The Devil's In The Detail (Men) Part One

[Guest guest]

..

This is "definitely" worth reading to the bottom.

Interesting history, interesting facts.......

 

Just me... Jan

Encourage One Another

===========================================

..

http://www.cancercoverup.com/newsletter/10-2004/Monthly Newsletter | www.CancerCoverup.com | October 2004"The Devil's In The Detail (Men) Part One"BY KATHLEEN B. DEOUL

Most Americans are painfully aware of the fact that health care costsare spiraling out of control. Many even understand that the exorbitantcost of prescription drugs is a major factor in the runaway inflationthat has afflicted healthcare spending. Few, however, are aware of therole that pharmaceutical sales representatives - called "detail men"in the industry - have played in this growing crisis.PILL PUSHERSEven a cursory examination of healthcare spending makes it evidentthat the current generation of doctors has been convinced that there'sa pill for everything that ails you - and even for some things that don't!U.S. sales of branded pharmaceuticals rose from $12 billion in 1980 to$58 billion in 1990 and $116 billion in 2000. According to theDepartment of Health and Human Services, Americans spent $162 onprescription drugs in 2002, an 11.3% increase from the previous year -at a time when inflation was virtually nonexistent!In fact, half of all Americans are now taking at least oneprescription drug and 7% are taking FIVE such medications. For seniorsthe numbers are even more stunning. Fully 94% of all people 65 andolder are taking at least one prescription drug and 23% take at leastFIVE! Among women over 65 12% or almost one in eight are taking TEN ormore prescription drugs!But who are these "detail men" (and increasingly women) who are behindthe tidal wave of pills that threatens to overwhelm our healthcare system?THE DETAIL MAN'S ROOTSDetail Men have actually been around a lot longer than you mightthink. The predecessors of today's "detail men" appeared on the scenearound 1850, peddling "proprietary" or "patent medicines" topharmacies, general stores and even post offices as well asdoor-to-door. These magic "elixirs" included such fancifully namedproducts as "Lydia Pinkham's Vegetable Compound,Dr. Kilmer'sSwamproot Kidney Liver Bladder Cure," and "Hall's Catarrh Cure." Itwas these names that gave rise to the characterization of patentmedicine peddlers as "snake oil salesmen," an ingredient that themedicines sometimes claimed to contain.The concoctions were most notable for two facts. First they all madeextravagant claims about their curative powers. Secondly, rather thancontaining snake oil, most were heavily laced with some type ofintoxicant. Alcohol was the favorite, but opium, cocaine and morphinewere used as well. It's small wonder that people felt better aftertaking them!This is not to say that none of them had any therapeutic value. Forexample, "Lydia Pinkham's Vegetable Compound," which was marketed totreat "the female complaint" was actually a suspension of themedicinal herb Black Cohosh in alcohol. Black Cohosh is widelyrecognized as an effective remedy for symptoms associated withmenopause and is currently being studied in a clinical trial at theNational Institute of Health's National Center for Complementary andAlternative Medicine.Of course, the fact that the root was dissolved in a solution that was20% alcohol - an amount roughly equal to the alcohol content of Portwine - didn't hurt its popularity.Pinkham eventually became a celebrity of sorts. She encouraged hercustomers to write her for advice and developed a wide following forher feminist viewpoint. Many of her correspondents, however, wereshocked to discover in 1905 that she had died 22 years earlier. Itturned out that the company employed a small army of women to answercorrespondence from carefully crafted form letters that advised themto solve their problem by taking more of the product!Even in the 19th Century, these predecessors of Big Pharma knew thevalue of advertising. One of the most successful was Frank J. Cheney,who owned the Cheney Medicine Company, manufacturer of "Hall's CatarrhCure." Cheney mailed two hundred thousand circulars promoting hisproduct daily. He was also instrumental in formation of the"Proprietary Medicine Association," the predecessor of today'spharmaceutical industry lobby and a powerful political force in itsheyday.An astute businessman, Cheney didn't limit his advertising to circulars.By his own estimate, he spent more than $20 million annually onadvertising in between 15,000 and 16,000 newspapers. This amounted toalmost $1500 for every newspaper he had a contract with. That comes tomore than $28,000 per paper in today's dollars!While being such a prominent advertiser would certainly have givenCheney clout with the press, he made sure he had a little insurance.He insisted that his advertising contracts included a so-called"silence clause" that stated "It is mutually agreed that this contract shall be null and voidif any law is enacted by your State restricting or prohibiting themanufacture or sale of proprietary medicines."Seeing a good thing, all of the other major patent medicinemanufacturers belonging to the Proprietary Medicine Association (andthat was virtually all of them) followed his lead - effectivelysilencing the press who were not about to publish anything in theirpages that could result in legislative action that could knock themoff the gravy train!Remember, patent medicine sales were BIG business in the 1800's. Intoday's dollars, their sales at the turn of the century would beroughly $1.5 billion and contemporary estimates indicated that as muchas one-third of that revenue was spent on advertising!Eventually, however their greed and contempt for the truth caught upwith them.In October of 1905 Colliers Magazine began a series of ten articlesabout the patent medicine business by noted muckraker Samuel HopkinsAdams. The expose revealed the actual content of some of the mostpopular nostrums, exposing the fact that most really were little morethan flavorings plus a heavy dose of alcohol or some other intoxicant.