Wednesday, February 07, 2007

Has the Pharmaceutical Industry Doomed American Healthcare ?

posted Feb. 11, 2007, 11:42 AM:

The World is a dangerous place, not because of those who do evil,
but because of those who look on and do nothing" - Albert Einstein

Yesterday I sat with my husband in a Physician's office waiting for Botox and Cortisone injections in my neck, shoulder and back. All for an injury left from a worker's compensation automobile accident. As I sat and waited I over heard the nursing saying, "Jane, the doctor will see you now". The impeccably well groomed, cheerleading, young blonde wearing a stylish suit with a low cut blouse and high heels was quite a contrast to me and the other sweat suit clad patients waiting to see the doctor.

Jane quickly gathered her detail bag and box of doughnuts. Grinning and chattering with the receptionist at the window, she deposited her treats and a handful of scratch pads and ink pens bearing her company's logo and drug name at the nurse's station then swept past the exam rooms to the sample closet. I could hear the nurse's gleeful reception and greeting in the hallway before the door closed. This representative was obviously one of their favorites.

I had been waiting over 45 minutes in uncomfortable, uncontrollable pain to see my physician. Some of the other patients waiting had been there when I arrived. Yet, Jane had gotten here only ten minutes or so ago, had left her business card at the receptionist window and she was already in the back talking to the Physician. Probably has a lunch appointment I thought to myself….. just then the delivery boy stumbled into the office with his arms full of pizzas.

As I looked up from the latest issue of People, I allowed myself to reflect back over my career. It seemed like a lifetime ago when I had been young, naive, and ambitious enough to be one of the best in the pharmaceutical business. Just a decade ago, Jane could have easily been me.

In 1989, I had joined the pharmaceutical industry at the age of 23. I was right out of college and ready to make my mark on the corporate world. Raised in a family of medical professionals, I joined the ranks of pharmaceutical sales representatives. When I started in the industry in the late 1980's, only 1/3 of the industry was women. The companies hired intelligent good looking women. We were able to get past more receptionists, get to see more Physicians and were paid less. This was a win - win situation for the manufacturers.

I was trained and indoctrinated in a semi military style. In fact, basic sales training classes are much like boot camp and are designed to weed out the faint of heart or easily intimidated, as working with the egos of doctors can wear on even the strongest self- esteem. The trainers pushed new recruits to the breaking point, often giving them long hours of homework assignments into the night and over the weekends.
Representatives must video tape sales presentations and continually test their medical product knowledge. The environment is highly competitive and large numbers do not complete all tiers of their training before dropping out from the pressure. Those that do make it are glorified as the best of the best and are then unleashed on the medical field with a false sense of bravado that soon fades.

As a member of the SKF, BMS and Novartisteams, I received extensive and phenomenal training. As a specialty and hospital representative and trainer, I participated in preceptorship learning programs that medical students participate in. Viewing surgeries, heart transplants and learning about various laboratories and testing. I can go head- to -head with any Physician out there and can hold my own on disease state and product knowledge.

Over the years, I earned incredible trips for top sales. I drove extensively to cover large territories, I mentored, trained, worked with managed health care and volunteered with a variety of local organizations. Including working with children at the local epilepsy camp, helping the local Alzheimer'sAssociation raise funds and dressing up at Christmas as Mrs Claus with my partner to hand out donated gifts we collected to young patients at our Children's Hospital.

As a younger representative, I remember the pride and exuberance I felt at national meetings in which the loud speakers pounded out motivating themed music. The medical researchers and marketing managers gave exciting emotional speeches. I soaked in every word with anticipation and awe. I believed I was going to help people. That was my goal in life!

After years of meetings though, I realized that manufacturers instructed their representatives to promote the company's products in a given manner and with a particular focus. This is called marketing direction. Each promotional period there is a "tag line" or special message that the representative is supposed to drive home with the Physician. Sales literature and visual aids are all geared toward the promotional message, and they are utilized in role plays until the presentations flow naturally.

Representatives are taught to handle and minimize the objections physicians might have. They are given the specific wording that best represents the company's position. If a visual aid initiates too many negative questions from the Physician, the bar graph, product errors and so forth are reworked for the next sales quarter in a way that presents the information in a more favorable light. I soon learned the manipulative advantage of semantics in research is called statistics. (And in medical studies, statistics can be spun any way you want them to be spun. If they can't be spun to the company's advantage, the study is lost or buried so far behind other material it is never found or seen).

In spite of the voluntary guidelines instituted by the PDMA several years ago which require that gifts given to doctors remain of nominal value, reps make generous contributions to office parties, fund-raisers, and speaking engagements with the assistance of corporate funds. Even the most ethical, prudent practitioner can be influenced by interacting with a pharmaceutical rep. Sometimes even against his/her better judgment.

