MinTankesmie

- Opplyser ikke om bivirkninger

Opplyser ikke om bivirkninger
aftenposten.no 6.7.2010
Legemiddelverket har dukket uanmeldt opp på 28 møter mellom leger og Legemiddelindustrien de siste årene. På 24 av møtene ga selgerne gal eller skjev informasjon. (...)

Fastlege Odd Bøyesen ved Markveien legesenter i Oslo, kjenner godt til hvordan legemiddelindustrien kommuniserer med leger som skal holde seg oppdatert om ny medisin på markedet. Regelmessig møter han selgere på kontoret og på konferanser.

– Informasjonen er pakket inn på en måte som skal selge. Men det blir feil når selgerne underrapporterer bivirkninger, overvurderer effekten av preparatet og ikke tar hensyn til samfunnsøkonomisk nytte. Hvis vi blir villedet, er det klart det kan gå ut over pasientene, sier Bøyesen.

Nå viser nemlig 28 uanmeldte tilsyn Legemiddelverket har foretatt, at Legemiddelindustrien svært ofte feilinformerer legene. (...)

(Anm: Legemiddelindustrien. (mintankesmie.no).)

- Ulovlig markedsføring av legemidler

Alarmerende resultater
Undersøgelse: Ulovlig markedsføring af lægemidler
bt.dk 27.6.2011
Den danske lægemiddelindustri bryder reglerne, når industriens sælgere opsøger læger for at markedsføre deres medicin.

Over halvdelen af de praktiserende læger har således oplevet, at lægemiddelindustriens repræsentanter uopfordret fortæller lægerne, at et lægemiddel kan bruges til andet, end det er godkendt til. Det viser en rundspørge, som Praktiserende Lægers Organisation (PLO) har foretaget i samråd med DRs nyhedsmagasin, 21 Søndag.

Formanden for PLO, Henrik Dibbern, kalder det alarmerende:

- Jeg synes, det er gravalvorligt, for denne praksis er klart i strid med reglerne. Det her stiller et ganske alvorligt spørgsmålstegn ved lægemiddelindustriens samlede troværdighed, siger Henrik Dibbern til DR Nyheder.

Patienters sikkerhed er på spilUndersøgelsen er baseret på svar fra 402 læger - og viser tydeligt, at de regler, der skal styre medicinalindustriens markedsføring ikke overholdes.

Ifølge reglerne må et medicinalfirmas sælgere således ikke reklamere for, at et lægemiddel kan bruges til andre sygdomme, end det er godkendt til. Alligevel har 51 procent af de praktiserende læger i undersøgelsen oplevet, at sælgerne har gjort lige netop det.

PLO-formanden mener, at det i sidste instans er patienternes sikkerhed, der er på spil, når industriens markedsføring ikke følger reglerne.

- Industrien har en voldsom påvirkning af lægerne, og når de ikke engang følger reglerne i vores kontakt med dem, så bliver vi meget bekymrede for, om den påvirkning er til gavn for vores patienter, og jeg er bange for, at svaret er, at det er den ikke et langt stykke af vejen, siger Henrik Dibbern. (...)

(Anm: Forskrivning utenfor preparatomtale ("off label") (utenfor indikasjon). (mintankesmie.no).)

- Tett regulering av franske legemiddelkonsulenter betyr at franske leger får en mer balansert informasjon enn i USA

Tight regulation of French drug reps mean French doctors get more balanced information than doctors in the US (Tett regulering av franske legemiddelkonsulenter betyr at franske leger får en mer balansert informasjon enn i USA)
BMJ 2010; 341:c6964 (3 December)
Limits placed by French authorities on what can be said and done by drug company sales representatives mean doctors in France receive more balanced information than their counterparts in the United States and Canada, a meeting on the regulation of drug promotion and the protection of public health was told.

Drug sales representatives in France provided information on harmful side effects of drugs in 60% of their encounters with doctors, but their counterparts in the US and Canada provided this information in fewer than 40% of encounters, according to results from a three country study of interactions between family doctors and drug sales representatives.

The French doctors were also rarely offered free samples (4% of them compared with 75% of doctors at the Vancouver site), and only 0.2% of French doctors were offered lunch or other food, compared with 23% in Vancouver and 24% at the US site in Sacramento, California, said Barbara Mintzes of the University of British Columbia. (...)

(Anm: Interessekonflikter, bestikkelser og korrupsjon (mintankesmie.no).)

- Bør du være bekymret dersom din lege står på Big pharmas lønningsliste

Should you be worried if your doctor is on Big Pharma's payroll? (Bør du være bekymret dersom din lege står på Big pharmas lønningsliste)
nashvillescene.com 2.12.2010
The time-honored relationship between the drug rep and the doctor dates back decades. In the old days, a representative of the pharmaceutical industry would simply pay a visit to a doctor's office, bearing gifts: sandwiches, samples of Paxil, brochures, and in the headier days of "doctor detailing" — that's what industry calls these visits — tickets to professional sporting events and all-expense-paid tropical vacations. The drug reps are often young, attractive, scrubbed, well-coiffed and intensely personable, and as long as they don't come right out and ask the doctor to prescribe more of a certain drug so they can meet their quota, they remain welcome guests in most offices.

But over the course of the last decade or so, this awkward, ritualized dance has grown more complex — and for Big Pharma, far more effective. (...)

ProPublica, a nonprofit organization dedicated to investigative journalism, didn't want to wait that long. Recently, the watchdog group assembled a searchable database combining the disclosures of the companies and linking them to individual doctors. For the first time, patients can search their doctors' names and find out which companies pay them and how much. (...)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

(Anm: Forskning og ressurser (mintankesmie.no).)

- Regler kaster lys over legemiddelfirmaers bånd til leger, reiser spørsmål om etikk

Rules shine light on drug firms' ties to doctors, raising questions about ethics (Regler kaster lys over legemiddelfirmaers bånd til leger, reiser spørsmål om etikk)
gazettenet.com 21.4.2012

• How this story was developed
• How much area doctors were paid

Helen Carcio, a South Deerfield nurse practitioner, says she's on a mission to educate other health professionals about treatment for overactive bladders - a quest paid for, in part, by Pfizer, the maker of a drug that treats the condition.

She is among 16 area medical professionals who have received anywhere from $280 to $254,000 from pharmaceutical companies for making speeches, consulting, doing research and for travel and meals, according to recently released documentation about medical professionals' financial arrangements with pharmaceutical companies. (...)

Carcio said she lectures for Pfizer because many medical professionals don't understand overactive bladders.

"I'm trying to take it out of the closet, to talk to providers that are clueless that something can be done about it," she said. "First you want to get people better, and the majority of us want to be paid for it, but mainly we want to be helpful."

While legal, the cash relationship between doctors and pharmaceutical/medical device representatives raises questions about conflicts of interest and other ethical issues, leading to federal legislation that will soon require public disclosure of these kinds of transactions.

Carcio is concerned about how people might interpret her relationship with Pfizer.

"I have a passion for making sure women are not incontinent. The more I raise awareness the better, but it's a Catch-22," she said. "I'd hate for someone to think I'm on the take, that I'm doing it for the money."

Carcio says she's one of the good ones.

"Some do it for the money," she said of medical professionals who speak on behalf of drug companies. "Some make $150,000 in a year. That would bother me."

Among the drug companies that have paid Valley doctors are GlaxoSmithKline, Pfizer, Novartis, Eli Lilly, Johnson & Johnson and Merck. (...)

But Alison Bass, author of "Side Effects," a book about the suppression of unfavorable research on the antidepressant Paxil, says that typically a speaker will mention a drug manufactured by the sponsoring pharmaceutical firm, saying it is an effective treatment for the disease.

Bass, a journalism professor at Mount Holyoke College in South Hadley, said doctors may be sincere in their endorsements of drugs, based on the data presented in clinical trials. But she maintains these trials are often flawed. (...)

- En konstitusjonell rett å selge forskrivningsdata?

Marketing Pharmaceuticals (Markedsføring av legemidler )
A Constitutional Right to Sell Prescriber-Identified Data? (En konstitusjonell rett å selge forskrivningsdata?)
JAMA. 2012;307(8):787-788 (February 22)
Pharmaceutical companies have strong economic interests in influencing physician prescribing behaviors. They advertise directly to consumers and to physicians. Beyond general marketing, manufacturers promote their drugs to physicians through “detailing”—sales representatives (“detailers”) visiting medical offices to persuade physicians to prescribe their products.

By law, pharmacies receive specific information with every prescription, including the physician's name, the drug, and the dosage. Pharmacies sell these records to prescription drug intermediaries (data miners), who use advanced computing to analyze prescriber-identified information (which physicians prescribe what drugs, in what dosages, and with what prescribing patterns). Data miners, in turn, lease sophisticated reports to pharmaceutical companies to refine detailers' marketing tactics, armed with knowledge about physician prescribing practices—for example, who are high or low prescribers and early or late adopters of new drugs.

Detailing raises vital health policy questions, including its effects on clinical decision making (safety, quality, and cost) and the patient-physician relationship (privacy and professionalism). Yet private companies claim a First Amendment right to buy and use prescribing data for product marketing. The tensions between privacy and commercial speech have deep implications for public health regulation. (...)

(Anm: ProPublica (Journalism in the Public Interest). (mintankesmie.no).)

(Anm: Legemiddelforskrivning (mintankesmie.no).)

Merck

Lawyer: Merck Scrapped Study on Vioxx (Advokat: Merck avblåste studie på Vioxx)
forbes.com 16.6.2006
(...) Jim Pettit, en av hennes advokater, viste juryen et brev skrevet av Mercks leder for lovgivende spørsmål som indikerer at firmaet var fornøyd med FDAs beslutning om advarselen, deretter et notat skrevet dagen etter av en Merck-forsker som opplyste leger om at sikkerhetstudier relatert til hjertet som var i oppstartfasen var annulert. (...) (Jim Pettit, one of her lawyers, showed the jury a letter by Merck's head of regulatory affairs indicating the company was content with FDA's decision on the warning, then a memo written the next day by a Merck research scientist telling outside doctors that the heart safety trial, about to begin, was being canceled.)

Pettit viste også jurymedlemmer en rekke Merck-dokumenter, som indikerer at firmaet etablerte team for å "nøytralisere" 36 fremstående leger som offentlig uttrykte bekymringer om risikoer ved bruk av Vioxx eller som foretrakk å forskrive konkurrerende smertestillende midler. Senere dokumenter fastslo at mange leger hadde blitt "nøytralisert" ved hjelp av metoder som at Merck indirekte betalte dem for å sitte i rådgivende styrer, holde firmavennlige foredrag eller delta i Mercks forskningsstudier. (...) (Pettit also showed jurors a series of Merck documents indicating the company set up teams to "neutralize" 36 prominent doctors who publicly voiced concerns about risks of using Vioxx or who preferred prescribing competing painkillers. Later documents stated many of the doctors had been "neutralized" by methods such as Merck indirectly paying them for serving on advisory boards, giving favorable speeches or participating in Merck research studies.)

Juryen fikk også se en komisk opplæringsvideo fra Merck som viste "V Squad" - Vioxx-salgsrepresentanter ikledt superheltkostymer - som lærer å kjempe mot salgshindringer, dvs. legers bekymringer om legemidlets sikkerhet eller at de foretrekker å forskrive andre legemidler. (...) (The jury also was shown a comical Merck training video depicting the "V Squad" - Vioxx sales representatives dressed in superhero costumes - learning to battle sales obstacles, meaning doctors' concerns about the drug's safety or preferences for prescribing other drugs.)

