S&R Blog

What do physicians really think about Big Pharma?

According to Dr. Candida Fink’s latest blog post on PsychCentral, not highly. In what clearly wasn’t a good year for pharma in terms of reputation, Dr. Fink highlights why she will “no longer see any drug reps.”

I didn’t want to hear from them, and I haven’t since. I avoid lectures and meetings that drug companies sponsor, and I use no drug company pens or notepads. The longer I avoid direct contact with drug company reps, the better I feel about it. The further removed I am from these things the more I realize I was getting a lot of my information about medications from company reps who had vested interests in my using their product. I realized that I don’t need samples, because the companies give samples only of their newest products, and those don’t have the research or track records that the older products have. Furthermore, the older products are now available as generics, which ultimately save my patients far more money than they save by taking a few free samples and then paying for the priciest, newest product.

Obviously, this is the opinion of one physician, but the points Dr. Fink brings up about her disdain for pharmaceutical marketing tactics have been echoed more than once lately. So if not from pharma companies, where would physicians get their information about products? According to Dr. Fink,”That isn’t to say I don’t keep informed and try new products that are appropriate for certain patients, but I do so based on research and my patients’ needs, not who bought me lunch last week.”

Samples, proper medical education, and other informative materials should be needed to help improve patient outcomes. But physicians seem to be turning their heads the other way.  If pharma doesn’t heal the wounds and restore the trust with physicians, credibility will be the least of its problems. What do you think?

Read Dr. Fink’s post here.


Will medical education help to fill the credibility gap in pharma?

David H. Recht of North State Resources Inc. and Kelli Soare and Ed Leon of S+R Medical Communications discuss how credible, needs-based branded medical education can help to make the pharmaceutical industry a trusted resource for physicians once again.

Source: Med Ad News

Recognizing the erosion of trust physicians have in the information they receive from the pharmaceutical industry, the healthcare advertising agency S&R Communications Group has recently re-engineered into two specialized companies, S+R Medical Communications and Friday Morning. Friday Morning will provide insight on a project basis into what physicians will and will not respond to as promotion. Meanwhile, S+R Medical Communications will provide educational vehicles that brands need to rebuild trust and help physicians and patients make better, more informed choices in healthcare.

To learn more about the need for credible branded medical education, Med Ad News spoke with Dave Recht, CEO of North State Resources – the holding company for S+R Medical Communications and Friday Morning– along with Kelli Soare, senior program supervisor, and Ed Leon, senior program director, both of S+R Medical Communications.

Dave Recht: The trust issue has crossed the boarders of promotional strategies in a pretty pervasive way. It’s not just the advertising. It’s not just the sales rep, but there’s also the trust issue in the whole area of medical education. Part of that stems from the fact that there are cases in which physicians look at any of the information that’s coming from the pharmaceutical industry and they’re very skeptical about it.

I’ll also say, immediately 180 degrees to the opposite, that one of the areas that continue to be described, at least to us, and other reports we’ve seen is that they do want education.

If you start out with the mission that pharmaceutical companies, aside from their discovery and development and marketing component, have an obligation to educate their physician and patient audiences. If you accept that as a basic plank of responsibility for the pharmaceutical industry, what that demands is the physicians are saying, we give you that you guys have the most knowledge and the most insight and the most information about the products that you’re marketing, there’s not a dispute that we don’t think those products can be valuable, but we need to know the information that you have and that we need to know to make informed decisions about which of those products are right for which patients.

If you take that perspective, physicians really do want to be educated. But I think they want to be educated now in a way that they can take that information along with information that they’re getting from a number of other sources – Internet, their colleagues, symposia, publications – and use their brains to filter through what are the best opportunities to treat their patients.

There clearly is a demand and a need for branded medical education.

Med Ad News: Is there a problem with the way branded medical education is being presented? Are they getting what they need?

Dave Recht: There’s some things that need to change. We’ve always taken the perspective on the branded side, or the medical information side, within labeling, that education has a set point, and that is to deliver information that helps somebody better understand and better make treatment decisions. Whether it’s certified education or whether it’s educational information within labeling, we really don’t distinguish that in the sense of one type of education being better than the other type. It is education across the board.

So, if you take that premise and you say to yourself, okay, the first thing about education is it has to be need-based. To go into a speaker bureau or some other educational program in which you’re talking about cough cold products, unless there’s a new revelation and high-powered product, nobody is going to pay attention. So, it has to be based on the educational needs of the doctor in terms of helping he or she make their treatment decisions.

Then, if you base it on need, the second thing that has to happen is it has to be credible. What are the hallmarks of credibility? It’s people whom you choose to associate with in developing the educational material, so your thought leaders and KOLs. They’re respected. They’re well grounded. They have good clinical application and perspective on how a product should be used. Not just the theory of it.

Then the information needs to be transparent. There needs to be a way in which physicians can look at the data that is provided as support for the particular product, and physicians need to be able to see the whole truth and nothing but the truth. That’s another plank of what good education is about. And unfortunately, it isn’t getting delivered as frequently as we might like it to be in today’s world.