The ethical arguments about the relationship between individual physicians and reps have often been stated badly or at least incompletely. Those opposing cozy relationships often speak as if the reps are evil people or are guilty of moral wrong doing. Standard arguments also portray physicians as akin to putty in the hands of the reps. This portrayal elicited a rebuttal that appeared in the Wall Street Journalin response to an article about a campaign by medical students to banish reps from teaching hospitals– that these arguments cast reps "as schemers with more money than sense and doctors as easily manipulated marionettes. The goal of the pharmaceutical industry is to increase its profits, which includes persuading physicians to prescribe more of the most expensive drugs." Continually rising drug costs are not in the best interests of the patient population as a whole, and the most expensive or most heavily marketed drug may not be the best alternative for any given patient. A current example of this can be found in the State of Texasrequiring girls between the ages of 11 – 13 to have the vaccine for the prevention of cervical cancer. Yes, my 13 is vaccinated but is was my choice – not a choice that was made for me through legislators who are influenced through monies given to them by the pharmaceutical companies. With every 11 – 13 year old girl in this country being vaccinated, how much guaranteed revenuedo you think that will bring in for the manufacturer?

Representatives are not evil, but they are time-consuming and serve interests that often are at odds with those of the patients.

Over the years as my knowledge base grew from the specialized training I received, I started to better understand the drugs and the effect they had on the body systems. I also became more adept at interpreting clinical trial data and laboratory results. I realized that drugs which were nominally effective were touted as phenomenal and side effects and drug interactions were minimalized. I observed drugs being over utilized, over dosed, and improperly promoted "off label" for indications that were yet untested and / or unapproved. I watched as year after year the FDA approved dangerous drugs that were later removed from the market. I observed the defensive cover-ups and posturing employed by the industry to save their own reputations. But most importantly, I witnessed the demise of fair-balanced education in medicine.

This once prestigious industry has left me with many haunting images – disturbing experiences that have completely altered my perception of medicine and the institutions that guard its ethical practice. I started awakening to the truth about the greed, deception, and corruption that permeated my industry.

Recently, in a new territory, on one of my first meetings with a physician, this professional proceeded to tell me he would not do business with me unless I "worked with him". He threw a deck of business cards out on his desk with the names of various representatives that "work" with him and suggested I call them to discuss their rankings. He then proposed $150 / month as a fee and I could get all of his business in my product class.

In my years in the field, I have been sexually propositioned in exchange for business (in graphic detail), I have been groped and kissed on the lips by professional medical speakers before they left town and this is just a taste of the inappropriate behavior I have been subjected to with no recourse or concern from my management as long as numbers were coming in.

I have become a part-time caterer working over 60 hours a week and sometimes more with weekend seminars. My days begin with breakfast and grand rounds meetings and end with several late night dinner programs a week. After that, I get to go home (forget the bed time stories with the kids) and do paperwork until 2 or 3 am – generating reports that management will never read. Since we work out of our homes, we are on call 365 days a year 24/7.

I have worked hard. I have been honest on sales call reporting and expense reporting (something many sales reps take advantage of). I have subscribed to numerous medical journals and prided myself for my product and disease state knowledge in my areas of expertise. In the end, all the hard work, dedication, and loyalty meant nothing when the chips were down. The companies always look out for their own best interests – even when they caused the issues and problems. Instead of supporting their staff that is making them money, they support management. Sadly, I have watched as CYA has become the rule of the day and ethics have gone right out the window!

Don't fool yourself into thinking it's the representatives and physicians who are all to blame in this disastrous downfall of our health care industry. The United States health care system is killing Americans at an alarming rate, even though we spend over fifteen percent of the Gross National Product (GNP) on health care. Millions of children throughout the nation suffer needless pain because their parents lack health insurance and cannot afford to take them to the doctor. Millions of the elderly suffer similar pain because they cannot afford the prescription medication they rely upon to survive.

According to the Journal of the American Medical Association, our health care outcomes ranked only fifteenth among twenty-five industrialized nations worldwide. Adverse effects from prescription drugs have become the third-leading killer of Americans. Only heart disease and cancer claim more lives. We trust our doctors to inform us and our government to protect us from medical malfeasance that may put profits ahead of consumer health and safety. But the fine line walked by the FDA between the interests of the pharmaceutical manufacturers and the American public has continually been crossed. The result is the unleashing of an unprecedented number of lethal drugs on the U.S. market!

Since 1998, drug companies have spent $758 million on lobbying – more than any other industry according to government records analyzed by the Center for Public Integrity The industry had 1,274 lobbyists – more than two for every member of Congress.They are Powerful!

Over the years, these lobbyists have been very successful, demonstrating that the industry knows politics as well as it knows chemicals. Drug companies won coverage for prescriptions drugs under Medicare 2003 while blocking the government from negotiating price downward. And they have protected a system that uses company fees to speed the drug-approval process. The industry's deep inroads into the government are rooted in its dependence on federal decisions. The government determines which products drug companies can market and how they're labeled. The government buys massive quantities of drugs through Medicare, the VA and other programs. With the new Medicare prescription benefit plan of 2006, the government began paying for 41% of American's drug bills, up from 24%. In addition to its lobbyists, pharmaceutical makers are among the top donors to national political campaigns and conventions – favoring republicans 2 to 1 – giving away approximately 7.3 million dollars just for events and gatherings. To me, this seems to be a huge conflict of interest and detrimental to patient treatment outcomes.