(One of the most popular patent medicines, laudanum - soldincidentally through the Sears and Roebuck catalog - was nothing morethan opium dissolved in alcohol.)Users of Lydia Pinkham's Vegetable Compound, many of whom were alsomembers of the Women's Christian Temperance Union, were shocked at thediscovery that it contained alcohol. The fact that the amount itcontained was reduced from the 20% of the original formulation to 15%by that time did little to assuage their anger. The same was true forusers of Hall's Catarrh Cure which was described in the article as "acheap cocktail."Following the Colliers expose, and under intense pressure from theWoman's Christian Temperance Movement, in 1906 Congress passed thePure Food and Drug Act bringing the era of patent medicines to a close.But the marketing lessons of that time were not lost on the modernpharmaceutical industry. Nor was the value of the snake oil salesmanin selling products.THE NEW SNAKE OIL SALESMENLike their predecessors in the 19th Century patent medicine business,Big Pharma knows the value of advertising. In 2001 the nine largestpharmaceutical companies - who produce the 50 drugs most oftenprescribed to seniors - spent $45.5 billion on advertising but just$19 billion on research.Big Pharma also understands the importance of the personal touch!Typically, the major drug manufacturers maintain a sales force ofnearly 5,000. Of these 4,000 sell to primary-care physicians - yourfamily doctor - and between 850 and 1,000 sell to specialists. This isfor EACH of the nine companies mind you.And their numbers keep growing.Between 1996 and 2001, the number of detail men more than doubled,rising from 42,000 to 90,000. Typically a major pharmaceutical companyspends around $1 billion to maintain this army of sales personnel. Incontrast, the Agency for Healthcare Quality and Research, the arm ofthe Department of Health and Human Services which oversees activitiesrelated to increasing the safety and effectiveness of medical practicehad a budget of only $303 million for fiscal year 2003!On the surface, however, it would seem that this enormous investmentwas hardly likely to bring much of a return.The average "detail call" costs between $100 and $150 exclusive of thecost of any medicine samples left behind. The trouble is that asalesman is only going to get to see the doctor about 20% of the time- one visit out of five. That means that the actual cost of seeing thedoctor is between $500 and $750! With the cost of samples left behindfollowing each visit, the total cost approaches $1,000! Even then, itwould seem that the visits could hardly be productive. Almost 40% ofthe time all the salesman gets to do is have a brief chat and drop offa sample. Almost 30% of the time they don't even get to do that but,instead are simply directed to leave their samples at the reception desk.So what's the big deal?Big Pharma understands something that most people don't: 70% to 80% ofall health care costs originate from a doctor's order. Whether it's atest, a procedure or, especially a prescription, it is the doctor whotells the patient to get it - and that really is a big deal.If the decision process can be influenced, the rewards can be enormous.How enormous?Scott Neslin of Dartmouth College performed an analysis of some 591drugs that each had annual revenues of at least $25 million between1995 and 1999. The purpose of his analysis was to find out howincreased spending on different forms of marketing affected theprofitability (return on investment) of each drug. He examined thefour principal methods Big Pharma used to market its products:detailing, direct-to-consumer advertising, medical journal advertisingand physician meetings and events. The results of the study werestunning. For every dollar spent on detailing, the company's return oninvestment increased by $1.72! That's a 72% rate of return - at a timewhen interest rates are under 5%!Those figures, however, were for all drugs. For the most popular items- those with $200 million or more in annual sales, the return oninvestment from detailing was almost beyond belief: $10.92! That'sroughly a 1000% rate of return. It's enough to make a Mafia loan sharkenvious. In comparison, advertising in medical journals for the sameclass of drugs had less than half the rate detailing did: $5.42 returnfor every dollar spent, and direct-to-consumer advertising a paltry(by these standards) $1.37.But can detailing really be that effective? After all, doctors arehighly educated, intelligent and sophisticated people (if you don'tbelieve it just ask one)! Could they be that vulnerable to theblandishments of modern-day snake oil salesmen?The evidence suggests they are.BLINDERS AND BLANDISHMENTSIn a classic study conducted of physicians in the Boston region,doctors were interviewed about the way they made prescribingdecisions. Initially they were asked to rate the relative importanceof several factors that could influence their prescription choices.The first factor they were asked to rate was their training andexperience.Fair enough, doctors spend anywhere from six to eight years learningtheir craft and the rest of their lives practicing it. As might beexpected some 67% said that training and experience were veryimportant in terms of influencing their prescribing decisions.Then they were asked about medical journal articles. After all,medical journal articles contained the latest information and doctorssupposedly read them like most people read light fiction. Again,unsurprisingly 62% of the doctors said that medical journal articleswere very important as an influence in their prescribing decisions.Finally, they were asked how important drug company advertisements andinformation provided by detail men - drug company salesrepresentatives - were in influencing their prescribing decisions.Here the response was quite different. The doctors interviewed allassured the researchers that such things had at best