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  • drdianehamilton 7:29 am on January 10, 2012 Permalink | Reply
    Tags: , , doctors, , Formularies, , , , Pharmaceutical lobby, , ,   

    Top 5 Reasons Why Big Pharmaceutical Companies are Failing: An Inside Perspective 

    The Wall Street Journal recently reported how drug companies are using cues taken from Disney to improve lagging sales.  I usually do not write opinion articles, but having worked as a pharmaceutical representative for 15 years, I witnessed a lot of mistakes in the industry that I believe should be uncovered.  While high pressured sales pitches may be causing some of the problems facing Big Pharma, there were plenty of other issues that I experienced.

    1. Too Many Reps – The biggest problem I saw was the number of sales representatives hired.  When I began selling pharmaceuticals in 1985, I had my own territory.  It consisted of several zip codes.  My job was to call on doctors within those zip codes once a month.  In that sales call, I presented information about my drug.  As time went by, leadership decided that if one person could do so well calling on doctors, having two people delivering the same message would just improve sales.  They began to think it was inspired to just double the amount of reps.  By the time I left in 2002, there were eight of us in my territory all delivering the same message to the same doctors.  It is no wonder that doctors began to stop seeing reps.  Doctors were tired of being overwhelmed by the same information.  While it may sound bad that a company like AstraZeneca is laying off 24% of its sales staff, perhaps it is important to realize that they may have had too many sales reps in the first place.
    2. Rewarding Mediocrity – The commission structure was set up in way that did not inspire motivation.  My company set up forecasts so that reps would attain around 105% of projections.  If a representative came in at 100%, the next year, their forecast would be decreased.  If the representative came in at 120%, the next year, their forecast would be increased.  There was no real incentive to do well, because it would catch up in the next cycle. Reps also were paid most of their income as a base salary.  Commissions were a smaller part of their income.  In the Wall Street Journal article, it mentioned that companies are now considering changing the way they pay commissions.  In the past, commissions were based on number of sales.  Companies like Glaxo are now considering basing commissions on physician satisfaction.  Now that I am just a patient and not a rep, I would rather a doctor wrote me a prescription for a drug because it is the best drug and not because they are satisfied with a drug rep’s performance.
    3. Lack of Control – A pharmaceutical rep either sold a drug that was or was not on a formulary.  A formulary is the list of medications an insurance company will pay for if a doctor prescribes it.  If the drug he or she sold was on the insurance company’s formulary that the doctor used, then the rep had a fighting chance of convincing the doctor to prescribe the medication.  If not, the rep had little effect because patients would not be willing to pay cash for their prescriptions.  The reps had no control over getting drugs on the formularies.  That was someone else’s job.  The lack of control led to low sales and poor performance.
    4. Training not Realistic – Pharmaceutical reps go through intense training before entering the field.  In that training, they are taught sales scripts.  These scripts were things they should say when they were in the doctors’ offices.  When a rep would get out into the field, they quickly saw that the training was not realistic.  They did not have the kind of time to say the kinds of things they were taught.  Doctors were too busy.  My boss basically told me to forget everything they taught me and just be conversational.  This is interesting to me now that the Wall Street Journal article claims that this style is now being embraced by Lilly.
    5. Doctors’ Preferences – Like it or not, many of the reasons people are given the medications are due to doctors’ friendships with and preferences for their reps.  I had a doctor tell me that he wrote a medication for a rep he hated just because he saw him so much it was “just in his mind” to do so.  He did not choose the drug because it was better.  The Wall Street Journal article explained that a psychiatrist deliberately wrote for a competitive product just because he did not like the rep.  It was disturbing to me to see the reasons why a doctor prescribed what they prescribed.  It usually was based on familiarity and friendship rather than anything else.

    I was fortunate that I was successful in my 15 years as a pharmaceutical rep.  I was a multiple winner of their coveted “Presidents Circle of Sales” award. However, some of my success was based on luck.  If my drug was on a formulary, it made my job a lot easier.  Now that I am a Professor of Business, I see many problems with their business model.  It may have worked for a while, but over time, there have been cracks in a less than solid foundation.

