Bucket of Money What does a regional sales manager for a major international drug company see when he looks at a doctor's office? Here's how one sales manager puts it: "I see it like this: There is a big bucket of money sitting in every office. Every time you go in, you reach your hand in the bucket and grab a handful. The more times you are in, the more money goes in your pocket. Every time you make a call, you are looking to make more money." Wow - that's brutally honest! But here's what makes it appalling: The sales manager is talking about oncology doctors. That's right - he equates doctors who treat cancer with a big bucket of money. Executives for the sales manager's company (AstraZeneca) also found the comment just a little too honest: He was promptly fired. Pay pal About a year ago I was sitting in a doctor's waiting room when a pretty young woman - actually a VERY pretty young woman - walked in. She was wearing a stylish business suit and was pulling a luggage caddy loaded with a box labeled with the name of a popular prescription drug. No doubt about it - she was a drug rep paying a sales call. What really struck me was the conversation she had with the receptionist - they were like old friends catching up on personal details. The receptionist even pulled out a set of vacation photos and the two of them shuffled through the photos together, chatting and laughing. I thought about that scene when I read a Reuters Health article with this headline: "Posing as Pals, Drug Reps Sway Doctors' Choices." The article looks at two recent studies that examine the strategies drug reps use to win over doctors and influence their prescribing practices. When Michele Cagan covered these studies earlier this month on her HSI On the Spot blog, she wrote: "Doctors may think they're immune to the lunches, the free drug samples, and little gifts, but studies show the freebies have a lot of influence on prescribing practices. The drug companies know that, and they even tailor training programs to target particular types of doctors. One defector, former Eli Lilly drug rep Shahram Ahari, divulged that company's policy to tag doctors as one of eight personality types, then market to them accordingly." You can read Michele's complete write up - "Doctor or Drug-Company Drone?" (5/1/07) - at this link: http://www.hsibaltimore.com/redir/blog.html Integrity for sale Meanwhile, back at AstraZeneca, things are not going well. That "big bucket of money" quote appeared in an AstraZeneca newsletter, sent out in April, and was intended for internal distribution only. But when it jumped the internal loop and surfaced on the Internet, it set off tremors through AstraZeneca's sales ranks. But now, about a month later, we find out that this inflammatory incident is actually very small potatoes compared to the potential tsunami of legal problems prompted by AstraZeneca's sales strategy for a breast cancer drug known as Arimidex. (Worldwide sales for the drug totaled about $1.5 billion in 2006). Congressional Quarterly reports that a group of current and former AstraZeneca employees recently accused the company of developing a clearly defined marketing strategy aimed at persuading doctors to prescribe Arimidex for off-label use. Doctors can prescribe drugs for off-label conditions for which the FDA hasn't approved the drugs, but drug sales reps are strictly forbidden from encouraging such use. A Health and Human Services (HHS) investigation may soon be underway, complicated by the fact that AstraZeneca was fined $355 million in 2003 for improper marketing of a prostate cancer drug called Zoladex. At that time, AstraZeneca executives signed a Corporate Integrity Agreement with HHS, promising to adhere to established standards of conduct. Oops! I guess someone at AstraZeneca didn't get that memo. | 