(Anm: Vioxx (rofecoxib COX-2) - informasjon vs kunnskap og visdom - hvem visste hva? (mintankesmie.no).)

(Anm: Spøkelsesforfattere (ghostwriters). (mintankesmie.no).)

Medicinsælgere fik forbud mod at tale om bivirkninger ved Vioxx
politiken.dk 1.10.2005
Fortrolige dokumenter afslører, at medicinalfirmaet bag gigtmidlet Vioxx forbød sælgerne at informere læger og sygehuse om risiko for blodpropper. (...)

Beteendevetenskap skulle maximera Vioxx-förskrivning
Läkemedelsvärlden 2005(1-2) (Mars)
Merck kartlade först läkarnas behov och beteenden och utnyttjade sedan beteendevetenskapliga tekniker för att läkarna undermedvetet skulle få ökat förtroende för konsulenterna. Genom att bland annat låta konsulenterna härma läkarnas uttryck och rörelsemönster lyckades man få dem att skriva ut mer Vioxx.

De interna dokumenten som Merck tvingats lämna ifrån sig till den amerikanska staten ger en sällsynt möjlighet för utomstående att få en inblick i hur marknadsföringen i ett globalt läkemedelsföretag går till på 2000-talet.

Grupperar läkare efter personlighet
Lika noggranna som läkemedelsföretag är när de undersöker effekter och biverkningar av sina läkemedel är de när de studerar sina primära försäljningskanaler – läkarna. Med hjälp av djupintervjuer och fokusgrupper med läkare kartlade Merck läkarkårens önskemål, behov och beteenden i detalj. Med den informationen delades sedan läkarna in i fyra olika grupper beroende på deras beteendemönster och personlighet. Läkemedelskonsulenterna fick tydliga instruktioner om hur de ska förhålla sig till var och en av de olika typerna av läkare för att lättare komma dem nära, vinna deras förtroende och inte irritera dem i onödan.

Till exempel skulle konsulenterna presentera data med grafer och procenttal för läkare med en ”teknisk personlighet”, för läkare med en ”stödjande personlighet” skulle de istället tala om fördelarna för patienterna medan de till läkare med en ”expressiv personlighet” skulle visa entusiasm och tala till läkarens ego. Den svåraste gruppen, ”de oförskämda” alternativt ”de kraftfulla” (på engelska ”bold”), kräver mest av konsulenterna. Konsulenterna varnas i de interna utbildningsmaterialen för att försöka med något annat än att vara extremt pålästa och snabba. För att inte bli bortgjord hos en läkare av denna typen måste konsulenten tänka på de tre B:na; ”Be bright, be brief and be gone” – översatt ungefär var påläst, var kortfattad och försvinn. (...)

Skaka hand och bryta bröd rätt
Det kanske inte är förvånande att konsulenter instrueras att föra noggranna förskrivningsprofiler för varje enskild läkare och gradera dem enligt en skala baserad på deras förskrivning. På så vis identifieras enskilda läkare som har stor potential att öka sin förskrivning av Vioxx. Mer anmärkningsvärda är de instruktioner konsulenterna får kring hur de ska närma sig läkarna.

I vissa fall är instruktionerna närmast att betrakta som komiska, till exempel den detaljerade informationen kring hur och när konsulenterna ska skaka hand med läkare – med ögonkontakt, stadigt utan att orsaka smärta, handslaget ska pågå i cirka tre sekunder och så vidare. På samma sätt är instruktionerna om hur de ska bete sig vid middagar.

I detalj redogörs för hur konsulenterna ska agera när gästerna kommer, under middagen och när middagen avslutas, att rött vin går till kött och vitt till fisk och kyckling, hur man ska bryta brödet och äta det i små bitar och så vidare. Allt sannolikt för att försäkra sig om att konsulenterna inte gör bort sig socialt i läkarnas närvaro. Men det visar också på vilken detaljnivå läkemedelskonsulenterna får sina instruktioner och att ingenting lämnas åt slumpen i den moderna marknadsföringen av ett läkemedel.

Beteendeveteskap för att manipulera Vid sidan av dessa, ganska harmlösa, vett- och etikettsregler uppmanas konsulenterna att använda avancerade beteendevetenskapliga tekniker för att komma läkarna nära. Till exempel ska de använda sig av så kallad spegling i mötet med läkare. Det innebär att de ska försöka ta efter läkarens uttryck och sätt att röra sig. På så vis ska konsulenterna lättare kunna ”komma in i kundens värld” och ”undermedvetet öka hans/hennes förtroende genom att bygga broar av likheter”. Detta därför att ”få tillgång till, och bygga relationer… är nyckeln som ger dig möjligheten att påverka din kunds beteenden” som det står i ett av de interna utbildningsmaterialen till konsulenterna. Och beteendet som ska påverkas är otvetydigt förskrivningen av Vioxx. Varje enskild läkares förskrivning av Vioxx är kopplat till ett bonussystem i Mercks interna datasystem vilket gör att varje konsulent direkt kan se hur läkarens beteendeförändring när det gäller Vioxx-förskrivningen påverkar den egna lönen.

FOTNOT: Alla exempel som nämns kommer från den amerikanska marknaden som, enligt många källor, skiljer sig ifrån den svenska i vissa avseenden i fråga om marknadsföringens karaktär. (...)

Merck vilseledde läkare om hjärtriskerna med Vioxx
Läkemedelsvärlden 2005(1-2) (Mars)
Genom att låta sina konsulenter föra fram vetenskapligt undermåliga och irrelevanta data lyckades det amerikanska läkemedelsföretaget Merck under två års tid vilseleda läkare om hjärtriskerna med Vioxx.

VIOXX Läkemedelsföretag argumenterar ofta för att deras marknadsförare ute på fältet – läkemedelskonsulenterna – fyller en viktig funktion genom att föra ut ny kunskap om deras läkemedel och utbilda läkarna.

I kölvattnet av indragningen av det smärtstillande läkemedlet Vioxx kommer information som visar en annan verklighet. Efter att Merck självmant drog in Vioxx den 30 september 2004 begärde en amerikansk statlig kommitté in samtliga interna dokument rörande marknadsföringen av Vioxx liksom all kommunikation till hälso- och sjukvårdspersonal rörande säkerhet och effekt av läkemedlet.

Resultatet – över 20 000 sidor interna och externa dokument – visar att Merck systematiskt använde sin konsulentstyrka för att mörka och tysta ner hjärt-kärlriskerna och för att föra ut vetenskapligt felaktig information för att få det att se ut som om Vioxx faktiskt var säkrare än andra NSAID:s. (...)

"Cheerleaders Pep Up Drug Sales," New York Times reports
BMJ 2005;331:1358 (10 December)US drug companies are hiring cheerleaders as sales representatives to promote drugs to doctors, the New York Times said on its front page on 28 November. The story claimed that drug companies were turning to cheerleaders as sales people because they were good looking and had enthusiastic outgoing personalities.

"Some industry critics view wholesomely sexy drug representatives as a variation on the seductive inducements, like dinners, golf outings, and speaking fees that pharmaceutical companies have dangled to sway doctors to their brands," the story reported. (...)

Psychiatrist Thomas Carli, an associate professor at the University of Michigan, who has tried to limit access for sales representatives, told the New York Times, "You’ll never meet an ugly drug rep."

Several hundred former cheerleaders had become drug sales representatives, a principal at Spirited Sales Leaders told the newspaper. The sales recruitment agency has many former cheerleaders on its books and a related firm runs cheerleading camps. (...)

The story gave no statistics on how many pharmaceutical sales representatives are former or present cheerleaders. Mr Trewhitt told the BMJ that the United States is home to an estimated 80 000 to 90 000 sales representatives. He said that a very informal survey of two or three pharmaceutical companies indicated that a quarter of their sales representatives had a background in health professions. They included nurses, pharmacists, nurse practitioners, and even a few doctors. He had no information on the background of other sales representatives, but research showed that several well known Americans had been cheerleaders in their college days. Among them were US presidents Dwight Eisenhower and Franklin Roosevelt (from the days when cheerleaders were often men), supreme court justice Ruth Bader Ginsburg, and television personality Katie Couric.

"The needs of companies vary," Mr Trewhitt said, but all have comprehensive training programmes for sales representatives. (...)

Pfizer

Pfizer to cut 20 per cent of US sales force
moneycentral.msn.com 29.11.2006
Pfizer, the world's largest drugmaker, will cut 20 per cent of its US salesforce in a move that will ripple through the pharmaceutical industry and could accelerate industrywide restructuring.

Its plan to slash about 2,200 people from 11,000-employee US sales organisation is the latest, and perhaps most stark example of sweeping changes occurring in big pharmaceutical makers.

Big pharma is rushing to restructure across its business from manufacturing to how it markets and sells its drugs. (...)

J.P. Garnier, chief executive of UK drugmaker GlaxoSmithKline, said once that drug salesforces had become an "arms race." (...)

Pfizer afsløret i forsøg på vildledning
berlingske.dk 6.2.2006
(...) Pfizer fortalte, at de havde lavet tilskudsskemaer i samarbejde med Lægemiddelstyrelsen. Men det passede ikke.

Verdens største medicinalselskab Pfizer holder sig ikke for god til at pynte på sandheden over for danske læger, hvis bare det kan få salget af potensmidlet Viagra helt op at ringe. (...)

Det passede ikke
Pfizer oplyste ifølge Medicintilskudsnævnet, at skemaerne var udarbejdet i samarbejde med Lægemiddelstyrelsen og gav dermed indtryk af, at det standardiserede skema, hvor Pfizers Viagra var fortrykt i rubrikken »præparatnavn«, blev runddelt med myndighedernes blå stempel.

I et konkret tilfælde troppede en lægemiddelkonsulent fra Pfizer således op hos læge Ellen Christine Beiter og udleverede ansøgningsskemaet og oplyste samtidig, at skemaet var lavet i samarbejde med Lægemiddelstyrelsen. (...)

Hvad konsulenten ikke vidste var, at Ellen Christine Beiter er medlem af Medicintilskudsnævnet under Lægemiddelstyrelsen.

Hun tog ansøgningsskemaet med til nævnets møde 13. december og forelagde det for nævnsformand Mogens Laue Friis, som ifølge referatet fra mødet oplyste, at:

»Lægemiddelstyrelsen har ikke udarbejdet et særligt ansøgningsskema om enkelttilskud til lægemidler mod erektiv dysfunktion, og skemaet må være udarbejdet af Pfizer, eftersom lægemidlets navn - Viagra - var fortrykt i rubrikken præparatnavn.«

Vildledning

Dermed er Pfizer blevet taget i at give urigtige oplysninger direkte til et medlem af det nævn, der afgør, hvorvidt medicin skal have tilskud eller ej, og dermed om medicin skal have en chance for at blive en salgssucces eller ej.

Mogens Laue Friis, formand for nævnet, betegner sagen som »meget uheldig« for Pfizer. Han betragter sagen som et forsøg på vildledning.

»Det er uærligt at gå ud og sige, at man har lavet noget i samarbejde med Lægemiddelstyrelsen, når det notorisk ikke er rigtigt.« (...)

