I know of you, you probably associate with fairly upstanding people. Are they unduly influenced by drug reps? Could you imagine any of them being unduly influenced? If the answer is no, then why such disbelief that about my statement about former colleagues, or of doctors in general who claim they're not influenced?

    Like I've said, I don't deny that there are issues, but in the world of pharma and medicine, this is such piddling nothing, I have a hard time understanding your obsession with it.

  7. Chill out, dude. You need a valium, not pizza! You are so full of yourself that YOU cannot recognize when someone else makes comments "with considerable tongue-in-cheek"!

  8. Anonymous9:48 AM

    I'm perfectly calm, but I didn't see your post as tongue-in-cheek, and re-reading it, I still don't think you wrote it as such, but rather, as a validation of your assertion that drug lunches have influences beyond what one would even think.

    With the exception of the "pizza fanatic" part, nowhere do you even hint at joking. And given your overall agenda, there's no reason to believe otherwise.

    You didn't answer my question about physician acquaintances, though. I'd be curious to hear your answer/experience.

  9. Frankly, I do have some qualms about the influence reps have on one or two of my physicians. I mentioned this before in posts.

    My family practitioner, for example, has an office festooned with pens, stickers, and other "stuff" from pharma companies. She also often has 4-6 reps in her office at a time and free lunches delivered to boot.

    I respect her opinion, but all this pharma branding going on in her office gives me second thoughts, which is the LAST thing a doc wants to see.

    Do I know that this stuff unduly influences her? No. That is something nobody can prove.

    I will only point out that drug companies may be spending up to $1.65 billion per year on lunches to physicians and the number of details with accompanying lunches have increased dramatically since PhRMA initiated its guidelines for gifts to physicians (see http://pharmamkting.blogspot.com/2006/10/free-lunch-redux.html).

    It is apparent that drug companies think free lunches are important -- not that the lunches themselves influence docs, but the lunches "soften the beaches" allowing access to docs by reps who then can influence the docs.

    So, no, free lunches are not evil, but they are increasingly being used as a tool for reps to see docs who otherwise claim they are too busy to see reps.

    In my opinion, docs should be more motivated to open their doors by the information reps bring them than by the lunches. Perhaps the information is not as enticing as the pizza! Which is shame on the drug industry!

  10. Anonymous10:44 AM

    I don't think I disagree with anything you wrote. Yes, the lunches are likely more of a way of getting/ensuring time, rather than influencing in and of themselves.

    I don't know what to say about companies are spending almost $2B on lunches. Is it fundamentally bad? I don't know. I know pharma and medicine and drugs are not like selling widgets, but then again, there are salespeople who nonetheless have to get out to see their clients. I'm not Mr. Free Market-Atlas Shrugged guy, but for whatever misgivings I have about DTC and drug rep visits, there's part of me that does have a very basic problem with attempts to stop it. I should clarify that I have no problem with institutions or offices not allowing them, but I would have a problem with legislation or other overarching restriction preventing them. Then again, there are no more tobacco ads on TV or at ballparks, and TV liquor advertising has only recently returned, with pretty tight restrictions.

    A lot of docs do seem to be very receptive to the local liaisons/info reps, too, so that's good.

  11. I am not in favor of legilation against free lunch or reps talking to physicians. I do believe, however, that there be more transparency about the gifts that docs receive from pharma. I've blogged on this before suggesting that docs give patients access to their pharma gift policy like we get access to their privacy policy.

    Regarding banning of DTC, which is a separate issue, I note that even without advertising on TV, tobacco is doing very well, especially amongst young people! Now, I am not sure how they have managed that without TV ads -- could be all the other marketing they do, which tells me that there is life after DTC!

  12. Anonymous2:56 PM

    Although it's hard to pass up a free lunch, one of the sales reps who hasn't visited here in a while just handed out copies of an incredible book on the topic of malpractice prevention book called PHYSICIAN, PROTECT THYSELF co-written by a defense lawyer and physician. Normally they don't give us anything we can really use but this short book really is a godsend. I told her these were the type freebies pharma should be passing out, things that help us with issues that really matter to us. She said you can also find it on on-line, which I highly recommend.

  13. Now I may be very naïve in the matter - being a recent graduate just looking to fulfill my dreams. But Anonymous’ last post gave me the willies! From my perspective, I believe that Pharm Reps are there to help the Dr and the PATIENT. After all, the patient should be considered #1 priority when it comes to healthcare (I have a feeling I will be considered wrong by some). But I think that it’s ironic that this gift was considered a ‘godsend.’ It’s ironic because it doesn’t focus on the patient’s needs. But yet it was a hot button for this person, and therefore was affected by the salesperson’s approach: “What’s in it for ME?”
    Every company from Walmart to the small knick-knack store in Bo-dunk, USA needs to have a successful marketing strategy in order to thrive against competition. The lunch program is Pharma’s. Even though this may not be the most economical application of advertising, it projects directly to the consumer (or at least the most influential intermediary).
    From trends I have seen, the reason most people are against the Pharmaceutical Representative concept is the $$ used on/by them. They believe this is the ultimate source for high-priced medications. Whether the money goes into lunch programs or into TV ads, the money will still be used. That’s considered “business!” But a certain amount must be spent to increase revenue. Revenue ($billions) in-turn creates R&D ($billions), R&D turns into product, product must be marketed ($billions), etc. It’s an ever-evolving and inevitable cycle.
    If Pharma’s ways are forced to change, either by outside or inside influences, what do you feel are the best approaches to market a product that will benefit the Dr and the patient?


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