    I believe that a lot of the problem in that industry is due to the lack of time doctors put forth in terms of researching their medications.  I have witnessed a lot of scary things that doctors have done over the years.  I witnessed a lot of doctors who only obtained information about medications based on a sales pitch.  I would rather have a well-informed doctor that has done his research prescribe my medication, than a physician who liked the lunch or “performance” delivered by the rep that was just in his office before I arrived for my appointment.

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  • drdianehamilton 10:36 pm on September 14, 2011 Permalink | Reply
    Tags: Annals of Family Medicine, Antidepressant, , doctors, , IMS Health, Journal of Internal Medicine, , Primary care, Primary care physician   

    Acceptance of Treatment of Depression 

    Article first published as Acceptance of Treatment of Depression on Technorati.

    As more people find themselves suffering from depression, more individuals are not reporting their symptoms to their doctors. The reason for this is based on their fear of the treatment their doctor may recommend. 

    The Annals of Family Medicine recently published an article titled Suffering in Silence: Reasons for Not Disclosing Depression in Primary Care.  In this study, they found that out of 1054 adults studied, 43% of them were reluctant to disclose symptoms of depression to their physicians. “Concern that the physician would prescribe antidepressants was the leading reason for nondisclosure of depression, far surpassing concerns about referral for psychotherapy. These findings suggest that patients lack confidence in their ability to negotiate an acceptable plan of care that reflects their treatment preferences.”


    In the Annals study, the authors found that over 87% of respondents felt that their primary care physician was the appropriate source for depression care.  In the article Which Doctor is Best for Treating Depression, it was noted, “Studies show that 74% of people seeking help for depression will first go to their primary care physician. Of these cases, as many as 50% are misdiagnosed. Even of the cases that are correctly diagnosed, 80% are given too little medication for too short a time.”

    In Medscape Today, it was noted that psychiatrists sometimes prefer for family practitioners to treat mild-to-moderate depression as long as they do the proper analysis, “Screening is best accomplished with the brief 9-item Patient Health Questionnaire (PHQ-9). Patients are asked how often they experience certain problems, such as lack of interest in activities, trouble sleeping, loss of appetite, inability to concentrate, and thoughts about death. Easy to use and score, this tool allows you to determine the severity of the illness.”

    For those who have had side effects to prior medications, the thought of trying something that may make them feel worse may be a real concern.  In The Journal of Internal Medicine article,  Older Patients’ Aversion to Antidepressants, the authors found, “Four themes characterized resistance to antidepressants: (1) fear of dependence; (2) resistance to viewing depressive symptoms as a medical illness; (3) concern that antidepressants will prevent natural sadness; (4) prior negative experiences with medications for depression.”

    It may be easier for physicians to prescribe an antidepressant than to spend time researching other possible causes of their patients’ symptoms.  Primary care physicians are prescribing more antidepressants than ever.  “Nearly three-quarters of all prescriptions for anti-depressants are written without a specific diagnosis.  This has medical experts worried that anti-depressants are being prescribed too often to patients who may not need them. According to IMS Health, an estimated total of 254 million prescriptions were written for anti-depressants last year alone, up from 231 million in 2006.  Each year, Americans spend $10 billion on anti-depressants. Additionally, seven percent of all visits to a primary care doctor end up with a prescription being written for anti-depressants.”

    While some may say that depression is on the rise, others argue that people are looking for a panacea or are requesting medications due to direct to consumer advertisements by the drug manufacturers. 

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  • drdianehamilton 11:22 pm on September 12, 2011 Permalink | Reply
    Tags: , , doctors, , , Investigative Medical, Medical, Pharmaceutical industry, , ProPublica   

    Scary Things Doctors Do: New Investigative Tool for Patients 

    Most doctors do wonderful things. They take care of their patients and work very hard. I’m married to a fantastic doctor, so I know they exist.  However, having spent 15 years as a pharmaceutical representative, I saw some scary things out there.  It’s important to keep in mind that someone had to graduate last in their class.  Here is a list of things that I actually saw occur in doctors’ offices while I was in the field.