Pfizer lavede det selv
Berlingske Tidende har fået aktindsigt i korespondancen mellem Lægemiddelstyrelsen og Pfizer om sagen. Pfizers direktør, Karin Verland, som også er formand for Lægemiddelindustriforeningen Lif, skriver i et brev 30. januar til Mogens Laue Friis, at da der ikke i forvejen findes et fortrykt ansøgningsskema til potensmidler, har Pfizer valgt at lave et. (...)

Under alle omstændigheder oplyser Karin Verland i brevet, at det nu er blevet indskærpet over for konsulenterne, at »... skemaet ikke er udarbejdet i samarbejde med Lægemiddelstyrelsen.« (...)

Myndigheder kulegraver medicinal- markedsføring
berlingske.dk 6.2.2006
Udbredt Medicinindustriens systematiske brug af standardiserede ansøgningsskemaer kan undergrave formålet med tilskudssystemet og kulegraves derfor af Lægemiddelstyrelsen. Ifølge Lif sikrer skemaerne patienterne ens behandling.

Medicinalindustriens systematiske uddeling af hjemmelavede og standardiserede ansøgningsskemaer til brug for de produktområder, hvor lægerne skal ansøge om individuelt tilskud for patienterne kulegraves af Lægemiddelstyrelsen.
Styrelsen ser med alvor på, at industrien laver skemaerne, da de kan ende med at erodere formålet med enkelttilskudssystemet, et område, der i 2004 havde en værdi af 600 millioner skattekroner. (...)

Styrelsen undersøger sagen og går blandt andet i dybden med, om der er tale om brud på reklamereglerne og- eller straffeloven.

Et ureguleret område
I Lægemiddelindustriforeningen, Lif, siger direktør Ida Sofie Jensen, at ansøgningsskemaerne viser, at virksomhederne forsøger at færdes på et ureguleret område.

»De har ingen intentioner om at bryde love eller regler. Skemaerne sikrer, at patienterne kan blive behandlet ens - uanset hvorfra de kommer i landet,« siger hun. (...)

Aktindsigt hos Lægemiddelstyrelsen viser, at Pfizer har spurgt styrelsen, hvordan der kan være tale om en straffelovsovertrædelse i forbindelse med ansøgningsskemaerne.

Hertil var svaret ifølge referatet fra telefonsamtalen, at »det kunne f.eks. være, hvis man angav forkerte kriterier, således at der var forsæt til bedrageri,« lyder det i svaret fra embedsmanden til Pfizers jurist. (...)

- Sorry, I don’t meet reps (Beklager, jeg tar ikke imot legemiddelkonsulenter)

My year without drug reps (Mitt år uten legemiddelkonsulenter)
Shane O’Hanlon, specialist registrar, geriatric medicine, Mercy University Hospital, Cork
BMJ 2010;340:c1102 (3 March)
It was switching to decaffeinated coffee that started it all. In a flash of lucidity I realised the dubious ethical basis for drug company representatives’ courtship of doctors. I noticed that my pattern of prescribing was mostly learnt from observing colleagues, many of whom sourced drug information primarily from drug representatives. I decided to take a drug rep holiday to see if I could emancipate myself from this moral quandary. My aim was to avoid contact with reps, promotional material, and sponsored sessions. I wondered how I might unsubscribe from their lists—and how they knew so much about each doctor?

Their calls generally went: "Hi, my name is Alison/Jane from Something-pharma, and I’m just getting to know the new docs. Would you have a few minutes to chat about my product?" The friendly and inviting tone of the first rep during my "holiday" meant I found it difficult to resist at first. But I had scripted my reply: "Sorry, I don’t meet reps." The brevity of my put-down seemed to stun her. This clearly hadn’t happened before. She floundered momentarily, not having a suitable response, and apologetically bid farewell. I used the same strategy effectively with all subsequent callers. Some recovered well and tried to do a brief plug for their product. Others asked whether they could leave some literature—I said no, but some did anyway. (...)

"– Han sa att det var en skitprodukt. Han tyckte inte om fluoxetin. "

Mutor skulle bana vägen för Prozac
lakemedelsvarlden.se 30.11.2007
Samtidigt som läkemedlet Prozac gjorde succé i många länder runt om i världen blev det tvärstopp i Sverige. Här godkändes det först nästan tio år senare, och då med namnet Fontex. Nu publicerar John Virapen, tidigare vd för Eli Lilly i Sverige, sin självbiografi som bland annat avslöjar vad som hände bakom kulisserna när Prozac skulle godkännas. (...)

Hans självbiografi ”Biverkningsdöd – korruption inom läkemedelsindustrin, en före detta vd talar ut” är hans andra bok som baseras på hans sammanlagt 30 år i läkemedelsbranschen. Förra året publicerade han i Tyskland den skönlitterära romanen ”Rubio talar ut” där många faktauppgifter utelämnades. I den nya boken talar han klarspråk om vad som egentligen hände. (...)

Varför var det så viktigt att få det godkänt i Sverige?
– Sverige hade ett mycket högt anseende i hela världen när det gäller psykiatri och fick vi det godkänt här skulle det gå snabbt i resten av världen, säger John Virapen. (...)

John Virapen studerade expertens vanor och hans stora fritidsintresse segling i detalj innan han tog kontakt och, med ett svepskäl, föreslog en middag på en restaurang. Och den middagen följdes av flera innan John Virapen tordes ställa den avgörande frågan.

– Han sa att det var en skitprodukt. Han tyckte inte om fluoxetin. Men vi måste ha den registrerad och vi tänkte inte vänta i sju år, säger John Virapen.

– Så jag frågade honom vad som skulle krävas för att han skulle få produkten godkänd snabbt. Han skrattade först och sedan sa han ”Pengar är ju alltid bra”. Och då hade jag honom på kroken, säger John Virapen. (...)

LMI og Dagens Medisin om legemiddelkonsulenter

NYHETER OM LEGEMIDLER
- Skjerper kravene til legemiddelkonsulenter
24.08.2007
Dagens Medisin skriver at legemiddelindustrien satser på færre, men bedre kvalifiserte konsulenter.
Les saken i Dagens Medisin

- Skjerper kravene til legemiddelkonsulenter (pdf) (...)

- Har legemiddelindustrien for mange selgere - skjerper de kravene?

Drug giants wary on cutting sales forces
reuters.com 9.11.2005
NEW YORK (Reuters) - Does the pharmaceutical industry have too many sales reps?

It is an issue uppermost in the minds of companies grappling with an increasingly tough market; but industry executives at the Reuters Health Summit in New York this week said they would not be rushing into major cutbacks.

"Frankly, there are lots of other places in the company to trim expenses before you would turn to the sales force," said Hank McKinnell, chief executive of the world's biggest drug maker, Pfizer Inc. PFE.N: Quote, Profile, Research).

Hans selskap reduserte sin tidligere amerikanske salgsstyrke på 12 000 mann med 500 tidligere i år, grunnet redusert fortjeneste for det bestselgende smertestillende midlet Celebrex. Men McKinnell sa at det at legemiddelkonsulenter møter leger er fortsatt sentralt i "historien" bak det å selge et legemiddel. (His company reduced its previous 12,000-member U.S. sales force by some 500 earlier this year, in the face of declining revenues from top-selling painkiller Celebrex. But McKinnell said getting reps in front of doctors remained central to selling the "story" of a medicine.)

Large sales forces are among drug companies' biggest costs, so it is no surprise they have come under the microscope at a time of slowing growth.

And there is no doubt companies are getting less bang for their buck than they once did, since overcrowding in the marketplace means the average duration of a rep call to a physician is now down around 1-1/2 minutes.

Many analysts blame the spiraling sales war on rival firms trying to out-gun each other in an "arms race" that generates no additional revenues for the industry as a whole. (…)

In the long term, Viehbacher said Glaxo would like to spend a lot more on researching new medicines and a lot less on selling them -- but the shift won't happen overnight.

"My personal view is that the change will be incremental versus revolutionary," he said. "So far we haven't found a more effective way of educating physicians."

Part of Glaxo's gradualist approach is to try to get more out of its existing sales force, which is second only to Pfizer's in the United States, at around 9,000.

This year, for example, Viehbacher said Glaxo had decided to launch a clutch of new products without increasing sales force headcount, as would have happened in the past. (...)

- Preventing access of drug company representatives to doctors would help stop drug companies putting marketing above innovation and force a change in the business culture

The bitterest pill
BMJ 2007;335:1098 (24 November)
In 2004 I attended a parliamentary subcommittee meeting and sat with stars of the medical firmament such as Andrew Hexheimer, David Healy, and Ike Iheanacho. I was there simply as an honest witness to the excesses I had seen and to express support for the No Free Lunch group (www.nofreelunch-uk.org). I was a mere pimple on an ailing and delirious drug industry being dragged down by a virulent infection called marketing. (...)

But all this is a painful and long overdue correction—the bursting of the bubble that is the notion that societies' social sicknesses can be cured by pills. Can we doctors help the industry? Yes: we must stop seeing pharmaceutical representatives. This is a logical move on several levels. Such contact increases costs and exposes patients to the dangers of new drugs, and the associated hospitality is inappropriate for public servants, undermining the status of doctors in the eyes of the public. (...)

Preventing access of drug company representatives to doctors would help stop drug companies putting marketing above innovation and force a change in the business culture. This might result in much screaming and blood on the carpets of corporate boardrooms, but a return to innovation offers the only hope of a cure to the industry's illness. (...)

- Amerikanske leger setter opp skilt med teksten "No drug reps"

US doctors display "No drug reps" signs (Amerikanske leger setter opp skilt med teksten "No drug reps")
BMJ 2008;337:a711 (Published 8 July 2008)
Amerikanske leger som nekter besøk av legemiddelindustriens legemiddelkonsulenter kan nå sette opp skilt, tilsvarende "No smoking", på sine kontorer. (US doctors who refuse to see drug companies’ sales representatives can now display a sign, similar to a "No smoking" sign, in their offices.)

The certificate says that the doctor’s office "does not allow visits from pharmaceutical salespeople because we rely on scientific information, not marketing, to decide what treatment is best for you." It adds: "This policy also means that we don’t provide drug samples."

"‘Free’ drug samples cost you money," it says, because they are promoted only for the most expensive drugs.

The idea of the signs is being promoted by PharmedOut.org, a publicly funded project of Georgetown University Medical Center in Washington, DC. The project’s director, Adriane Fugh-Berman, said that one in five US doctors refuse to see pharmaceutical sales representatives. (...)

(Anm: PharmedOut (pharmedout.org).

No Drug Reps Certificate (pdf) Display this in your office.)

- People do it automatically (- Mennesker gjør det automatisk)

Human Brains Wired to Empathize, Study Finds (Menneskehjerner koblet for empati, ifølge studie)
health.yahoo.net 26.7.2011
TUESDAY, July 26 (HealthDay News) -- A person's brain works hard to empathize or understand what it's like to walk in other people's shoes, no matter how different they may be, a new study indicates.

Researchers from the University of Southern California found people automatically attempt to empathize -- even with those who are physically very different. To do that, however, people must use two separate regions of their brain.

In a paper, published online by Cerebral Cortex, USC researchers found that empathy between two people who can relate to each other more directly relies primarily on the intuitive, sensory-motor parts of the brain. A person who empathizes with someone who is very different or with whom they cannot directly relate, however, depends more on the rationalizing part of the brain.

