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My Kingdom for a Sandwich

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 14 in the March 19-20, 2005 issue of
The Mississauga News under the feature: Health & Wellness, Medical Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

It seems that the Canadian Media has suddenly woken up and realized that the pharmaceutical industry, while a vital aspect of health care, is above all else a business. It is about bottom lines, mergers and profits as much as it is about helping mankind. And like any other industry, it has a mandate to sell its products at the best possible price. Sales techniques are no different than in any other industry. There is one small difference. In the pharmaceutical world, the doctor is the unbiased, unpaid middleman who pre-approves the product before the consumer can touch it. The traditional approach was to hire a sales force and spend a certain amount of your budget trying to convince these middlemen that you have a product worth prescribing. Even larger and more lavish amounts are spent on pharmacists who actually buy the product. These strategies are costly and different yet less ethical approaches have appeared. One disturbing trend is marketing directly to the masses via television ads. The idea is to get patients banging on the doctor's door to demand a prescription for the product.

The pharmaceutical industry can be intensely competitive in some respects and yet hold monopolies in other respects. The industry has found a way of getting their executives together from time to time. The secret club finally found a name and was called the Research Based Pharmaceutical Company Club. In this forum, top officials from competing companies can meet behind closed doors and develop "policies". If anyone asks, it officially has nothing to do with decreasing advertising budgets or controlling competition, but is really about championing proper ethical "development" of those poor misguided physicians, yet accepting that pharmacists are always morally correct. It seems to me that if you are going to withdraw a particular marketing strategy, you had better make sure all the other boys on the block do the same. But, not all the boys will play this game, and some have decided that they want no part of this club.

I often feel sorry for the front line pharmaceutical representatives of today. These people are handed down increasingly impossible corporate rules under which to sell their products, and improve the bottom line. Time demands on doctors have increased exponentially, because simple tasks in the health system have been transformed into lengthy non-achievable ones. Not too many doctors are willing to sacrifice patient care time to meet with salesmen during office hours. Like telemarketers and the rest of the world, the talented sales force finds ways to get their message across after hours. The traditional way was to throw a "CME dinner". The basic scheme was to find a catchy title that assumes something of vital importance essential to everyday practice will be reviewed. Then hire a neutrally appearing doctor who will tell other doctors how good a certain product is, and throw in a nice dinner. Topics of these "educational" evenings were always selected and approved by the company and not by physicians. These polite commercials were not lavish parties and company reps were soon hard-pressed to find doctors willing to attend, apart from the culinary-challenged newly divorced ones. Newer and brighter ideas emerged, such as pushing products on the golf course. On the rare occasion, doctors and pharmacists would be invited to attend conferences in another city at company expense. The great majority of physicians that I know who attend worthwhile conferences pay out of their own pockets. Interactions take place without sacrificing patient care time. Both sides understand that it is a chance for doctors to get information about new products at the expense of family time. But no physician relies solely on a sales pitch for new product information.

This year, the old boys club has decided that it is time to expose the dirty secret. The hard working front line reps, of course, were racking up the expense accounts. Something needed to be done to improve profits. I mean ethics. The decision was that spending large amounts of money conveying product information on a personal level to physicians was perhaps unethical, but okay for pharmacists. I can only assume that the secret data showed that a nice steak dinner worked about as well as a Big Mac to change a doctor's view on a product. And this is coming from a group whose enormous profits largely depend on doctors? In the end, the new corporate "ethical" guidelines are telling reps that it is more "ethical" to throw working meetings at the golden arches instead of the Royal York.

I submit a more plausible explanation. In the real world, I am constantly inundated by salespeople. People selling me tickets to circuses that I have never heard of, people informing me that I have a free weekend awaiting for me at their resort, people asking me to test-drive their cars, buy their windows and get a door for free. Years of accidentally answering the telephone at dinner time have made doctors savvy consumers as well. Perhaps doctors do really care which medications they prescribe to their patients and the high priced sales events are not improving the bottom line for companies. It amazes me how much advertising money can be redirected to profits with the new "ethics". The real dark cloud is hanging over reps. Handcuffed by the new rules, they will be struggling to get the message out. If sales do not slump with this strategy, then the next step is to eliminate the front line reps all together. Without budgets and direct TV ads, perhaps next year's ethics will deem them surplus. I personally believe that the timing has been atrocious. The industry has had a year of product withdrawals, and trust from doctors is at an all time low and in serious need of rebuilding. I believe that most doctors will simply not trade golf balls for bad products.

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