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Kai Ryssdal: With an, if you can’t beat them, join them story… It’s about health care. Face time, as they say in sales, is one of the best ways to push a product. And nobody knows that better than drug companies. They’ve got almost 80,000 pharmaceutical sales reps out there. That’s one for every five doctors. And they are very good at what they do.
Sales of brand name prescription drugs in this country are worth billions of dollars a year. Thing is, states pick up a lot of that tab through programs like Medicare and Medicaid. Obviously, they’re looking to hold down costs anyway they can, which brings us to the join them part. States using drug company sales strategies to bring doctors a somewhat different message.
From our health desk at WHYY in Philadelphia, Gregory Warner reports.
GREGORY WARNER: Kristin Nocco works for the state of Pennsylvania as an academic detailer. Her job is to visit doctors and give them a rundown of the latest independent research on which drugs and other treatments work best for different conditions. The idea is to let doctors see how that expensive, brand name drug stacks up against the older, cheaper one. If, that is, Kristin can get through the door.
KRISTIN NOCCO: You’re dealing with front office staff who are used to dealing with a drug rep, “Hi, I’m from Lilly. Oh, hi, I’m from this oxygen company.” And now I’m this person who doesn’t have samples who… am I working for the government? To give the doctor education? It was a hard concept to get around.
The doctor’s staff is so used to hearing a sales pitch, the fact that Kristin doesn’t have anything to sell makes her suspect. Many times she’s been turned away.
And so, Kristin approaches every doctor’s office kind of like a fortress that must be scaled.
Eight thirty in the morning. She pulls her minivan into a doctor’s parking lot. She jumps out in a blue business suit.
Opening a pack of gum with one hand, she pulls an information booklet from a crate of brochures with the other, and wedges a five-pound bag of peppermints under her arm.
NOCCO: Give me my bag of mints!
WARNER: Mints? Is that crucial?
NOCCO: Every office, everyone wants a little mint, a little candy. I think it’s important to give someone something.
Kristin has a lot of practice getting into doctor’s offices because for years she worked as a sales rep for the drug company Eli Lilly. She sold Prozac, and Humulin, and something called Ceclor. She was that drug rep you’ve seen cruising into the doctor’s office, kibitzing with office staff, passing out freebies.
NOCCO: Here’s some pens for you or here’s some sticky pads, or, I got a mug that you’ll love.
All that stuff that’s illegal today.
NOCCO: Hi, Dr. Galante.
Now Kristin walks into the office armed with nothing but an information packet. And mints. She’s a familiar face now. The doctor leads us right in.
LISA GALANTE: It’s a little chilly still in here, sorry.
NOCCO: Well, I have my thermals on today!
Lisa Galante is a busy primary-care doctor. Like all the doctors in this education program, she sees a lot of elderly patients, prescribes a lot of drugs. And she tells me something most doctors aren’t so eager to admit.
GALANTE: You don’t have time as a doctor to verify what everybody’s telling you, you just kind of smile and sign for the samples! I mean basically in a rush rush rush rush! And Kristin comes in and gives you data looking at all the kind of summary of the research that’s out there.
The summary that Kristin presents is produced by Harvard. But you can tell someone’s worked hard to make it seem not so Ivy League. The idea behind academic detailing is to present the most respected research using the snazzy marketing of the drug companies. It’s glossy and colorful, with bullet points and simple charts easy to reference for a busy doctor.
GALANTE: So I feel like I’m getting non-biased information. I’m not just picking a drug because a drug rep put it in my head. I’m choosing it for the right reasons.
TOM SNEDDEN: The industry’s trying to sell a product. What we’re trying to sell is clinically-appropriate prescribing.
That’s Kristin’s boss, Tom Snedden. He runs a program for the state of Pennsylvania that helps low-income seniors pay for drugs. He’s hired 11 academic detailers like Kristin. Compared to Pennsylvania’s 8,000 drug reps, he says…
SNEDDEN: It’s a very small band of guerrillas.
Small but effective. Since the program began in 2005, the doctors who have met with academic detailers have prescribed fewer brand name drugs and fewer drugs overall. Snedden told me the savings offset the million-and-a-half dollars a year the state spends on the program.
Kristin says she’s not there to sway doctors off expensive drugs. She’s there to give them the information they need to make the best choice.
NOCCO: So now I’ve validated what you’re doing. You’re not doing it bad by choosing the cost-effective option.
It’s a strange world we live in when non-biased information needs its own sales rep. And yet, 10 states now have programs like the one in Pennsylvania. A bill making its way through Congress — separate from health care reform — would establish these programs around the country.
It’s not going to reduce the marketing by drug companies, of course. It just gives a little more face time to the other side.
In Philadelphia, I’m Gregory Warner for Marketplace.
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