In conducting the study, USC researchers showed videos of hands, feet and a mouth doing "tasks" to a woman who was born without arms or legs, as well as 13 typically developed women. The participants were also shown videos of injections being given on certain parts of the body.

As they watched the videos, the women's brains were scanned. Researchers compared those scans to pinpoint sources of empathy.

The researchers found that when the woman without limbs watched videos of tasks being performed using body parts that she did not have, the sensory-motor areas of her brain were still strongly engaged. The researchers noted, however, even without limbs, the woman was able to perform some of these tasks herself by improvising with the body parts she did have.

If the action was impossible for her however, another set of brain regions involved in deductive reasoning were also activated, the study pointed out.

The intuitive and rationalizing parts of the brain work together to create the sensation of empathy, said Lisa Aziz-Zadeh, assistant professor of USC's Division of Occupational Science and Occupational Therapy in a university news release. "People do it automatically," she said. (...)

- Lærdommen av Vioxx

The Lessons of Vioxx — Drug Safety and Sales (Lærdommen fra Vioxx — Legemiddelsikkerhet og salg)
NEJM 2005;352:2576-2578 (June 23) (New England Journal of Medicine)
(...) The next day, Merck sent a bulletin to its rofecoxib sales force of more than 3000 representatives. The bulletin ordered, "DO NOT INITIATE DISCUSSIONS ON THE FDA ARTHRITIS ADVISORY COMMITTEE . . . OR THE RESULTS OF THE . . . VIGOR STUDY." It advised that if a physician inquired about VIGOR, the sales representative should indicate that the study showed a gastrointestinal benefit and then say, "I cannot discuss the study with you." (The next day, Merck sent a bulletin to its rofecoxib sales force of more than 3000 representatives. The bulletin ordered, "DO NOT INITIATE DISCUSSIONS ON THE FDA ARTHRITIS ADVISORY COMMITTEE . . . OR THE RESULTS OF THE . . . VIGOR STUDY." It advised that if a physician inquired about VIGOR, the sales representative should indicate that the study showed a gastrointestinal benefit and then say, "I cannot discuss the study with you.) (…)

“Merck further instructed its representatives to show those doctors who asked whether rofecoxib caused myocardial infarction a pamphlet called "The Cardiovascular Card." This pamphlet, prepared by Merck's marketing department, indicated that rofecoxib was associated with 1/8 the mortality from cardiovascular causes of that found with other antiinflammatory drugs.

The Cardiovascular Card provided a misleading picture of the evidence on rofecoxib. The card did not include any data from the VIGOR study. Instead, it presented a pooled analysis of preapproval studies, in most of which low doses of rofecoxib were used for a short time. None of these studies were designed to assess cardiovascular safety, and none included adjudication of cardiovascular events. In fact, FDA experts had publicly expressed "serious concerns" to the agency's advisory committee about using the preapproval studies as evidence of the drug's cardiovascular safety.4

Persistent physicians who sought additional information about the cardiovascular effects of rofecoxib were directed to send inquiries to the company's headquarters. Merck's response to these physicians highlighted the misleading information from the Cardiovascular Card.

Beyond these specific communications to physicians, our committee also heard evidence of a broad disparity between the evidence-based perspective provided by scientific journals and expert committees, on the one hand, and the sales pitch used by the company's field staff, on the other. Merck instructed its sales representatives, for example, to provide only certain approved study results to doctors. Approved scientific studies were defined as those that provide "solid evidence as to why [doctors] should prescribe Merck products for their appropriate patients." By contrast, those studies that raised safety questions about drugs were considered background studies. Distributing the results of a background study was "a clear violation of Company Policy."

Merck also trained its representatives to identify speakers for educational events who were "opinion leaders" who could provide "favorable" views of the company's products to other doctors. Underlining the promotional nature of these events, Merck instructed its sales representatives to track whether the physicians who attended them subsequently prescribed more Merck drugs.” (...)

Confessions of a drug rep
BMJ 2005;330:911 (16 April)
A forthcoming movie claims to spill the beans on Big Pharma
Think big. Think money. Think drugs. And then think of all the sly, silly, ethically impaired things that people will do to sell drugs, and you'll have a taste of Kathleen Slattery-Moschkau's film, Side Effects. (...)

Gratisprøver

Drug Makers' Free Samples May Bias Doctors
medicinenet.com 28.7.2005
(HealthDay News) -- Resident physicians with access to free drug samples in a medical clinic are more likely to prescribe heavily advertised drugs and less likely to recommend over-the-counter (OTC) and inexpensive drugs to their patients than doctors who don't have access to these handouts, according to a new study.

The findings raise questions about the influence of pharmaceutical companies on physician prescribing practices, the researchers say.

"We found that resident physicians with access to drug samples in clinics were more likely to write new prescriptions for heavily advertised drugs, and less likely to recommend OTC drugs than their peers. There was also a trend toward less use of inexpensive drugs," wrote study author Dr. Richard F. Adair of the University of Minnesota and Abbott Northwestern Hospital in Minneapolis. (...)

Software company defends sale of patients' data to drug companies
BMJ 2005;331:128 (16 July)
Health Communications Network, a subsidiary of Primary Health Care, has sold a software program, Medical Director, to more than 16 000 GPs in Australia who use it to write more than 90 million prescriptions a year. Included in the software is a data extraction tool, AsteRx, that allows data about patients, stripped of name, date of birth, and sex, to be accessed from participating practice computers via the internet.

In October last year, the Australian Consumers Association complained to the Australian Privacy Commissioner that the extraction of the data was in breach of privacy laws. This followed the leaking of a letter in which CAMM Pacific, a market research company, wrote to doctors seeking participation in a "study" from those who regularly saw drug companies' sales representatives and were willing to sell anonymised patient data in return for a payment or gift voucher. (...)

DRUG MARKETING: Freebies for doctors curbed
Detroit Free Press Inc. 12.7.2005
You've seen them breeze through the doctor's office lobby. They're usually polished and good-looking. They often tote lunch for the doctor's staff with cases full of goodies. You've probably received one of their free samples.

These are pharmaceutical salespeople, and on average, they each generate about $1.9 million in sales a year for the big pharmaceutical companies, investment firm Lehman Brothers reports.

But a growing minority of doctors and hospitals say the free lunches, pens and brand-name drug samples they provide affect doctors' prescribing behaviors and drive up the cost of health care.

So nationwide, doctors and hospitals -- including the University of Michigan Health System and Henry Ford Health System -- increasingly are imposing strict rules dictating when sales representatives can come calling and what they're allowed to bring. (...)

- Kartlegger reseptblokker

Kartlegger reseptblokker
aftenposten.no 19.4.2007
Legemiddelindustrien vil se hva leger gir pasienter
(…) - Jeg oppfordrer leger som får dette spørreskjemaet til ikke å svare. Ved å svare, vil den enkelte lege gi fra seg opplysninger som gir legemiddelindustrien en gyllen mulighet til å spisse sin markedsføring mot leger ytterligere. Det håper jeg leger ikke vil være med på, sier president Torunn Janbu i Den norske lægeforening.

(…) 7000 leger. Før påske mottok 7000 allmennleger et brev fra firmaet Cegedim Norway AS. I brevet inviteres leger til å være med i undersøkelsen Icomed. I brevet heter det blant annet: Cegedim samler inn opplysninger om leges generelle forskrivningsvaner og medisinske interesseområder. Ditt svar tilgjengeliggjøres for legemiddelindustrien slik at du skal kunne motta målrettet medisinsk informasjon. (…)

To ganger i året. Som takk for at de svarer, tilbys legene en gave. (…)

Statens legemiddelverk og datatilsynet mener at så lenge legene ikke gir ut pasientopplysninger, så m på det være opp til hver enkelt lege om de vil svare på spørreskjemaet eller ikke. (…)

- Salg av statistikk over legers forskrivninger til legemiddelfirmaer

Supreme Court Strikes Down Ban on Data-Mining
medpagetoday.com 23.6.2011
WASHINGTON -- Data on which doctors are prescribing which drugs is speech that is protected by the First Amendment, and pharmaceutical companies have every right to buy that information and use it to target their marketing efforts, the Supreme Court has ruled.

The nation's high court handed down a verdict Thursday in the Sorrell v. IMS Health case, striking down by a 6-3 vote a 2007 Vermont law that that bans the practice of data mining -- the sale and use of prescriber-identifiable information for marketing or promoting a drug, including drug detailing -- unless a physician specifically gives his or her permission to use the information.

Vermont argued that selling prescriber-identifying information is "conduct," not "speech," but the Supreme Court didn't buy that and ruled that "the creation and dissemination of information are speech for First Amendment purposes." (...)

Courts Will Have to Decide Who Owns Prescription Data
Psychiatr News 2011;46(1):8-9 (April 15) (American Psychiatric Association)
The country's two largest drug-store chains are sued in separate cases involving their sale of consumers' prescription data, in one case to pharmaceutical manufacturers and in the other to data-mining companies.

A parent who had his two daughters' prescriptions filled through a Walgreen Company drugstore has sued the company, charging that it had no legal right to sell the girls' prescription information to so-called data-mining companies that then sell it to pharmaceutical companies for marketing purposes.

In the class-action suit, which was filed in California in March, plaintiff Todd Murphy insists that such information is the property of the patient who pays for the prescription, and thus Walgreen sold something it did not own. This is a change of tactics from other lawsuits challenging the legality of data-mining practices, which were based on breaches of confidentiality of physician prescribing information. (...)

Data-mining and the Supremes: A Viewer’s Guide
postscript.communitycatalyst.org 1.4.2011
Later this month, the Supreme Court will hear IMS v. Sorrell, about the right of Vermont and other states to restrict a practice called data-mining – the collection and sale of doctors’ prescribing histories that drug companies then buy and use in marketing to MDs and other prescribers. Vermont’s law banning this practice was struck down in the Second Circuit Court of Appeals, after the First Circuit upheld similar laws. (Both New Hampshire and Maine have standing laws, and Massachusetts is considering a bill this year supported by consumers and the state medical society that would do the same.)

Prescription data-mining is a multi-million dollar business for companies that buy prescription records from pharmacies and physician lists from the American Medical Association, and then match these to produce profiles that they sell to drug companies. The companies then arm their drug reps with this information to market their drugs to individual prescribers. (Way more about that in the PostScript archives)

Why did the court strike the law? The drug industry trade group PhRMA and the ‘data-mining’ companies, like IMS, who sell this information argued that it was ‘speech’ protected by the First Amendment.

Speech? Are your purchases on Netflix speech? This seems like a stretch. (...)

States Cracking Down on Drug Marketing (Stater slår ned på markedsføring av legemidler)
forbes.com 12.4.2007
Pharmaceutical-company sales reps who visit doctors' offices to promote their products know a surprising amount about the physicians before they even walk through the door.

Maybe too much, some lawmakers around the country say.

Legislators are taking a hard look at data-mining companies that keep detailed records on exactly what drugs are prescribed by nearly every doctor in the U.S.
These databases, updated weekly, are stripped of patient names and then sold to drug companies, which use the information to identify doctors who might be particularly receptive to their sales pitches. (...)

For Sale Physicians Prescribing Data
New England Journal of Medicine (NEJM) 2006;354:2745-7 (June 29)
Since the early 1990s, health care information companies have bought electronic records of prescriptions from pharmacies and other sources and linked them with information about doctors that is licensed from the Physician Masterfile of the American Medical Association (AMA). These information companies, the largest of which is IMS Health of Fairfield, Connecticut, have then compiled and sold individual physicians' prescribing data to pharmaceutical manufacturers. (...)

