Physicians and Drug Reps

Transcription

1 Marketing to physicians Physicians and Drug Reps Exploring the dynamics of the relationship Susan Chimonas, PhD Troyen Brennan, MD, JD, MPH David Rothman, PhD Institute on Medicine as a Profession, Columbia University sc2254@columbia.edu 90,000 reps ( detailers ) in the U.S. - 1 for every 5 physicians Reps provide information and free gifts/services Medical equipment Promotional items golf balls, mugs, Ipods, etc. Office supplies pens, prescription pads, etc. Office assistance paperwork, samples, etc. Meals at restaurants, conferences, and seminars Trips and retreats Tickets to performances, sporting events, etc. Drug companies spend $7B/yr on reps and their gifts ($8,400 - $15,400 per doctor) Detailing increases healthcare costs and skews prescribing Physician attitudes The extent and impact of physician-detailer interactions are well documented, but little is know about how physicians view the relationship: What are physicians attitudes toward these interactions? Surveys reveal contradictory attitudes Doctors view interactions with reps as educational and ethical Yet they also believe detailing can compromise objectivity Most believe detailing affects colleagues prescribing Yet they feel they themselves are unaffected Most feel gifts are appropriate Yet they believe gifts can influence prescribing, and they do not want gift relationships made public

2 Making sense of contradictions Cognitive dissonance Question: How do physicians resolve the contradiction between their approval of detailing and their awareness of its ill-effects? Festinger: People prefer their beliefs/behaviors to be consistent. Inconsistencies cause people to experience discomfort, and they will attempt to reduce the dissonance Hypothesis: Physicians may use psychological mechanisms identified by cognitive dissonance theory Physicians face dissonance by interacting with detailers and knowing such interactions are intended to influence prescribing Methodology Focus groups: 1) probe physicians awareness of the conflicts of interest in their interactions with detailers 2) explore how they managed the attending dissonance Open-ended questions: Define conflict of interest, provide examples Hypothetical situation drug reps and gifts Results The contradiction between participants approval of detailing and their understanding of the inherent conflicts of interest emerged clearly Recognizing conflict of interest did not inhibit physicians interactions with detailers

3 Acknowledging conflicts of interest We re all conflicted In our industry, it s inherent. It s nice to see the people constantly They re dropping off pens and pads [because] drug reps want sales. I ll be honest, I miss getting the [sporting] tickets These things can be a form of kickback. It s basically just educational materials now The golden era is gone for physicians There are doctors that, if they re wined and dined, they re going to prescribe that product out of loyalty. Managing cognitive dissonance Welcoming detailers, lamenting restrictions on gifts Eliminating the dissonance altering one or more of the conflicting attitudes or behaviors Rationalization using additional information to reduce dissonance Denial forgetting or rejecting the significance of one of more conflicting elements We re not allowed to bring our significant others to dinner It s ridiculous, insulting Avoiding the issue I rarely think about it It s not something you generally wind up talking about. I don t think it s a big discussion [topic] with people, without really knowing who they re talking to. If you re either saying the wrong thing or getting people to think that they do things that they shouldn t do.

4 Avoiding responsibility There s always a conflict of interest, every time you decide to do a test there s a conflict of interest Every time you do it you re going to get a benefit from it. There s a conflict of interest in the procedure. I own stock in major pharmaceutical companies. And I prescribe their products. So is that a conflict of interest?...you cannot escape writing Pfizer medications. Today everything is owned by Pfizer. But it s my way of telling you that it [happens] at all levels. Emphasizing benefits I don t think it s a conflict of interest. It s a way of getting you to learn about a product. They just tell you about their product and you learn about it. A lot of the things I know about the new drugs, I learned from the pharmaceutical representatives. If I can get some of these samples, that s in the best interest of the patient Dismissing Harms Implications You accept the perks that are offered, but personally it never made any difference in what I have or have not prescribed. Voluntary codes of conduct are insufficient Prohibition of physician-detailer exchanges may be necessary Government regulation is intensifying Because physicians will not police themselves, the growing likelihood is that they will be policed by others I don t mind hearing their spin, I just take it with the appropriate grain of salt. One class of drugs has five products, so five reps are coming in to talk to you. It is not like one rep is coming and that is all you hear. These are two equal drugs, and you are coming a being nice and being helpful to the staff I m not hurting my patient What is wrong with that?

5 Table 1: Characteristics of Focus Group Participants Primary Care (n=18) Specialists (n=14) All (n=32) No. (%) male No. (%) in practice 1-10 years years 20+ years No. (%) in private practice 16 (89) 5 (28) 8 (44) 5 (28) 11 (61) 11 (79) 5 (36) 6 (43) 3 (21) 8 (57) 27 (84) 10 (31) 14 (44) 8 (25) 19 (59) Total costs Spending on Marketing vs Research Marketing* R&D* Merck 15% 6% Pfizer Bristol-Myers Squibb Pharmacia Abbott American Home Products Eli Lilly Schering-Plough Allergan *Percent of total revenues in 2000 (reported by Families USA)