E-DRUG: Drug Reps, Doctors and Pharmacists
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[Here is the transcript of the relevant part of a radio program called "Too
Much Choice: Consumers and Competition" broadcast last sunday in Australia.
Beverley Snell]
Too Much Choice: Consumers and Competition
Background Briefing ABC Radio National (Australia)
Thursday 3 June 2004
Produced by Stephen Long
.........................
There's another industry where competition for the middle man is
causing serious concerns. When you visit a doctor, trust is vital.
But for the drug company the doctor is the key link in the supply
chain, a VIP to the pharmaceutical companies who are competing to get
their brand of drug prescribed.
Drug companies are spending huge sums on ways to influence doctors,
and that money adds to the cost of the medicine.
At Hurlstone Park, in Sydney's west, Dr Con Costa of the Doctors'
Reform Society, runs a busy GP practice. Con Costa shows me a diary
full of upcoming events and talks, hosted by drug companies at fine
restaurants and resorts.
Con Costa: That's coming up next week. Crystal Seafood Restaurant.
Stephen Long: Erectile dysfunction, depression, Crystal Seafood Restaurant.
Then he shows me a cupboard full of free samples from drug companies.
Con Costa: That's our cupboard. So I just gave that lady some
arthritis tablets and something for her stomach. For a couple of
reasons: one is she's been intolerant to them before so I thought
that rather than make her pay for a scrip and everything, I'd just
try and see the strategy first. If it works, then we'll write her out
some scripts. So obviously it's more convenient to have a few samples
to give the patients, especially as we know that about 30% of more
probably, even if we write the script, won't be able to go out and
afford to buy it, and probably about 50% of the scrips, we're not
sure how it's going to work out in the long run anyway.
Stephen Long: So there is an upside to getting the free samples, but
how much influence do you think it has on prescribing practices?
Con Costa: Well that's the downside. The downside is obviously that
you've got to spend a lot of time with the drug reps and most of that
time ends up being fairly confusing because they're detailing their
particular drug and highlighting the good bits and obviously not
mentioning the bad bits. And also, once you start a patient on a
sample, when they come back you're probably going to write them up
the same medication, even though there might be a cheaper one. But
it's just a bit too confusing to start the patient on one, and then
change it to another one. So there's a lot of influence, there's a
lot of downside but the upside is that you do have a cupboard full of
samples that you can give to your patients, especially as these drugs
are getting to be very expensive.
Stephen Long: A new code of conduct for the pharmaceuticals industry
is meant to limit the largesse and the pressures drug companies can
place on doctors, but it makes no mention of the disturbing amount of
information the companies are able to get about the doctors.
Con Costa: It's always a bit startling when during the lunch the drug
representative can actually look you directly in the face and say,
'Well, why aren't you prescribing our product?' and you might tell
them a white lie and say, 'Oh yes, I do', and they'll say, 'Oh no,
we've checked the figures with the local chemist and you haven't
written out any prescriptions'. "It's always a bit startling when
during the lunch the drug representative can actually look you
directly in the face and say, 'Well, why aren't you prescribing our
product?'" So obviously the doctor is probably the second stop in the
area, and the first stop is probably at the local pharmacist. And
maybe there's other ways that they get information on our prescribing
as well.
Stephen Long: So drug companies are actually finding out information
about your prescribing practices, very detailed information you
believe, from chemists. That seems like an invasion of privacy.
Con Costa: Well it is a bit unnerving when the drug rep seems to know
so much about you and your prescribing habits. Now whether they've
got that directly from the chemist or where they get those figures
from, I'm not 100% sure. What I am pretty sure about is that they
have got the figures, and that they will target doctors being fully
aware of what those doctors' prescribing habits are.
Stephen Long: And the drug companies' code of conduct doesn't say
anything about using sex and charm to sell.
Con Costa: I think a lot of doctors are vulnerable because of
overwork and too much stress. They're seeing sick, if you like to
term it, whinging people, complaining, a lot of people under stress,
they come to the doctor to get it off their shoulders. So when they
get a visit from a young often female drug rep in a short skirt or
see-through top if you like, of course they're going to make time for
them, of course they're to go maybe out at night and maybe that's
their only social event in their calendar. I've had one wife of a
doctor ring me once and complain bitterly about this situation, and
how much at the mercy her husband had become of the drug reps. You
can see how they would be susceptible to this sort of constant
attention and free gifts and often, sad to say it, but the drug rep
becomes the shoulder on which the doctor can cry on, if you like. So
it can become quite entwined, yes.
Stephen Long: There's no shortage of scientific studies linking the
marketing efforts of drug companies and inappropriate prescribing by
doctors. It's blowing out the costs of the Pharmaceutical Benefits
Scheme by encouraging doctors to prescribe the more expensive
medicines.
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