Doctors, Legislators Resist Drugmakers' Prying Eyes
washingtonpost.com 22.5.2007
(...) He is not alone. Many doctors object to drugmakers' common practice of contracting with data-mining companies to track exactly which medicines physicians prescribe and in what quantities -- information marketers and salespeople use to fine-tune their efforts. The industry defends the practice as a way of better educating physicians about new drugs. (...)

The American Medical Association, a larger and far more established group, makes millions of dollars each year by helping data-mining companies link prescribing data to individual physicians. It does so by licensing access to the AMA Physician Masterfile, a database containing names, birth dates, educational background, specialties and addresses for more than 800,000 doctors. (...)

- Kritikk av salg av forskrivningsdata

Opinion Piece Criticizes Sale of Physician Prescribing Data
kaisernetwork.org 26.7.2007
The American Medical Association should end the sale of information about physician prescription practices to pharmaceutical companies, which use the data to market their products, Robert Restuccia, executive director of the Prescription Project, and Lydia Vaias, president of the National Physicians Alliance, write in a San Francisco Chronicle opinion piece. According to the authors, AMA sells information from a database called Masterfile to health information organizations, which "pair the identifying information with prescribing records from pharmacies" and sell the data to pharmaceutical companies.

Pharmaceutical company sales representatives use the information to "tailor their pitches to each physician," a practice that has "resulted in new, costlier drugs replacing established medications that have proven histories of safety and effectiveness," the authors write. (...)

Prescription mining raises millions for doctors' group
Robert Restuccia and Lydia Vaias
sfgate.com 25.7.2007
Drug companies care about what your doctor prescribes just as much as you do - and they're paying big money to find out. They are paying so much, in fact, that even though the vast majority of physicians disapprove of the sale of their personal prescribing data for marketing purposes, the American Medical Association persists in selling detailed physician information to the pharmaceutical industry. This data must be used for legitimate public health research - not brand promotion.

Drug ads cover doctors' offices, coating everything from wall calendars and paperweights to stethoscopes and prescription pads. The numbers show that these advertisements work: doctors are prescribing more brand-name, higher-cost drugs than ever before. (...)

- Søknader og kvalifikasjoner - legemiddelkonsulent-utdanning

Søknad om fritak fra legemiddelkonsulent-utdanningen (medisinsk del)
lmi.no 18.8.2007
Oppdaterte kriterier august 2007.
Nye legemiddelkonsulenter må som hovedregel gjennomføre og bestå eksamen i ”legemiddelkonsulentutdanningen” (medisinsk del) samt LMIs eget lov og bransjekurs for at legemiddelfirmaene skal kunne registrere dem som legemiddelkonsulenterer. Den medisinske delen gjennomføres som en halvårsenhet ved Høgskolen i Oslo (Utdanning i grunnleggende medisin og farmakologi) og gir generell studiekompetanse (30 studiepoeng).

Utdanning som automatisk kvalifiserer til fritak fra medisinsk del er (ikke nødvendig å søke fritak):
Lege, tannlege, veterinær, Cand.pharm/master i farmasi, reseptar, sykepleier.
Legemiddelkonsulenter i som arbeider i de andre nordiske landene får også automatisk fritak. (...)

Legemiddelkonsulenter
jobbsok.monster.no (Søknadsfrist 19.5.2006)
AstraZeneca AS er et av verdens ledende farmasøytiske selskaper. Vi bruker hvert år ca. 25 milliarder norske kroner på forskning verden over for å utvikle nye medisiner. Dette har resultert i en rekke nyskapende og effektive legemidler.

• AstraZeneca AS har som forretningsidé å utvikle og markedsføre kostnadseffektive behandlingsløsninger basert på innovative legemidler for å fremme helse og livskvalitet.
• Vi skal være det mest respekterte legemiddelselskapet i Norge.

Ledige stillinger som legemiddelkonsulenter i AstraZeneca AS
AstraZeneca AS har ledige stillinger som legemiddelkonsulenter i område Nordland, Troms og Finmark og området Trøndelag / Møre og Romsdal.
Legemiddelkonsulenten har ansvar for gjennomføring av markedsplaner og aktiviteter.

Dette består i hovedtrekk av å drive oppsøkende salgsvirksomhet og markedsføring av våre kampanjeprodukter. Kundegruppen er først og fremst leger.

Salgsaktivitetene foregår ved oppsøkende virksomhet på legekontorer/sentra, eller ved å gjennomføre fagmøter/seminarer.

Arbeidsdagen er hektisk og ofte medfører stillingen kvelds-, eller helgearbeid. Som legemiddelkonsulent må du være innstilt på en del reisevirksomhet.
Stillingene er selvstendige. Arbeidsoppgavene er utfordrende med gode muligheter for faglig og personlig utvikling.

Kvalifikasjoner

• Av formell bakgrunn er høyere utdanning innen økonomi, markedsføring, helsefag og/eller bred salgserfaring ønskelig.
• Den viktigste suksessfaktoren som legemiddelkonsulent vil være ditt talent og motivasjon for salg.
• Av vesen må legemiddelkonsulenten være arbeidsglad, seriøs, og ambisiøs med vinnerinstinkt.

Det er ønskelig at søkerne er registrerte legemiddelkonsulenter, men ikke en forutsetning.

Egenskaper
AstraZeneca AS ønsker velutdannede medarbeidere som er utadvendte, fleksible, markeds- og gruppeorientert. Det er dessuten ønskelig at medarbeiderne identifiserer seg med våre verdier; åpen, nyskapende og troverdig.

Betingelser
AstraZeneca AS kan tilby et ungt og engasjerende miljø med gode muligheter for personlig utvikling. Lønn etter avtale og bonusordning, pensjons- og forsikringsordning, firmabil.

Søknad og CV kan sendes Gro Fjeller, AstraZeneca AS elektronisk på stilling@astrazeneca.com.
Søknaden merkes med hvilken stilling som søkes. Alle søkere vil bli tilskrevet.

Søknadsfrist 19. mai 2006.

Ved spørsmål til stillingene kontakt HR manager Thomas Røed eller personalsekretær Gro Fjeller på tlf 21006400.

Vennligst henvis til at du har sett annonsen på Monster.no
Please refer to Monster.no in your application (...)

Gir et 6 måneders kurs kompetanse?

Den medisinske del av legemiddelkonsulentutdanningen: Orientering om årets kurs
lmi.no 6.4.2006
Høgskolen i Oslo, avdeling for helsefag gjennomfører et kurs i grunnleggende medisin og farmakologi på oppdrag fra LMI (Legemiddelindustriforeningen). Kurset er en halvårlig heltidsutdanning og gir 30 studiepoeng. Kurset utgjør den medisinske delen av legemiddelkonsulentutdanningen.

egemiddelkonsulenter markedsfører legemidler til leger og annet helsepersonell bl.a. på sykehus og på legekontorer. (...)

Emneområder: Det undervises i følgende fag: Biokjemi/kjemi, cellebiologi, anatomi, fysiologi, mikrobiologi, sykdomslære, farmakologi og etikk.

Hva kan jeg bruke utdanningen til? Kurset er obligatorisk for alle som vil arbeide som legemiddelkonsulent i en av Legemiddelindustriens medlemsbedrifter. Det kan imidlertid være av interesse for andre som kan ha behov for grunnleggende medisinske kunnskaper og innsikt i legemidlers virkning og bruksområder. Kurset kan for eksempel være nyttig for ansatte på apotek, i sykehuslaboratorier, andre helsearbeidere, journalister, skribenter mm. (...)

- Leger motsetter seg innsamling av legemiddeldata

Doctors Object to Gathering of Drug Data (Leger motsetter seg innsamling av legemiddeldata)
nytimes.com 4.5.2006
Although virtually unknown to consumers, the information has long been considered the most potent weapon in pharmaceutical sales — computerized dossiers showing which physicians are prescribing what drugs. Armed with such data, a drug sales representative can pressure a doctor to write more prescriptions for a name-brand medicine or fewer orders for a competitor's drug. (...)

"It's the most powerful tool a drug rep has, for sure," said Jamie Reidy, a former drug salesman who was fired last year by Eli Lilly & Company after writing "Hard Sell," a humorous exposé of the pharmaceutical industry. Mr. Reidy said the pharmaceutical representatives received updated prescription data every two weeks. The information also sometimes characterizes each physician's prescribing patterns, Mr. Reidy said.

For example, "early prescribers" — also known among drug representatives as "cowboys," according to Mr. Reidy — are those doctors who start prescribing a drug as soon as it comes to market. If you are a drug sales representative, "you go to see that doctor in the first week," Mr. Reidy said.

Although the drug representatives are told not to share the prescribing details with doctors, some nonetheless have confronted doctors with the data. A representative might become frustrated, for example, if after providing numerous lunches to a doctor's staff, the data show that the doctor is not writing prescriptions for the company's drug.

"It just creates a weird atmosphere," Mr. Reidy said. (...)

- Gratis legemiddelprøver kaprer leger

Free pharmaceutical samples hook doctors (Gratis legemiddelprøver kaprer leger)
nola.com 26.11.2006 (New Orleans Times-Picayune)
Drug makers use them for influence

Antonio Morgado is a pharmaceutical sales rep's dream come true.
Morgado, an endocrinologist, sees 600 patients a month at Palisades Medical Center in North Bergen, N.J. He is among New Jersey's most prolific prescribers of top-selling drugs for diabetes, cholesterol and blood pressure, according to prescription data services. (...)

Every weekday, a virtual army of sales reps, mostly young women with eye-catching hair, makeup and wardrobes, come calling with mugs and pens sporting company logos, piles of medical literature and arm loads of drug samples.

Morgado said he agrees to see the reps in exchange for a steady supply of samples, which he gives to patients who are poor or uninsured.
"It's difficult to practice medicine without the patients taking the appropriate medicine," Morgado said. "I tell them (sales reps) to give me the samples or I kick them out."

Three years after the pharmaceutical industry agreed to clean up its act and rein in the most aggressive sales practices, free samples have become the hard currency of prescription drug marketing. A slice of the industry's estimated $23.6 billion annual sales and marketing budget keeps two storage rooms in Morgado's office brimming with the newest diabetes drugs, some of which sell for $5 a pill, on the assumption he will favor brand-name medicines over low-cost generics. (...)

(Anm: Kanskje Vinmonopolets ansatte også bør tillates å dele ut gratisprøver for å overtale kundene til å bruke et spesielt brennevinsmerke.)

- Analyse: tidligere legemiddelkonsulent avslører taktikker

ANALYSIS: FORMER DRUG REP REVEALS TACTICS (Analyse: tidligere legemiddelkonsulent avslører taktikker)
upi.com 23.4.2007
WASHINGTON April 23 (UPI) -- A former pharmaceutical company insider and a physician who researches drug marketing reveal the tactics used by drug reps to manipulate physicians' prescribing habits in an article released Monday and argue that doctors should seek more credible sources of information about pharmaceuticals.

In the article, which appears in the April issue of PLoS Medicine, Shahram Ahari, a former Eli Lilly rep, and Adriane Fugh-Berman, of Georgetown University Medical Center, detail the ways in which drug reps use the allure of friendship, gifts and other well-crafted strategies to influence even the most skeptical of physicians.

