Another Point of View of Drug Representatives

By Richard A. Valentine, M.D.

Dr. Richard Valentine is a family practice physician in Phenix City, Alabama. He has been practicing medicine for over 25 years. Parts of this article were originally published as a letter to the editor in a local newspaper.

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On 9/2/02 in our local paper, there was an article by Tony Pugh of the Knight-Ridder newspapers entitled "Doctors closing the door to drug salespeople." The article raises a number of points. It generalizes that the reason that the drug costs are so high is that the salesforce has doubled in size (how un-American to hire people while everyone else is laying off workers). Tony cites that the drug houses spent 16 Billion persuading doctors to prescribe their drugs. Nonsense! They indeed may have spent that much detailing their medicines, but, trying to "persuade" a doctor to do what they want is like trying to herd cats. It's impossible! Doctors are the most fiercely independent thinkers on the planet.

He states that drug companies gave away $ 10.6 Billion worth of free medicines last year "in order to maximize sales of their patented drugs". Isn't this the American Way? And he gives them no thanks for it. A $10.6 Billion giveaway deserves at least an "atta boy", does it not? How drug reps work differs in no way from the Budweiser sales force..or tire salesmen. They are lobbyists for their industry and operate much the same as lobbyists in the halls of congress. This is how business is conducted in America.

Factually incorrect is the statement that "one of the aims ...is to ward off generic competition". Actually, once a drug becomes generic, the reps cease promoting it because they are all or partly paid on commission and there is no commission for generic drugs. He assumes that generics are "therapeutically equivalent" to brand name drugs when in reality, the generic makers are held to a lower standard than the "ethical drug companies" and may be off as much as 15-25% in drug content and effectiveness. Some drugs should never be taken generically due to this reason.

The American Medical Student Association is quoted as having a policy urging doctors not to accept promotional gifts and to ban drug company funded lectures and lunches. I understand their idealism but I doubt they will continue their policy once they become doctors out in the field. These lectures, even if sponsored by a drug company, allow doctors to learn from local, regional and sometimes nationally respected authorities on diseases we treat commonly. For some of us in small towns, it's a welcome opportunity to brush up up on the latest treatments. The speakers, while admittedly being paid by the drug houses, are not just shills for the drug companies (we wouldn't listen to them if they were) and present the benefits of all the medicines available for treating a disease and, of course, mention the company's drug along with the rest. The comment that the information coming from drug reps was 11% inaccurate and was in error in favor of their drug may be correct...but how does that compare to the information coming from the stock brokerage houses?

When it costs $800 Million -$1 billion to bring a new drug to market and the patent (which is 17 years from the date the drug is submitted to the FDA for consideration) may expire in 5 years because 12 years were soaked up doing research, one can see there is only a short time to recoup those huge costs. If the FDA would either lighten up on their requirements or extend the effective patent life on a drug, the drug costs would come down.

Drug reps are professional, educated, family people with a difficult job to perform. Although they supply me with free samples to give to my needy patients and afford me access to continued education....they do not ask me to sell my soul in return...just to listen to what they have to say. That's the trade off. They shall always be welcome in my office.