Pharmaceutical sales representatives working for the company Novartis are trained in such minute details as how to hold a pen when presenting information about a drug to a doctor, according to legal documents in an employment case.
The case concluded a years-long battle by 2,500 pharmaceutical representatives in California and other states to earn time-and-a-half pay for overtime work. They won and, along the way, earned support from the federal Department of Labor, which filed a friend-of-the-court brief.
The case was interesting in another light, though. It provided a window into the training and techniques of 6,000 workers nationwide who are paid to influence doctors to prescribe particular drugs.
A decision out of the 2nd U.S. Circuit Court of Appeals in New York City recounted the testimony of one Novartis salesman, who described the job as so prescribed that the sales reps are like “robots.”
“Brand managers” for Novartis tend to formulate the sales pitch and research articles that each representative is expected to deliver to doctors.
Representatives are trained in four “social styles” that people may have in interacting with others and “teaches the reps to tailor their presentations to a physician’s particular social style,” the court decision says. The sales reps are also trained in strategies to overcome a doctor’s objections if he or she does not prescribe a certain drug.
The company hires consultants to observe their most successful reps and incorporates the findings into training.
The court record says the company expects reps to visit doctors a certain number of times each trimester and has a “core message” for reps to deliver for each drug.
The sales representatives cannot deviate from the script. If doctors ask questions the sales representatives can’t answer, they instruct them to call the company’s medical division.
If doctors don’t take visits from sales reps, Novartis instructs them to “use other techniques to make contact, such as showing up at hospitals early and before medical rounds,” the court decision says. Another technique includes hosting meals for doctors where information about drugs is presented.
Data-gathering companies sell Novartis detailed information on prescribing by individual doctors for 72 percent of pharmacy-filled prescriptions. The company uses this information as a basis for determining the commission for sales reps, giving them more money if doctors in their territory are prescribing more Novartis drugs.
The pharmaceutical "detailing" is standard in the industry, but is controversial with academics and policymakers. Both have launched efforts to blunt its impacts, which are seen as padding a company bottom line without always resulting in the best treatment for patients.
Research has established for years that industry-funded research – which is likely what reps provide to doctors – is biased in favor of the funder.
To counteract the sales pitches delivered to doctors daily, some researchers are turning to “academic detailing.” It is a term for personal visits to doctors during which a detailer presents unbiased research on the most cost-effective and high-quality remedy for a medical problem.
Organized efforts to spread evidence-based and unbiased information have been limited, but apparently effective.
In California, state Assemblyman Bill Monning, D-Carmel, an attorney who is married to a doctor, introduced a bill that would limit the access that pharmaceutical companies have to individual doctor’s prescribing data.
Here’s a summary of what the bill, which died in committee this year, might have addressed:
The author believes that using prescribing information for marketing purposes increases health care costs, promotes irrational drug selection, threatens the professional integrity of the medical profession, and promotes harassing and invasive marketing practices by pharmaceutical companies. Additionally, the author states that prescription drugs are one of the fastest growing health care expenditures as pharmaceutical companies have an interest in encouraging doctors to prescribe newer, more expensive drugs.
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