Yes, I do agree it is very expensive to bring a new, innovative drug to market – somewhere in the ballpark of $1 billion. On the other hand, this industry wastes more money in one month on lobbyists, Fed Exshipments, cheap pens and too many uneducated sales reps with no purpose it's unbelievable. In addition, drug makers sell their message through TV advertising. During 2003-4 they spent a combined $45.1 million dollars on advertising on TV alone.

Due to the lax regulatory environment that the pharmaceutical industry has operated in, it is no wonder that they have come under increased public scrutiny. With all this in mind, it is also not surprising that Pfizer has recently received a letter from the AIDS Healthcare FoundationPresident Michael Weinstein stating:

After repeated attempts to engage Pfizeron the negative impact of its
marketing and advertising strategy and tactics for its erectile
dysfunction drug, Viagra, there has been no recognition by your
organization of the documented correlation between Viagra and the recent
rise in sexually transmitted diseases and HIV in men who have sex with
men. In addition, Pfizer has made no attempt to address this alarming

By not taking responsibility for the dangers resulting from the use of
Viagra, a blockbuster drug that has generated revenues of $1.65 billion
worldwide in 2006, Pfizer does not demonstrate corporate citizenship and
responsibility appropriate for an organization that profits from the
public's health. It is clear that Pfizer's efforts to educate and inform
consumers on its products are without regard for the safety of the
consumer, and therefore have no place in the patient-centered environment
AIDS Healthcare Foundationprovides.

Please inform your representatives that they will no longer be granted
access to AHF's 13 Healthcare Centers." Pfizer is once again pushing the advertising envelope with Viagra ads that encourage recreational use of the drug rather than address and treat a diagnosed medical condition, and in the process, we believe
Pfizer is ultimately jeopardizing the public health and wellbeing with its
Viagra advertising campaigns. This is why we are banning Pfizer's drug
representatives from our clinics and why we filed the lawsuit." Pfizer has engaged in and continues to engage in this conduct despite clear evidence of its illegality and harmful effects."

This volatile industry as a whole definitely needs some leadership.

The Nurses' voice brought my attention back to the present and reality. The reality is that I have spent the last 18 years contributing every waking moment to my profession. One that used to be a large caring family. One I was proud to say I was a part of. I have spent my life volunteering, educating, entertaining and helping others. Recently, sadly, I have had to come to the realization that I've contributed to lining the pockets of a multitude of uncaring CEOs who are guaranteed "golden parachutes" should something happen to their company position and may have unknowingly caused harm to the thousands of trusting, innocent people I had started out to help.

On top of all of this, I am now unemployed due to discrimination against me as a result of an automobile accident during work hours - while bringing in top sales and money for Sepracor pharmaceuticals, I was harassed by management – reported it to HR and top management and was then retaliated against and terminated. I have two children and a disabled husband that I care for. We have no income as I wait for neck surgery to have 2 of 6 injured discs fused. We have no insurance due to my husband's pre-existing condition. We can't afford the $1500 a month for COBRA on top of our other bills with no income. In addition my husband has over $1000 a month in prescription bills alone.

Sadly, I'm not alone. This industry would rather spend money on lawsuits than function with professionalism and integrity. Ultimately, we will all pay with higher drug prices. I can't afford more expensive drugs – Can You?!

We don't live lavishly. We represent the middle class. We work hard for what we have. We pay our taxes and our bills. We don't waste money. We save for our children's college education and retirement. We donate our time and resources to the United Wayand our Church to help the less fortunate. We value honesty, education and hard work.

Today, we are selling things off in our home – precious keep sakes – just to pay the bills and hopefully find medical coverage. This middle class family is now on its way to welfare support because of frivolous law suits that allow people who spill hot coffee on themselves to win millions in damages (when the idea of coffee is that it's hot). Yet, when hard working individuals are hurt by corporations, The federal government, the corporation nor anyone else seems to care until it happens to them! It can happen way too quickly - are you prepared?!

Write your Senators, Write your Congressmen – stop these companies and other like them from continuing to lie to and harm the citizens of this country. If we as a country continue to be in denial, our drug costs will continue to increase.

Politicians are always promising Americans access to things like education and better health care. Where have these promises led? Don't let the drug companies buy our legislators and researchers – Speak UP – we are the wealthiest country in the world and deserve to have a middle class that isn't afraid of losing their job every other day and we deserve the best medical care possible for ALL of our citizens!!

Copyright 2006 – Kimberly Elliott
5674 Telegraph Rd #211
St Louis, MO 63129

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