"I hope physicians will read this article and realize the friendships they think they have with drug reps are actually business relationships in which they're being emotionally manipulated," Fugh-Berman told United Press International.

"That's not an appropriate place to find scientific drug information," she added. "The concept that reps educate physicians is absurd. They're sales people; they have a very limited and distorted view of the medical literature." (...)

Vi er ikke instruert til å lyve, men vi er opplært og trenet til å skape forvirring og få frem vår egen særegne agenda og sukre data som om de var objektive. (...) ("We're not instructed to lie, but we are taught and trained to obfuscate and come in with our own particular agenda and sugarcoat it as if it was objective scientific data," he said.)

(Anm: Following the Script: How Drug Reps Make Friends and Influence Doctors. PLoS Med 4(4): e150 doi:10.1371/journal.pmed.0040150.)

Hva er forskjellen på disse to påstander?

DON'T MISS' PANORAMA - MONDAY, STV,8.30pm
therapeuticsdaily.com 27.1.2007
Scottish reporter Shelley Joffre investigates a pharmaceutical firm charged with misrepresenting information over production of its anti-depressants. (...)

This is not only hard-hitting, it's frankly terrifying.

What's the difference between these two statements?

"... demonstrates remarkable efficacy and safety in the treatment of adolescent depression..."

"...the results of the studies were disappointing. The possibility of obtaining a safety statement from this data was considered but rejected..."

The first is what drugs company GlaxoSmithKline (GSK) told its sales reps after it tested an adult antidepressant on teenagers. (...)

- Tar du imot konsulenter fra legemiddelindustrien?

Tager du imod konsulenter fra lægemiddelindustrien?
Niels Christian Heebøll-Nielsen, IRF
irf.dk (27.8.2007)
Hvis en lægemiddelkonsulent vil præsentere et nyt lægemiddel, må man være forberedt!

Du kan starte med at spørge:
•Hvad nyt er der ved præparatet?
•Hvorfor betragtes dette nye som nyttigt?
•Er forskellene fra de tidligere produkter af klinisk betydning?

Når du er nået dertil, kan du gå videre med at spørge om:
•Hvor meget varierer »korrekt dosis« hos forskellige patienter?
•Hvad betyder maksimal dosis?
•Ingen yderligere effekt eller toksisk effekt ved øgning af dosis?
•Hvor lang er virkningsvarigheden af en enkelt dosis?
•Hvor meget varierer halveringstid og virkningsvarighed for den enkelte patient?
•Hvilken betydning har nyrefunktion og leverfunktion på halveringstiden?
•Findes der klinisk betydningsfulde interaktioner?
•Med hvilke intervaller og med hvilke mængde skal dosis øges eller nedsættes, hvis det er nødvendigt?
•Hvis lægemidlet ikke umiddelbart viser effekt, hvor længe skal man da afvente eventuel effekt?
•Kan lægemidlet anvendes til gravide og ammende kvinder?
•Kan lægemidlet anvendes til børn?
•Hvor mange patienter har været behandlet med præparatet inden markedsføring?
•Hvilke bivirkninger forekommer og med hvilken frekvens?

•Ved udsagn som: »Kan anvendes med forsigtighed ved tilstand XX«, skal det anføres, hvori denne forsigtighed består:
- Skal man undlade at anvende præparatet?
- Skal der anvendes mindre doser?
- Skal patienten til hyppig kontrol? (...)

(Anm: Hvorfor legger ikke de statlige kontrollmyndigheter svarene på de nevnte spørsmål ut på internett for hvert enkelt legemiddel, slik at alle har tilgang til denne informasjonen?

Er det tilstrekkelig at legemiddelkonsulenter (selgere) muntlig besvarer de nevnte spørsmål overfor den enkelte lege?

Er det ikke brukerne (pasienter og pårørende) av legemidler som egentlig bør få et entydig (skriftlig) svar på de nevnte spørsmål?)

- Lovgivning kan sørge for "nyttig motgift" mot legemiddelindustriens innflytelse på leger, ifølge lederartikkel

Legislation Could Provide 'Useful Antidote' to Pharmaceutical Industry Influence on Physicians, Editorial States (Lovgivning kan sørge for "nyttig motgift" mot legemiddelindustriens innflytelse på leger, ifølge lederartikkel)
kaisernetwork.org 20.3.2008
Sens. Herb Kohl (D-Wis.) and Richard Durbin (D-Ill.) plan to introduce a bill that could provide a "potentially useful antidote to drug company influence over the prescribing practices of doctors," a New York Times editorial states. According to the editorial, the legislation would authorize federal grants to prepare educational materials and train health care professionals to "visit doctors to give unbiased guidance on the safety and effectiveness of drugs to counter the one-sided sales pitches they get from pharmaceutical company representatives."

Based on the results of similar programs in Pennsylvania, other states and abroad, the "end result should be better care, quite often at lower cost," and the senators hope that their bill would "pay for itself by lowering drug costs to federal programs," the editorial states. "With comprehensive, unbiased information, doctors should be more likely to prescribe the best drug for a patient, not necessarily the newest, high-priced drug that is being pushed by a drug company sales representative," the editorial concludes (New York Times, 3/20). (...)

Countering the Drug Salesmen (Imøtegåelse av legemiddelkonsulentene)
EDITORIAL
nytimes.com 20.3.2008
A potentially useful antidote to drug company influence over the prescribing practices of doctors is under consideration in Congress. The idea is to have government-funded health professionals visit doctors to give unbiased guidance on the safety and effectiveness of drugs to counter the one-sided sales pitches they get from pharmaceutical company representatives. The end result should be better care, quite often at lower cost. (...)

Now Senators Herb Kohl, Democrat of Wisconsin, and Richard Durbin, Democrat of Illinois, are planning to introduce legislation that would authorize federal grants to prepare educational materials and train health professionals to conduct visits to prescribing physicians. Their hope is that the program would pay for itself by lowering drug costs to federal programs.

With comprehensive, unbiased information, doctors should be more likely to prescribe the best drug for a patient, not necessarily the newest, high-priced drug that is being pushed by a drug company sales representative. (...)

- Sjekk hvem som er medlem av Frimurerlosjen

Frimurerne skjerper hemmeligholdet
vg.no 5.2.2010
Nå blir det ikke lenger mulig å se hvem av statskirkens prester som også er ridderprester i Den Norske Frimurerordenen. (...)

Avslører frimurernes ritualer
tv2nyhetene.no 9.10.2009
Frimurerne tok skjelett fra en kirkegård for å bruke hodeskaller og knokler i ritualene sine. (...)

Hvem er medlem i losjene der du bor, hvem sitter de sammen med og hvilke yrker har de? Finn det ut her (Listen er fra 2008) (...)

- Frimurerlosjen kan være farlig
nrk.no 9.10.2009
Det mener Roger Karsten Aase fra Trondheim, som har skrevet bok om sine 15 år som frimurer. (...)

Undersøker politiets losjepraksis
tv2nyhetene.no 29.10.2008
Spesialenheten for politisaker er koblet inn etter avsløringer på TV 2 om ulovlige tjenester mellom losjebrødre i politiet. (...)

Klikk her for å se listen over lensmenn og se resten av politilistene nederst i artikkelen. (...)

Klikk her for å se listen over politibetjenter
Klikk her for å se listen over politiførstebetjenter
Klikk her for å se listen over politiavdelingssjefer
Klikk her for å se listen over politioverbetjenter
Klikk her for å se listen over lensmenn
Klikk her for å se listen over politiinspektører
Klikk her for å se listen over politimestere (...)

Mystikken oppheves
tv2nyhetene.no 26.10.2008
Frimurerlosjen har alltid vært forbundet med mystikk, i motsetning til demokratiets åpenhet.

Tv2nyhetene.no offentliggjør i dag frimurerlosjen sin medlemsliste.
Listen er ikke hemmelig, men den har vært vanskelig tilgjengelig. Det gjør vi nå noe med. (...)

Åpenhet
Nettverk og vennetjenester kan lett komme i konflikt med demokratiets krav til åpenhet og rettferdig byråkratisk behandling.

En mulig usunn kobling mellom livet som bror og som et viktig samfunnsmedlem har gjort at norske dommere må opplyse medlemskap i brorskap som frimurerlosjen.

Ved å gjøre listene tilgjengelig gjør vi det lettere for alle å finne ut hvem som er med i losjen.

Sjekk hvem som er medlem av Frimurerlosjen her (...)

Frimurerordenen
tv2nyhetene.no 26.10.2008
Det hemmelige brorskap

De norske losjene samler over 18.000 medlemmer. På denne siden kan du finne ut hvem som er medlem i losjene der du bor, hvem de sitter sammen med, hvilke yrker de har.

Listene på tv2nyhetene.no er basert på «Matrikkel for Den norske frimurerorden, 2008». (...)

- Brorskap mellom leger og legemiddelkonsulenter (- 400 leger samt et knippe legemiddelkonsulenter)

Brorskap mellom leger og legemiddelkonsulenter
dagensmedisin.no 30.10.2008
Blant frimurerne fins rundt fire hundre leger samt et knippe legemiddelkonsulenter. – Uproblematisk, sier frimurer og leder for Etisk råd i Legeforeningen, Trond Markestad.

Blant legene som klatrer i gradene i den omtalte frimurerlosjen, fins både overleger, kommuneleger og spesialister.

Også lederen for Legeforeningens etiske råd, Trond Markestad, er mangeårig frimurer.

Blir kjent – uansett
Markestad mener det er uproblematisk at eventuelle legemiddelkonsulenter har mulighet til å påvirke legene dersom de er «brødre».

– Jeg ser ikke noe problem med dette. I enhver forening blir man kjent med hverandre, og det er alltid en mulighet for forbindelser uansett hvilke foreninger en tilhører, sier Markestad til Dagens Medisin. (...)

Diverse artikler

Reality Check
The dos and don’ts of collaborating with industry
BMJ 2012;344:e3247 (8 May)
If you haven’t read the recent guidance on doctor-industry relationships, it’s certainly worth a look.¹ Endorsed by leading professional groups, it argues that promising collaboration with industry “may be missed or even rejected” because of “misconceptions” arising from historical practices or rogue individuals. To set the record straight, the guidance emphasises the value of seeing sales representatives, the benefits of industry sponsored education, and the critical importance of health professionals serving on companies’ advisory boards.

To drive home its message, the guidance spells out some DOs and DON’Ts for doctors, and this is where it starts to sound just a tad defensive, not least because of the use of BOLD CAPITALS. First among the DOs is the instruction to treat industry as a partner and to get involved with company funded trials and education. The DON’Ts feel like the desperate pleas of a lover fearing that a long term affair may be on the rocks: “Don’t establish blanket policies denying interaction with industry,” and “Don’t be tempted to accept the negative myths about cooperating with industry.”

Given the slightly shrill tone, it might be helpful to strengthen the guidance with a few more DON’Ts for doctors, offered here with respect and humility. (...)

Sales representatives
Firstly, don’t read the 2010 systematic review that concluded, “With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations.”² Secondly, don’t read salacious whistleblower testimony describing how one of Pfizer’s top selling reps boasted of using strip clubs to help boost sales of sildenafil (Viagra) and other products.³ (...)

Inappropriate prescribing for the elderly-a modern epidemic? (Uhensiktsmessig forskrivning for eldre - en moderne epidemi?)
Eur J Clin Pharmacol. 2012 Feb 15. [Epub ahead of print]
(...) PURPOSE: The elderly often use several drugs on a regular basis and are especially at risk for drug-related harm from side effects and interactions. The aim of this study was to explore the overall prevalence of and predictors for potentially inappropriate medication use among Norwegian elderly outpatients.

