Angry Doctor

Wednesday, February 08, 2006


I have nothing against drug reps as people.

They are educated (most if not all have a degree, sometimes two), intelligent (they sound like they know what they are actually talking about), and smart (they can teach doctors how to use that new laser machine, or how to insert the new implant), and as mentioned in the comments to the previous post, most have the personality and appearance to do sales. I try to deal with them honestly and professionally, and occasionally they respond in kind.

They don't have the easiest job, and they don't deal with the easiest bunch of people to deal with. (It's bad enough to have to push a new, expensive drug that is only marginally better than its predecessor or closest competitor, but wait till you are the guy assigned to push the company's brand of paracetamol or children's vitamin syrup...)

I'm not out to make things difficult for them, but I think we should all be aware of the consequences of our actions.

What a drug rep does (if he or she is doing the job correctly) is to influence doctors to prescribe a medication over other brands (not necessarily type), for reasons other than purely medical ones. The means by which they do this have already been discussed, and we can assume that they succeed because they are still in employment.

There is a cost behind this, consisting of the salary of the drug reps, their commission (if any?), the costs of all the free gifts and lunches, plus all the advertising material and literature.

Ultimately, the cost is passed on to the patients, or in cases of subsidised patients, taxpayers too.

I'm aware that as people working in the 'healthcare sector', we all to a degree live off people's misfortunes and fears. But at the end of the day, I would like to feel that what I am doing is about supplying a need, and not creating a want.



  • Qn:
    What makes you think that by rejecting those pens and lunches = lower costs to patients?

    Strictly from economic point of view, at the end of the day it only means Higher Profit margin for the pharma companies without having to print special mugs (premiums)for every product. They'll just give themselves Bigger salaries for doing such a good job. :)

    Always thought the hospital/clinic chains will have better negotiating power (??) Since there are only so many hospitals in S'pore, who else can these drug companies sell to, right?
    It's not like you selling Consumer goods to mass mkt and have so many mkt segments to target and manipulate.

    So the tougher the hospital/ pharmacy -the person who decides to buy and negotiates for the purchase, to push down the price of the drug. That's where Your Patients benefit from lower costs, isn't it?

    The free premiums and lunches will automatically Stop when the profit margin Drops.

    Have you ever asked the drug reps why all these gimmicks when they do their sales pitch to the doctors? ... want to pamper the poor doctors also kena whacked...

    By Blogger pretzel, At February 08, 2006 6:29 pm  

  • Rejecting freebies is not about lowering costs for patients, but about sending a message about your objectivity and independence.

    "want to pamper the poor doctors also kena whacked..."


    By Blogger angry doc, At February 08, 2006 7:11 pm  

  • I suppose it's not really the doctors who are wacking the drug reps or "doctor pamperers"

    It's the public. It's the patients. They perceive it to be doctors being in cahoots with the drug companies to rip them off their money.

    The doctors rejecting free lunches are trying to send out a message to the public that not all of us are susceptible to such marketing tactics and "bribes"

    .....want to reject bribes from pharmas and be good doctor to the poor patients also kena whacked....

    By Blogger Dr Oz bloke, At February 08, 2006 8:13 pm  

  • muahahahaha...i'm still subsisting on the leftover pens, post-it notes, etc. makes you wonder how much of freebies i took from them :-p

    By Blogger andrew, At February 08, 2006 9:33 pm  

  • I take what they give and pass it to my HOs etc., keeping just enough for my own use. Like pretzel said, rejecting isn't going to change drug prices.
    Since my prescibing practice is not influenced by the gifts, am I honest to my patients or dishonest to the drug reps? :)
    Anyway, what about big ticket items like sponsorship to legit international conferences? Would you accept it if there was no other way you could ever afford to go on your own?

    By Anonymous Anonymous, At February 08, 2006 9:51 pm  

  • "Would you accept it if there was no other way you could ever afford to go on your own?"

    I won't.

    I believe in paying for my own education.

    If I really wanted/needed to go, I would take a loan that I can repay.

    By Blogger angry doc, At February 08, 2006 10:10 pm  

  • The female reps who detail me are almost without exception 'smoking hot'.

    I understand that many college cheerleaders are recruited for detail jobs.

    They're bright, bouncy, have nice smiles, and have an easier time than most convincing men to do what they want.



    By Blogger Big Lebowski Store, At February 09, 2006 12:47 am  

  • I've noticed a similar trend here in Oz, Dr Flea ;-)

    I had a medical colleague I was sharing clinic space with a few years back. Youngish lady, very charismatic, very physically attractive.

    She was approached by a drug company to work as a specialist pharma sales rep...and was offered much more than she was earning as a doc !

    By Blogger Dr Dork, At February 09, 2006 2:24 am  

  • I think it's all about business really. Sad to say.

    Money dollars and cents is taking priority over care for sick people.

    I'm not trying to belittle health care professionals here nor the pharmas. But in reality if the entire structure was on a purely voluntary or charity basis, how many would stay in the industry?