    1. Illegal drug use in doctor’s office – There was one office where the receptionist actually had her boyfriend shoot something (I assume heroine) into her arm while I talked to her through the glass partition that separated the waiting room from the doctor’s area.  The reaction she got from the medication made it clear it was some form of illegal substance.  The doctor walked right by and had no reaction. 
    2. Doctors popping pills – There was one doctor I called on who would take Prozac while he chatted, bragging, “I take these things to lose weight.”  This same guy was always popping some form of pill, usually for an off-label use.
    3. Doctors committing fraud – Another doctor in my territory was arrested for charging the government for testing blood that he never actually tested.
    4. Doctors not using best medications to save money – I called on a doctor who once told me that he would not prescribe a drug that he thought he was good for his patients because, as he put it, “that comes out of my budget  . . . if they go to the ER, someone else pays for it.”  He had no problem telling me that he didn’t mind if his patients suffered if it meant he could make a few more bucks from the HMO. 
    5. Doctors getting paid by pharmaceutical companies – It is not unusual for a doctor to get paid to speak for certain pharmaceutical companies.  I remember calling on a particular doctor who made it very clear that he not only spoke for a particular company but also had a great deal of stock in that company. Because of this relationship, he had no intention of using competitive products even if they were better. 

    The good news is that the Internet allows for patients investigate issues with their doctors.  According to the article, How To Find Out if Your Doctor and Drugmakers Are In A Relationship, “The nonprofit investigative journalism outfit ProPublica has a tool you can use to see how much money your doctor has received from drug companies.”  To find out if your doctor is profiting from drug companies, click here to go to the ProPublica site.

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    • drdianehamilton 8:17 am on March 1, 2012 Permalink | Reply


      I am so sorry to hear about your experience. You seem to have done all of the right things by contacting the police and legal council. You might consider contacting the medical board to see what they advise.

  • drdianehamilton 10:20 pm on August 1, 2010 Permalink | Reply
    Tags: , , doctors, doctors social media, , , , , Medical Ethics, , ,   

    Is it OK for Doctors to Use Social Media? 

      With Twitter breaking the 20 billion tweet record, social media has shown it is becoming the way for people to communicate.  Businesses are using sites like Twitter, Facebook, LinkedIn and others to get their messages across.  Doctors have traditionally been slow to get into some forms of advertising.  Some feel it doesn’t seem professional.  Others just don’t have the time.  However, there are some things that social media could offer for many physicians such as ability to stay in contact with patients, answering common questions, possible virtual visits, and a general enhanced patient relationship.  

        The question may be where to draw the line?   Is it OK to offer medical information online if there is a demand for it?  The New York Times reported: a survey by Pew Internet and American Life Project reported 61% of Americans will go online for health information.   Doctors are looking for guidance as to what is acceptable in terms of how close of a relationship is deemed appropriate in terms of communication.  This has lead to the first set of guidelines ever published on using e-mail in patient care.   Anonymity is a huge issue when dealing with patients and HIPAA (The Health Insurance Portability and Accountability Act).  HIPAA was devised partly to ensure protecting the privacy of Americans’ personal health records by protecting the security and confidentiality of health care information.

        However, helpful information can be shared through social media if it is general in nature and doesn’t involve specific patient information.  Mayo clinic is even tweeting these days.  Are you ready to be friends with your physician on Facebook? Are there better avenues such as LinkedIn or other more professional sites where contact would be a better option?  Michael Lara, MD recently stated that he felt there are 5 social medial tools for physicians that he considers helpful:

    1.  Facebook Practice Page
    2. Google Reader for Medical Articles and News
    3. YouTube Channel for Patient Education Library
    4. Twitter for Connecting with Colleagues
    5. Practice Blog 

        I know a lot of physicians from my 15 years being a pharmaceutical representative and being married to a plastic surgeon.  From my experience, I see that they have a lot on their plates; learning social media may not be a priority for them.  That is not to say they may not benefit from hiring a social media manager.  Wouldn’t it be interesting to see which of your messages gets through to your physician in a timelier manner some day. . . the message you sent where you had to sit on the phone system listening to the recording asking you to push 1 for appointment desk, 2 for billing . . .  or the message that you tweeted to them quickly from your iphone . . .

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