Thinking about Life Sciences: Counterdetailing: A Cure for A Pharmaceuti... http://blog.aesisgroup.com//2008/03/17/counterdetailing-a-cure-for-a-ph...

Thinking about Life Sciences

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Monday, March 17, 2008

Counterdetailing: A Cure for A Pharmaceutical Addiction?

In a little known but very significant development, a Senate Special Committee on Aging held a hearing last Wednesday to hear
from industry experts on pharmaceutical marketing tactics and entertain “counterdetailing” proposals. Sen. Herb Kohl (D-WI)
who chairs the committee said:
“Pharmaceutical reps often confuse educating with selling, and evidence shows that doctors' prescribing patterns can be heavily influenced by
these sales representatives.”
I’ve written in some detail on pharmaceutical marketing and a blog entry from last Fall “A Pharmaceutical Addiction” which
summarizes what has become a spiraling “arms race” among pharmaceutical firms in building and sustaining vast armies of sales
reps who call upon physicians. In that article I point out how the pharma drug rep model has come under increasing attack due
to a number of factors and concerns such as:

Unsustainable high cost. Hence the massive layoffs that Pfizer announced last year.
Concerns that marketing costs add to the cost of drugs passed on to patients.
Ethical concerns about inappropriate pressures being made on physicians with respect to gifts and other benefits being
distributed by drug reps
The banning of pharmaceutical drug reps from some medical campuses including Stanford, Henry Ford and Rush University
medical centers.

Another article sums up many of the ethical and practical aspects relating to what one commentator described as the “monster
[created by] the pharma industry.” It’s a big problem. It has been estimated that the pharmaceutical industry spends nearly $20
billion annually on marketing to physicians in the form of gifts, lunches, drug samples and sponsorship of education programs.
The number of pharmaceutical sales representatives calling on physicians has more than doubled within less than a decade to over
100,000 now [Source: Pipal Research].
Many individuals and groups – both those in the industry and outside - would like to change the model. Despite the
attractiveness of free lunches and golf junkets, physicians generally resent the impositions on their time, pharma executives groan
under the spiraling costs and, of course, patient advocacy groups and regulatory agencies express concern about the ethical
challenges. Yet, it’s a hard nut to crack and calling it an “addiction” – metaphor as it is – may be quite apt.
Last week’s Senate committee hearings were quite interesting in this regard as Sen. Kohl also indicated that he along with Sen.
Richard Durbin (D-IL) would introduce legislation that would encourage “counterdetailing” programs. According to the Kaiser
Daily Health Policy Report:
“Kohl said that one grant program would help create training material to inform physicians about safety elements and comparative
effectiveness of different medications, and a second program would send trained health care professionals to physician offices to provide the
information to physicians.”
Apart from the details of such proposals, it is interesting to see the Senator’s approach to the problem. Some have cynically
lambasted “big pharma” for creating and sustaining the “marketing monster” but from direct personal experience I know that
many top pharmaceutical executives are keenly interested in solutions to the problem rather than sustaining what is ultimately an
unsustainable “arms race.” Of course, the term “addiction” has quite pejorative connotations but to the extent that “big pharma”
wants to get back to the business of bringing innovative medicines to the public rather than sustaining massive sales teams, the
“external” help suggested by Senators Durbin and Kohl should be welcome. These – as well as some proposals outlined in my
previous article – will help, rather than hinder, the pharmaceutical industry.
In this regard, I would think the pharmaceutical firms would embrace rather than counter these “counterdetailing” proposals.

Ogan Gurel, MD, MPhil

gurel@aesisgroup.com
http://blog.aesisgroup.com/

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