    So the bottom line is that it's all designed to make money and profits.

    Shareholders demand that the drug companies make money. So too the larger health care networks. Everybody wants to make more money.

    Patients and governments demand that health care bills are kept low and affordable. But then some of the very same people would applaud when their stock holdings in the health care industry go up due to reports of ballooning revenues and earnings.

    You can't please everybody.

    By Blogger Dr Oz bloke, At February 09, 2006 9:46 am  

  • Sure it's a business.

    Making toys is a business.

    Running a casino is a business.

    Cutting down rainforests to make ranches is a business.

    It's about what kind of business you want to work for.

    By Blogger angry doc, At February 09, 2006 10:53 am  

  • It's also about what kind of business people are willing to pay for.

    The reality is people tend to go wherever the money is.

    Morals and ethics sometimes go out the window.

    With regards to morals. This question has been posed to students before.

    Would you steal from the baker today to feed your starving family, or would you let your family starve because stealing is wrong?

    Perhaps somethings in life are also not so clear cut.

    By Blogger Dr Oz bloke, At February 09, 2006 11:06 am  

  • An inappropriate analogy. None of the educated, intelligent, smart drug reps are in a 'work for big pharma or family will starve to death' situation, as far as I know.

    By Blogger angry doc, At February 09, 2006 11:21 am  

  • Is your beef with the drug reps?

    I personally don't blame them. They are just doing their job.

    It is not easy to get a job these days. Sometimes we doctor do not understand that point (we had a job the moment we entered med sch)

    I think it would be unfair to say to the drug reps "You should not have this job. By having this job, you are supporting the evil pharmas who are spending more on marketing than research, giving freebies to bribe doctors...."

    It's not the drug reps. They just happen to be on the frontline and represent a face to the whole business.

    By Blogger Dr Oz bloke, At February 09, 2006 11:24 am  

  • They are in it because they think it's upmarket talking to docs. What they don't realise at the beginning is that they think these docs are big spenders.

    In actuality, they are not what these eagle beavers imagined. On the contrary, more like it. That's why there is a big staff turnover for these pharma companies. Look at the ads. in the "appointments" page.

    I am just wondering why GPs in Clinics count every penny. Is it a very tough profession to earn money. Seems so to me.

    By Blogger uglybaldie, At February 09, 2006 11:35 am  

  • I'm saying one should be aware of the impact of what one is doing.

    If one honestly believes that the drugs being sold are genuinely better for the patients, and the means used to advertise them are fair, then that's fine.

    If I were working for a clinic that prescribed sleeping pills inappropriately, I don't think 'just doing my job' and 'just happen to be on the frontline and represent a face' are adequate defences.

    By Blogger angry doc, At February 09, 2006 11:36 am  

  • Well that's where added responsibility is as a professional.

    The professional body will come after you if you step out of line.

    However for non-professionals, there are no such added restrictions. They are just bound by the law. Morals? Ethics?

    So I think these people see things very differently from us, they are also subject to very different judgments.

    I guess that's the burden we have as doctors. We will never be able to run away from accusation of doctors making money like it's a sin. But when it comes to the drug reps and pharmas. It's part of life to people.

    By Blogger Dr Oz bloke, At February 09, 2006 12:14 pm  

  • so conclusion sale people have no morals!!!! They are just in it for the money!!!

    Sometime I think you are being too idealistic.

    The whole pharma idustry is drivien by profits. Can you find good and novel drugs if there is no constant profits pumping back into the system. How many philantrophist are willing to pump in millions for the good of mankind? I am not sure you can even find one.

    So you can only choose betwen a pharma industry that continues to create new and useful drugs fueled by profits or a pharma industry that waits for funds to pour in before any discovery is made.

    To think about it, if no active advertising and promotion of drug use from the pharma compnay do you think they will survive with flagging sales. Even with star product after the patent they might be facing a death sentence, unless they have enough to create a new and useful product.

    Should the pharma industry be profit driven? The ideal answer is no. Of course we have seen the ill effects of pushing drugs into the market eariler than they are supposed to. The reality however is the funds for reseach has to come from somewhere. The question is who will provide this money.

    By Anonymous Anonymous, At February 09, 2006 12:23 pm  

  • just to add that doctors I believe are trained to make the best decision for the patients.

    By Anonymous Anonymous, At February 09, 2006 12:26 pm  

  • I am not idealistic.

    Forgive me, as I was trying to play devil's advocate.

    The point is that nothing is ever that clear cut in life. I wrote that in a previous comment. Perhaps you didn't read it.

    Sales is far from being all about money. Sales is actually service. "sel" is norweigian for serve.

    As a doctor I do sales. The earlier people accept that sales is part and parcel of our lives and not a bad thing the better they will be at whatever they do.

    The way the world works, the economies, the stock markets, the governments etc....can they really be judged on a right or wrong basis?