a "minimal"influence on their prescribing decisions. After all advertising wasself-serving, and detail men lacked the academic credentials they andtheir peers possessed.It was ludicrous to think that such marginally educated people couldpossible have any sort of significant influence.Or was it?The researchers then questioned the doctors about the properties of anumber of drugs. The drugs the researchers asked about were selectedbecause detail men routinely made claims about them that either werecontradicted by studies published in peer-reviewed journals or atleast were unsupported by research. In the majority of the cases, thedoctors parroted the false claims of the detail men rather than theactual data from studies and other medical research.In short, the same detail men they held in such contempt were actuallythe primary influence on their opinions concerning the drugs they wereprescribing.For example, fully half of the doctors said that Darvon was morepotent than aspirin even though there was no evidence to support thatconclusion. In their arrogance, they couldn't admit, even tothemselves, that they had had the wool pulled over their eyes. Theysimply had blinders on in regard to acknowledging the influence of BigPharma's blandishments.This might be little more than an object lesson in humility except forone thing: the influence of detail men on prescribing decisions iscosting all of us money - money that would otherwise be available tolower healthcare premiums!Just how bad is the problem?The experience of General Motors is a useful illustration of the trueextent of the problem.GENERAL MOTORS TAKES ON BIG PHARMAGM self-insures its employees. As a result, the company takes care toensure that it knows where its health care dollars are going. In 2001,an analysis of its prescription reimbursements uncovered the fact thatin that year alone GM had spent $52 million for the heartburn drugPrilosec. When GM investigated, it was stunned to discover that 91% ofthe patients who had been given prescriptions for the drug had noprior history of heartburn, and had not previously been prescribedheartburn medication.How could this have happened?GM blamed drug company ads. The year before Prilosec became GM'ssingle largest drug expense, Prilosec had set records as the mostheavily advertised drug on the market, and Astra-Zeneca detail menwere pushing it hard in doctor's offices.Interestingly, GM decided to fight fire with fire. It created whatwere in effect its own "detail men" and sent them out to the officesof doctors participating in their health plan with samples of genericheartburn drugs that were equally as effective as Prilosec urging themto prescribe the generics instead of the expensive brand-name alternative.What was the result?In the first year alone, the share of generic drugs prescribed to GMemployees rose by 3% saving the company $35 million!A PERVASIVE PROBLEMOf course, not every company has the financial resources to do what GMdid. Moreover, Prilosec is not the only example of how Big Pharma'sdetail men contribute to high health care costs. Nor is the problemlimited to the United States.For example a study of British doctors found that they too wereinfluenced by detail men and by Big Pharma's propaganda. Specifically,the study found a direct relationship between the extent to which adoctor had contact with detail men and used them as a source ofeducational material and their willingness to prescribe drugs producedby that company. The study also found that doctors who had frequentinteraction with detail men were likely to be dissatisfied if they sawa patient and were unable to write them a prescription for a drug.In other words, they had been brainwashed into believing that if theyDIDN'T prescribe a drug they FAILED as a doctor!Given the high prescribing rate in the United States, it would appearthat British doctors aren't the only ones who feel this way!Of course, in recent years, Big Pharma has applied another basicpublic relations notion to its detail force to make it more effective:the notion that sex sells!THE DETAIL (WO) MANIncreasingly over the past decade, the detail man has been replaced bythe detail woman and not just any woman - a drop-dead gorgeous, moviestar beautiful woman. Big Pharma understands that a harried physicianis much more likely to take a moment to talk to a stunning young womanthan they are to disrupt their busy schedule to talk to "one of theguys." Numerous studies of the relationship between doctors andpharmaceutical representatives point to the fact that establishing afriendly rapport is an essential element in gaining the ability toinfluence prescribing decisions. Protestations to the contrarynotwithstanding, it is not information, or journal articles or anyother sort of scientific data that is the primary source of influence- it is the strength of the personal relationship a doctor has with asales rep. Clearly, a beautiful woman has an advantage in establishingsuch a relationship.Of course, the industry can't really be faulted for using sex as atool. Everything from automobiles to running shoes rely to some degreeon images of beautiful women to hawk their products so why not drugs?The reason why is really quite simple: unlike automobiles, runningshoes or any of a thousand other products, the use of pharmaceuticalproducts have life and death consequences. Therefore prescribingdecisions need to be made on the basis of sound science and the bestinterest of the patient, not runaway testosterone!But while perhaps sordid, the use of sex as a sales tool is not themost objectionable innovation in how Big Pharma's snake oil salesmen(and women) are approaching their job. What is truly dangerous is theoutright corruption that has increasingly been uncovered - corruptionthat not only results in inflated costs, but endangers the health ofevery American. Next month in Part Two of "The Devil's in the Detail (Man)" theshocking truth about corruption in pharmaceutical sales will be revealed..

..

(amf)=========

=========

..

..