METHODS: A pharmaco-epidemiological retrospective cross-sectional survey was undertaken based on data from the Norwegian Prescription Database. Prescriptions from all doctors in Norway, dispensed by pharmacies to home-dwelling elderly ≥70 years in 2008, were included for a total of 11,491,065 prescriptions from 24,540 prescribers to 445,900 individuals (88.3% of the Norwegian population in this age group, 58.9% females). We applied a list of criteria for pharmacological inappropriateness for elderly people (the NORGEP criteria) to determine the prevalence of potentially inappropriate medications (PIMs) and applied a multiple logistic regression model to identify predictors.

RESULTS: According to our criteria, 34.8% of the study population (28.5% of the men, 39.3% of the women) was exposed to at least one PIM. Of these, 59.9% represented psychoactive substances. The odds of receiving potentially harmful prescriptions increased with the number of prescribers (OR 3.52, 99% CI 3.44-3.60 for those with ≥5 compared to those with 1 or 2 prescribers). Twenty percent were prescribed more than 10 medications; among these two-thirds had at least one PIM. Adjusted for differences in age distribution and the number of prescribers involved, women were more frequently exposed to PIMs than men, with an odds ratio of 1.60 (99% CI 1.58-1.64).

KONKLUSJONER: Omtrent en tredjedel av den eldre norske befolkning blir utsatt for mulig uhensiktsmessig medisinering, og eldre er spesielt utsatt for risiko. (...) (CONCLUSIONS: About one-third of the elderly Norwegian population is exposed to potentially inappropriate medications, and elderly females are at particular risk. )

Doctors must not be lapdogs to drug firms
BMJ 333 : 1027 (9 November)
Last month I gave a talk at Presbyterian Hospital in Albuquerque, New Mexico, about the influence of the drug industry on continuing medical education. As usual, pharmaceutical companies contributed funds to the conference, and there was a small exhibition area with the usual monopoly of drug firms.

Immediately after my talk, one pharmaceutical company representative announced to a conference organiser that her company would no longer support the annual conference. Another packed up his exhibit and walked out. Other drug representatives were observed muttering angrily into their cell phones, which may, or may not, have been related to the near total exhibitor boycott the next day. Only one exhibitor showed up, prompting a physician friend of mine to remark, “Maybe he missed your talk.”

I had been so thrilled to receive my first United States invitation (outside of my university) to speak about how pharmaceutical companies manipulate prescribing. OK, to be entirely accurate, I was invited to speak about herb-drug interactions. But my “buy one get one free” lecture offer was taken up, and the organisers arranged a debate with a sales representative on whether pharmaceutical companies should fund continuing medical education for physicians.

The drug representative who agreed to the debate later backed out on the advice of “legal.” Despite having been offered equal time, this is the same person who announced that her company would not support future conferences.

My talk covered the costs of drugs, the costs of promoting drugs to doctors, the salaries of drug representatives, the funding of continuing medical education, and the connection between polypharmacy and adverse drug events. I also covered psychological profiling and monitoring of physicians, including prescription tracking. (...)

Physicians Saying No More Often To Drug Reps (Leger sier oftere nei til legemiddelkonsulenter)
kaiserhealthnews.org 7.5.2010
The Wall Street Journal: A report out Thursday on the accessibility of doctors to pharmaceutical reps showed that fewer physicians are letting reps visit them. "The number of physicians who were 'rep-accessible,' defined as meeting with at least 70% of salespeople who come calling, dropped by 18% from last year, according to sales and marketing consultants ZS Associates." The report noted that now 58 percent of prescribing doctors are considered rep-friendly, and those who see 30 percent or less of reps who come calling are up to 9 percent of all prescribing doctors (Hobson, 5/6).

Pharma Times: "The study looked at the sales rep-related interactions of more than 500,000 physicians, nurse practitioners and other pharmaceutical prescribers in the USA and both the planned and completed calls of more than 41,000 reps — about half of all those operating in the country" (Grogan, 5/7). (...)

Drug companies should target drug plans, rather than physicians, consultant says
CMAJ 2010;182 (1) (January 12)
Pharmaceutical companies should increasingly focus their attention on payers, such as public and private drug plans, rather than physicians, says Paul Crotty, general manager of IMS Health Canada Ltd.

"What amazes me is the lack of connection between Big Pharma and the payers," Crotty told the seventh annual Canadian meeting of the Drug Information Association in Ottawa, Ontario on Nov. 3.

"Over time, the role of the doctor in deciding what prescriptions get written has eroded," said Crotty, head of the Canadian branch of a global consulting company that provides market research and intelligence to the pharmaceutical and health care industries. (...)

Death of a salesman: drugmakers recast reps' role (En salgsmanns død: legemiddefirmaer endrer legemiddelkonsulenters rolle)
reuters.com 16.12.2009
LONDON (Reuters) - The old-style sales rep may have had his day thanks to shifts in the pharmaceutical market and a cost-cutting drive by drug companies.

Healthcare Reform

The pace of decline in rep numbers has accelerated across Western markets this year, driven by a fresh spate of mergers and a looming wave of patent expiries for some of the industry's biggest-selling medicines.

But the cutbacks are not just about saving money.

The industry is also undergoing a profound structural change in which the payer, not the prescriber, is taking over as the true gatekeeper to pharmaceutical sales. (...)

Markedsføring af lægemidler har stor effekt - hvad er mekanismerne?
irf.dk 14.12.2009 (Institut for Rationel Farmakoterapi (IRF)
(...) Det er nok kun de færreste, der kan opretholde illusionen om, at større gaver ikke har indflydelse på lægers ordinationsvaner. Intuitivt vil man antage, at jo mindre værdien gaven har, jo mindre markedsføringsmæssig effekt. Desværre kan den videnskabelige litteratur ikke understøtte den hypotese. Også små gaver kan være overordentligt effektive markedsføringsværktøjer (15,16). Blandt de mest effektive virkemidler er de simple, nemlig mad, venskab og smiger, som alle er helt essentielle for opbygning af relationer imellem mennesker (15). En interessant observation er, at jo flere gaver læger modtager, jo større er deres tendens til at mene, at gaverne ikke påvirker deres medicinordinationsmønstre (17,18). (...)

Astrazeneca drar ner på säljstyrkan
lakemedelsvarlden.se 21.10.2009
Som ett led i nedskärningarna erbjuder nu Astrazeneca hela sin säljstyrka att sluta mot betalning. Totalt rör det sig om över 5000 anställda som nu uppmanas att tänka efter hur de vill ha det.

AVGÅNGAR För drygt ett år sedan annonserade Astrazeneca om nedskärningar i de europeiska delarna av säljverksamheten. Nu är det amerikanernas tur. I stället för att direkt säga upp personal har företaget gått ut med ett erbjudande till alla som arbetar inom säljstyrkan. Totalt rör et sig om mellan 5 och 6000 personer, rapporterar tidningen Pharmalot. (...)

Inside GSK's CASSPER Ghostwriting Program
industry.bnet.com 21.8.2009
A look inside GlaxoSmithKline’s CASSPER ghostwriting brochure reveals that Paxil Product Management at GSK expected its drug sales reps to control the process, even with doctors who were clearly unfamiliar with existing published data on the drug.

BNET noted yesterday that GSK (formerly SmithKline Beecham in the U.K.) maintained the program to create ghostwritten medical journal articles about its antidepressant, Paxil. (...)

(Anm: Seroxat (Paxil) (paroxetine; paroksetin) (SSRI) (mintankesmie.no).)

Lilly makes buyout offer to 4,000 sales reps
forbes.com 4.8.2009
NEW YORK -- Eli Lilly & Co. said Tuesday it is offering buyouts to 4,000 U.S. sales representatives with the hope of eliminating a few hundred jobs.

The Indianapolis-based drugmaker also said it plans to restructure its sales operations in diabetes, neuroscience and osteoporosis, giving sales representatives smaller territories to increase their contact with physicians. Eli Lilly did not estimate the costs of the retirement or restructuring packages. (...)

Eli Lilly spokesman Ed Sagebiel said the company will give its sales representatives smaller territories, with each representative responsible for dealing with a single physician. Sagebiel said the company has been testing that approach in Ohio and Wisconsin.

The company's best-selling drugs include Zyprexa for schizophrenia and bipolar disorder, Cymbalta for depression, Byetta for type 2 diabetes, and Evista for osteoporosis. The patent supporting Zyprexa, which bought in $4.7 billion in revenue last year, is set to expire in 2011, exposing the drug to cheaper generic versions. (...)

Drug reps in the slums - walking a fine line (Legemiddelselgere i slummen - å balansere på ein knivsegg)
social.eyeforpharma.com 7.7.2009
It’s inevitable that no matter which direction pharma steps in attempting to market its drugs, it will fall under fire at some turn with its broad host of critics. If it caters to the wealthy in developed countries, it is painted as ignoring those most in need of high quality medical care. But as it ventures into poorer nations with sales tactics developed in the west, it runs the risk of arming its critics with even more ammunition against it.

The path to the world’s poorest communities is littered with landmines for reps beating these streets. They are walking a fine line as they peddle their pharma wares.

A recent Wall Street Journal article (http://online.wsj.com/article/SB124691259063602065.html) tells of an effort by Pfizer to sell its drugs to the mostly poor residents of Petare, Venezuela. The article describes a “strategic shift in the $770 billion pharmaceutical industry to target the working poor in the developing world.” It is a story where the word “target” takes on the familiar negative connotations so often ascribed to the tactics of pharma. (...)

Drug Firms See Poorer Nations as Sales Cure (Legemiddelfirmaer ser fattige land som en mulighet for å opprettholde salget)
online.wsj.com 7.7.2009
(...) It was business as usual for Mr. Rodriguez. As a representative in Venezuela for U.S. pharmaceutical giant Pfizer Inc., his sales route takes him through one of Latin America's most dangerous neighborhoods. To avoid attracting attention, he wears a polo shirt with a red logo, the color worn by supporters of President Hugo Chávez.

Mr. Rodriguez is part of a strategic shift in the $770 billion pharmaceutical industry to target the working poor in the developing world.

For the first time in a half-century, sales of prescription drugs are forecast to decline this year in the U.S., historically the industry's biggest and most profitable market. The Obama administration and Congress's attempt to pass legislation overhauling the health-care system, including provisions that could lower the cost of medicine, could put drug makers' U.S. businesses under further pressure.

As a result, developing countries like Venezuela have begun to look more attractive to the industry. Sales of prescription drugs in emerging markets reached $152.7 billion in 2008, up from $67.2 billion in 2003, according to IMS Health, which tracks the industry. IMS forecasts sales will climb to $265 billion by 2013. (...)

Svikt på alle nivåer dreper
aftenposten.no 12.12.2008
Svikt både internt i sykehus, internt i kommunene og mellom ulike aktører involvert i pasientbehandling er for omfattende, mener Helsetilsynet.

–Betyr dette at dårlig kommunikasjon og mangelfullt samarbeid faktisk tar liv i Helse-Norge?

–Ja, det har vi flere eksempler på. Vi må imidlertid ikke legge hele skylden på den enkelte helsearbeider. Dette er stort sett systemfeil. Det er et lederansvar og vi ser svikt på alle nivåer når det gjelder samarbeid og kommunikasjon, sier direktør Lars E. Hanssen i Helsetilsynet.