    I don't think so.

    By Blogger Dr Oz bloke, At February 09, 2006 12:39 pm  

  • I don't think it's a matter of sales people having no morals. If you understand the impact of what you are doing and are fine with that, I think that's moral integrity. My point is that we should all be aware of how our professions impact on other people.

    I am not so idealistic that I expect drug companies to work without profits, but the amount of profits and the means of marketing need to be examined in the context of what they make. It's one thing if you make a car that the ordinary person cannot afford, or market a soft drink that people can actually live without, but another if you price a life-saving drug beyond the reach of many, or sell an unsafe or un-needed drug to people who are ill.

    What the companies make in profits and what the spend on marketing far exceed what they put into research, so it's not a matter of them living hand-to-mouth just so they can save people. Money is being spent to prolong patents and increase market share against competitor for existing drugs.

    Examine their claims that the profits are necessary for research of new drugs carefully (as you should all data people provide on this blog), and decide for yourself whether they should change their ways.

    By Blogger angry doc, At February 09, 2006 1:01 pm  

  • "just to add that doctors I believe are trained to make the best decision for the patients."

    Haha. I believe doctors are trained to lay out the best options for the patient, but the patient himself must decide what the best decision is.

    By Blogger angry doc, At February 09, 2006 1:42 pm  

  • We have no problem paying top $$$ for the good kind doctor who puts his/her patient’s welfare as priority.
    But got serious problem with paying obscene monies to unethical doctors.
    That’s the diff.

    Doctors always tell us how they have to endure verbal abuse from upset patients, overworked, given up changing the system, etc… now got an ally (albeit with vested interest) willing to pamper you lot with opportunities to attend free seminars, networking sessions for knowledge sharing amongst your peers, chance to be away from the daily routine to re-charge yourself… and you agonize over this???
    Why make life so difficult for yourself?

    To those companies, those pens and mugs are nothg… it’s not like they give you gold bars or smthg. That’s out right Bribery.
    Alternatively, the hospital/organization as a whole can set a policy about staff accepting gifts from vendors.. then makes life easier for you lorr.
    But it means the hospital has to spend more $$ on stationery --> higher operating costs --> charge patients higher fees... back to Square One *Bleah*

    By Blogger pretzel, At February 09, 2006 3:06 pm  

  • Yeah, why make life difficult for yourself, the organisation you work for, the pharmas, the world in general.

    Little knick knacks just some advertising material to keep you and others aware that they, the pharmas exist. Nothing more than that. Free luncheons and conference cruises, you can choose not to go isn't it, if you're so concerned about these goodwill gestures swaying your judgement when writing out the prescription. No one is going to hold a gun to your head and say you must prescribe X medicine or else!

    Be at peace with yourself. I've said this but I wish to repeat in case you did not get the message:

    You can't change the world and it's not gonna change for you.

    By Blogger uglybaldie, At February 09, 2006 7:30 pm  

  • "You can't change the world and it's not gonna change for you."

    Exactly. But you can change the way YOU think. You can change the way YOU react. You can change YOUR attitudes. You can change YOUR actions.

    The reality is that the only thing we are really in control, is our thoughts and our actions.

    It begins with me.

    By Blogger Dr Oz bloke, At February 10, 2006 10:06 am  

  • Spot on.

    I've changed myself to adapt to the new reality. You probably haven't because you are still asleep in the realm of fools.

    No impossible idealism, no misguided charity, no need to scrooge on my pets, no debts, no obligations to anyone, no hangups, no regrets.

    And look at me now!

    By Blogger uglybaldie, At February 10, 2006 10:44 am  

  • Dear OZ,

    "You probably haven't because you are still asleep in the realm of fools."

    Sorry, that was uncalled for.

    Beg your Pardon.

    By Blogger uglybaldie, At February 10, 2006 10:57 am  

  • See? I took your advice.

    I've changed!

    Not many people had the privilege of me saying "sorry" to. :p

    By Blogger uglybaldie, At February 10, 2006 11:18 am  

  • Wah an apology from uglybaldie!

    I must go buy TOTO liao.

    By Blogger Dr Oz bloke, At February 10, 2006 2:12 pm  

  • I believe this is an imperfect world. There is alot to change but I guess it is an uphill battle. People are spurred by monetary benefits. That seems to be motivating factor for the investors in the pharma industry.

    "Haha. I believe doctors are trained to lay out the best options for the patient, but the patient himself must decide what the best decision is."

    I think doctors do make many decisions for the patient. Maybe some do it more often then others. In a sense the doctors are given a trust to make accurate judgment and decisions.

    "You can't change the world and it's not gonna change for you"

    I guess if one has not tried they might never know. Maybe someone here can indeed change the world with a new system. People who dream big dreams might just revolutionise the healthcare profession. For me I too pragmatic to pursue such lofty goals :)

    By Anonymous Anonymous, At February 10, 2006 3:17 pm  

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