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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

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    Thursday, April 13, 2006

    Waiting Room Reading: This month's issue of the Atlantic Monthly has a depressing article on drug pushers - the legal kind. Here's a story from the salad days told by a former drug rep:

    One of the more important clinics Carbona called on was a practice there consisting of about fifty doctors. Although the practice had plenty of patients, it was struggling. This problem was not uncommon. When the movement toward corporate-style medicine got under way, in the 1980's and 1990's, many doctors found themselves ill-equipped to run a business; they didn't know much about how to actually make money. Carbona was detailing this practice twice a week and had gotten to know some of the clinicians pretty well. At one point a group of them asked him for help. "Gene, you work for a successful business," Carbona recalls them saying. "Is there any advice you could give us to help us turn the practice around?" At this point he kne he had stumbled upon an extraordinary opportunity.

    Carbona decided that the clinic needed a "practice-management consultant." And he and his colleagues at Astra Merck knew just the man: a finanical planner and accountant with whom they were very friendly. They wrote up a contract. They agreed to pay the consultant a flat fee of about $50,000 to advise the clinic. But they also gave him another incentive. Carbona says, "We told him that if he was successful there would be more business for him in the future, and by "successful," we meant a rise in prescriptions for our drugs.

    The consultant did an extremely thorough job.....He turned the practice into a profitable, smoothly running financial machine. And prescriptions for Astra Merck soared.

    When I asked Carbona how the consultant had increased Astra Merck's market share within the clinic so dramatically, he said that the consultant never pressed the doctors directly. Instead, he talked up Carbona. "Gene has put his neck on the line for you guys," he would tell them. "If this thing doesn't work, he might get fired."...."Those guys went berserk for me," Carbona says. Doctors at the newly vitalized practice prescribed so many Astra Merck drugs that he got a $140,000 bonus. The scheme was so successful that Carbona and his colleagues at Astra Merck decided to duplicate it in other practices.

    True? Or salesman braggadocio?

    The article goes on to posit that today, drug reps are being replaced by doctors. That's true, although I suspect this has always been one of their more successful strategies. They're just realizing now that it's a lot cheaper to get some respected specialists (or "thought leaders") in a community to talk up their drugs than to pay a salesman to do it. If you can convince a town's gastroenterologist to use the newest proton-pump inhibitor, then pretty soon all the generalists in the town will be using it, too, because suddenly it becomes the standard of care for that community. They've come to realize that the same strategy can work just as easily on a national level - with far more profit for them.

    Beware of specialists selling drugs.

    posted by Sydney on 4/13/2006 09:31:00 AM 0 comments


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