Do pharmaceutical reps really influence doctors’ prescribing?

Yes, the evidence shows that they do.

It seems highly unlikely that pharmaceutical companies would spend so much money on promoting their products to doctors via pharmaceutical reps – more than US$6 billion annually in the USA – if reps were ineffective. It would also be irresponsible to their shareholders to spend money in this way. Unfortunately for those of us outside the pharmaceutical industry, we don’t get to see much of the industry’s data on the effectiveness of promotion.

We don’t see the data, but the companies do. We know that the profit from each rep must outweigh their total annual cost: salary, vehicle, training, gifts and other add-on costs. And we know the rep’s only method of making a profit is to influence what flows out of the doctor’s prescription printer.

Specifically, the profit comes from the extra volume of company products the doctor prescribes after seeing the rep, compared to the volume they would have prescribed anyway if they had not seen the rep. If this difference was nil or minimal (as many doctors claim would be their own case), all drug rep jobs would have vanished long ago. In fact, the after-costs profit from these extra scripts presumably totals more than $6 billion annually in the US, or the pharmaceutical industry needs some new accountants!

Many researchers have tried to study direct examples of whether promotion is linked to prescribing changes, and whether these prescribing differences are good or bad. In 2010, Geoff Spurling and colleagues did a systematic review of all such available studies looking at the provision of information from pharmaceutical companies and doctors’ prescribing. This included pharmaceutical reps, print advertising, meeting sponsorship and so on. They found that promotional information was not always linked to changes in prescribing, but when it was, it was almost always associated with more prescribing, lower quality prescribing, and more expensive prescribing. (Spurling)

According to a WHO report, in developing countries sales representatives are frequently the only source of drug information, and in some countries there are as many as one rep for every five doctors. (Norris)

The 2014 BBC documentary Panorama, in Who’s Paying Your Doctor interviewed Blair Hamrick, GSK Sales Rep 1997-2004, about the days of flying doctors to Disneyland or gifting the hardest-to-get tickets to Madonna concerts.


Hamrick:
We would have these CME programs that would get hours of CME credit for the doctors, that were nothing but a commercial.
There was a ‘Return On Investment’ (ROI) analysis, so if we spent $5000 on a speaker and $20,000 on tickets and food, that’s $25,000 invested. They would take all those physicians and they would monitor their prescription volume, and they would want to see an increase in prescriptions greater than $25,000.
Interviewer:
Did you generally see a good return on investment?
Hamrick:
Always. Always.

If pharmaceutical reps consistently improved doctors’ prescribing, we wouldn’t be running this campaign. However, given that the evidence points towards negative effects on doctors’ prescribing (i.e. lower quality, more expensive) we feel our campaign is important.

References