Han understreker at det mange steder fungerer godt, men finner det nødvendig å slå alarm etter at Helsetilsynet har gått igjennom alle tilsyn og alle saker de har hatt i perioden 2004–2008. (...)

Today Examines No-Cost Prescription Drug Samples
kaisernetwork.org 1.12.2008
USA Today on Monday examined how no-cost prescription drug samples can influence physicians' prescribing habits and how health systems across the U.S. are beginning to ban or limit the samples. According to a study published in September in the Southern Medical Journal, more than 90% of U.S. physicians receive no-cost samples and more than half of older patients report getting at least one sample in a given year. The study also found that physicians at one practice were three times as likely to prescribe less-costly generic drugs to uninsured patients after the practice stopped storing sample drugs in 2000. (...)

Doctors ditch drug samples to avoid influencing treatment
usatoday.com 30.11.2008
Who doesn't like freebies, especially when it comes to pricey pills?
But free medication samples, which at first glance look like a win-win-win situation for manufacturers, doctors and patients, can have hidden costs. Doctors might pick a sub-optimal drug simply because they have a sample. Plus, only makers of expensive brand-name drugs are doling out samples. And leaving pharmacists out of the equation might raise the risk of errors. (...)

Legemiddelkonsulenter gir ikke nøytral informasjon
Tidsskr Nor Legeforen 2008; 128:2620 (20.11.2008)
(...) I forbindelse med Vioxx-skandalen ble det imidlertid avslørt hvilke metoder legemiddelkonsulenter bruker for å påvirke leger til å forskrive de legemidlene som gir høyest inntjening (2). Denne salgsteknikken, som går ut på å etablere, utvikle og opprettholde nære relasjoner til leger, bl.a. ved hjelp av gaver, påspanderte måltider og reiser, påfører samfunnet store unødvendige kostnader. Det er vanskelig å forstå at legemiddelkonsulenter (som ikke er rådgivere, men selgere), som i hovedsak formidler en muntlig subjektiv informasjon, kan sette legen i stand til å danne seg sin egen mening. (...)

Om legemiddelkonsulenter og legemiddelinformasjon
P Kormeset
Tidsskr Nor Legeforen 2008; 128:1684-5
I Tidsskriftet nr. 5/2008 presenterte Jørund Straand & Inger Johanne Christensen en studie som hadde som et av sine hovedfunn at legemiddelkonsulenter unnlater å nevne viktig sikkerhetsinformasjon om produktene de promoterer (1). Undersøkelsen er interessant, men den ligger seks år tilbake i tid og resultatene må tolkes i lys av dette. (...)

Merck & Co axes 1,200 sales jobs in the USA
pharmatimes.com 6.5.2008
A week after US regulators rejected the firm’s new combination treatment MK-0524A, Merck & Co has announced plans to cut 1,200 sales jobs in the country.

The move represents part of the New Jersey-based drugs giant’s previously-announced reorganisation project, ‘Plan to Win’ which was launched at the end of 2005 and has to date led to the elimination of 8,100 jobs. The latest cuts will “optimise our cost base and improve Merck's effectiveness”, said Kenneth Frazier, president of the firm’s Global Human Health unit. (...)

The latest round of cuts, combined with 400 sales jobs eliminated last year, will affect about 20% of Merck’s 8,500-strong field force in the USA. (...)

The future of the pharma rep: a time for change – again
eyeforpharma.com 24.4.2008
What’s in store for pharmaceutical sales reps? Are their roles likely to change significantly and, if so, how?

Baba Awopetu, Manager of Brand Strategy, EMEA at Stryker, says a review of recent media reports on the pharmaceutical industry confirms that future sales force models continue to dominate industry debates. But it’s certainly not a new discussion. (...)

Ex-drug salesman: We lured docs with gifts
bostonherald.com 30.3.2008
Companies recruit ‘beautiful people’ as reps
(...) He is working with The Prescription Project, a group fighting the impact of pharmaceutical marketing on physicians’ prescription decisions.

The group contends that aggressive marketing to physicians by pharmaceutical companies creates conflicts of interest in the medical profession and raises questions about the appropriateness of treatment choices.

Many blame drug companies’ aggressive marketing efforts for a portion of the rise in health-care costs, because physicians are swayed into prescribing newer, more expensive medicines instead of older, less expensive brands. (...)

19 Percent of Office Based Physicians Refuse to See Pharmaceutical Biotech and Medical Device Sales Reps (19 prosent av allmennpraktiserende leger nekter å se legemiddel- og utstyrsselgere)
drugs.com 22.1.2008
IRVINE, Calif., January 22, 2008 - Based on a comprehensive telephone survey of 180,000 doctors, 19 percent of U.S. office-based physicians refuse to see sales representatives from the drug and device industry at any time, according to the recent study by SK&A Information Services, Inc. Another 22.7 percent of doctors require the reps to set an appointment. These findings underscore the increasing limitations that physicians are imposing on visits from the medical industry. (...)

Catania's Bill Would Regulate Pharmaceutical Salespeople (Catanias lovforslag vil regulere legemiddelselgere)
washingtonpost.com 9.12.2007
The District could become the first jurisdiction in the country to license pharmaceutical sales representatives, a move a council member says would help protect doctors and patients from disreputable agents who help drive up the costs of prescription drugs.

The drug industry says the move is unnecessary because it overlaps with federal laws.

The D.C. Council is set to vote Tuesday on member David A. Catania's SafeRx Act, which would also ban pharmaceutical manufacturers from using doctors' prescription data for marketing purposes without the doctors' knowledge. (...)

Dr. Drug Rep (Dr. legemiddelkonsulent)
nytimes.com 24.11.2007
On a blustery fall New England day in 2001, a friendly representative from Wyeth Pharmaceuticals came into my office in Newburyport, Mass., and made me an offer I found hard to refuse. He asked me if I’d like to give talks to other doctors about using Effexor XR for treating depression. He told me that I would go around to doctors’ offices during lunchtime and talk about some of the features of Effexor. It would be pretty easy. Wyeth would provide a set of slides and even pay for me to attend a speaker’s training session, and he quickly floated some numbers. I would be paid $500 for one-hour “Lunch and Learn” talks at local doctors’ offices, or $750 if I had to drive an hour. I would be flown to New York for a “faculty-development program,” where I would be pampered in a Midtown hotel for two nights and would be paid an additional “honorarium.” (...)

Sunshine Laws and the Pharmaceutical Industry (Sunshine-lover og den farmasøytiske industri)
JAMA. 2007;297:1255-1257
Recent research would suggest that the US public should be pleased with the role the pharmaceutical industry plays in advancing public health. (...)

So why is there so much dissatisfaction with the pharmaceutical industry today?⁶ The answer appears to lie in its reliance on a distinctive model of marketing. The mainstay of the marketing effort has been a combination of advertisements to physicians, direct visits to physicians by pharmaceutical sales representatives, and a variety of gifts to physicians and their institutions, supplemented only recently by direct-to-consumer advertising. This approach must have been effective, given the size of the marketing budgets of most manufacturers, but it has also raised persistent issues about conflicts of interest from both legal and ethical points of view.⁷ (...)

To be clear, for-profit industries do not share the same ethical norms to which physicians and other health care professionals must adhere. Their primary commitment is to create shareholder value, not maintain an altruistic commitment to patients. But at some point the leadership of the pharmaceutical industry and their boards of directors must begin to recognize that growing public and professional mistrust could substantially detract from that value. (...)

(Anm: Interessekonflikter, bestikkelser og korrupsjon (mintankesmie.no).)

(Anm: Sakkyndige legers integritet, partiskhet og habilitet versus løgn i rettssalen (sakkyndighet) (mintankesmie.no).)

Sales Reps File More Overtime Lawsuits
pharmalot.com 28.6.2007
Sales reps are filing lawsuits today against two more drugmakers - Bristol-Myers Squibb and Abbott Labs - over alleged violations of state and federal overtime laws. With these filings, all of the biggest drugmakers face overtime lawsuits in state and federal courts, according to the lawyers for the sales reps. (...)

“Although the companies claim that the representatives are salespersons and therefore not protected by overtime laws, with some exceptions, they actually don’t sell anything,” says Charles Joseph, one of the lawyers.

“Rather, they are tasked to influence the prescribing behaviors of doctors. Many employees in all industries are under the mistaken impression that being salaried means that they are not protected under the overtime laws. But a salaried employee is entitled to overtime unless they fit within one of the closely defined exceptions to the rule.” (...)

Effective Sales Techniques for Physician Relations Representatives
healthleadersmedia.com (24.5.2007)
Searching for the key to successful physician sales?
Quality time with physicians is hard to come by these days. An ever-expanding group of salespeople vying for face-time has doctors and their gatekeepers on guard. And when you do finally get in front of a referring physician, too often you spend that precious time listening to a litany of complaints—instead of focusing on increasing or maintaining referral levels.

Learn how to get in the door and make the visit count. (...)

How pharmaceutical representatives change your behaviour
Shortcuts from other journals
BMJ 2007;334:1029 (19 May)
"It's my job to figure out what a physician's price is. For some it's dinner at the finest restaurants, for others it's enough convincing data to let them prescribe confidently and for others it's my attention and friendship . . . but at the most basic level, everything is for sale and everything is an exchange." So writes one former pharmaceutical representative in an article explaining to doctors just how drug reps work their clients. (...)

States Cracking Down on Drug Marketing (Stater slår ned på markedsføring av legemidler)
forbes.com 12.4.2007
Pharmaceutical-company sales reps who visit doctors' offices to promote their products know a surprising amount about the physicians before they even walk through the door.

Maybe too much, some lawmakers around the country say.

Legislators are taking a hard look at data-mining companies that keep detailed records on exactly what drugs are prescribed by nearly every doctor in the U.S.
These databases, updated weekly, are stripped of patient names and then sold to drug companies, which use the information to identify doctors who might be particularly receptive to their sales pitches. (...)

The Doctor Won't See You Now
NEWS & INSIGHTS
businessweek.com 5.2.2007
Dr. Lucy E. Hornstein is fed up with pharmaceutical salespeople. So whenever a rep walks into her Valley Forge (Pa.) family practice, she whips out a sheet of rules. Among them: No visits allowed except between noon and 2 p.m. Do not bring any pens, sticky pads, or other knickknacks bearing the name of the drug you're touting. Furthermore, Hornstein says, "I tell them, 'don't talk to me about drugs because everything you say is propaganda.'" The constant stream of salespeople in Hornstein's office has pretty much dried up, for which she declares: "Good riddance." (...)

Changes in the industry put limits on pharmaceutical company employees newsobserver.com 21.12.2006
They hang out in hallways, hoping to snatch just two minutes with a doctor. They stock supply closets with drug samples and know the latest medical research inside and out.

But pharmaceutical sales representatives, once welcomed by doctors as the bearers of golf outings and days at the spa, have been pushed by many physicians to the margins of their practices. (...)

Pharmaceutical Sales Representatives Declining in Popularity, Raleigh News & Observer Reports
kaisernetwork.org 22.12.2006
The Raleigh News & Observer on Thursday examined how pharmaceutical sales representatives, who were "once welcomed by doctors as the bearers of golf outings and days at the spa, have been pushed by many physicians to the margins of their practices." (...)