Then to me the final point of it is how do you present that information? What is it you choose to do in terms of the different types of mediums? The graphic design. The language you use.

And by the way, when we develop our educational programs, we always look at key principles of adult learning. What are some of those key principles and how do we apply those to the educational process and the programs we’re putting together for an audience?

So, the end of this whole thing becomes a process by which physicians who get an educational event from us … that education should be meaningful, worthy, credible, applicable from a clinical perspective, and it needs to be presented in a way that the physician receiver can easily understand the information and gain knowledge very quickly.

Ed Leon: A lot of clients probably don’t accept the reality that the way doctors get information has changed quite a bit, and it’s changing rapidly. Just like consumers and patients, doctors are active seekers of information much more than they were 10 or 20 years ago. They’re not just passive recipients. You have to meet the doctors where they are, where they’re seeking information. It’s very rare that a doctor is going to sit in his office and just wait for a sales rep to come in and get his first piece of information about a therapeutic area or a product.

Read the rest of the interview here.

Doctors increasingly close doors to drug reps, while pharma cuts rank

Many physicians see detailers only with scheduled appointments. Drugmakers are responding to hard times with layoffs and a shift toward online marketing.

Source: American Medical News

The relationship between doctors and drug reps may never be the same again.

Pharmaceutical companies — battered by a sluggish drug pipeline, the looming loss of blockbuster patented drugs, an economy in recession and scrutiny of their relationships with physicians — are re-examining the value of sending drug reps into doctors’ offices. Detailers are struggling to grab a shrinking slice of physicians’ valuable time and attention while adjusting to new drug industry rules banning freebies such as pens and notepads.

At its peak in 2007, the American pharmaceutical industry fielded 102,000 sales reps, said Chris Wright, managing principal for the consulting firm ZS Associates’ U.S. Pharmaceuticals Practice. Drugmakers have slashed the number to 92,000 since then, and ZS projects the number will fall to 75,000 by 2012 at the latest, saving the industry $3.6 billion.

Pharma’s return on investment in its sales force has plummeted. For every 100 reps who visit a practice, 37 place their products in the office’s sample cabinet, and only 20 speak to a physician in person, said the New York-based consulting group TNS Healthcare. Profit per drug rep visit fell 23% from 2004 to 2005, said a February PricewaterhouseCoopers report on pharma’s future.

“The old sales model is broken now, and who knows how it will look in the future,” said Peter H. Nalen, president of Compass Healthcare Communications, an online drug marketer in Princeton, N.J. “What’s happening is that pharmaceutical companies are realizing there are other ways to reach the doctor instead of banging on the door of the doctor who just doesn’t want to talk to you.”

1 in 4 doctors works in a practice that refuses to see drug reps.

The time squeeze and the new drug industry rules are “changing the landscape quite dramatically,” Nalen said. Another troubling sign for drugmakers: More than a third of medical schools require drug reps to have appointments before seeing physicians or residents, according to the American Medical Student Assn.’s 2008 PharmFree Scorecard. The Assn. of American Medical Colleges recommended the by-appointment-only policy in May 2008.

While most physicians still have positive views of detailers and drugmakers, those sentiments are cooling.

About one in four physicians works in a practice that refuses to see drug reps. Of doctors who do see reps, about 40% will meet with detailers only with scheduled appointments. The by-appointment-only figure jumped 23% during the last six months of 2008, according to a survey of more than 227,000 medical practices representing 640,000 physicians that was released in February.

The survey, conducted by the doctor-profiling firm SK&A Information Services Inc., did not seek to determine why some physicians are giving drug reps the cold shoulder. But physicians and pharmaceutical industry consultants say doctors have felt besieged by the number of reps visiting their offices and taking up precious time in an era of declining payment.

Last year saw a slight drop in a measure of the quality of detailers’ relationships with doctors, based on a TNS survey of more than 1,500 doctors. And negative word-of-mouth about pharma rose sharply among physicians — this so-called market-resistance index jumped 62% in the last year, TNS said.

Controversies over the drugs marketed as Vioxx (rofecoxib), Avandia (rosiglitazone) and Vytorin (ezetimbe and simvastatin) appear to be making doctors more skeptical of drugmakers as an information source, said Jerome L. Avorn, MD, professor of medicine at Harvard Medical School in Massachusetts.

“Doctors are increasingly concerned that the sales pitches from drug reps are not giving them the full story,” said Dr. Avorn, author of the 2004 book, Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs.

Ken Johnson, senior vice president at the Pharmaceutical Research and Manufacturers of America, said in a statement that detailing visits are good for doctors and patients. “Interactions between physicians and pharmaceutical company representatives benefit patient care through the exchange of information about new medicines, new uses of medicines, the latest clinical data, appropriate dosing and emerging safety issues.”
Interacting with detailers

For every physician, it seems, there is a different way to handle drug reps.

Charles E. Crutchfield III, MD, is a dermatologist with a high-volume practice in Eagan, Minn., a suburb of Minneapolis. Though five to 10 reps visit his office daily, he strictly limits detailers to one five-minute session a week and requires that the rep provide lunch for his staff.

More than a third of med schools require drug reps to make appointments.

“The reps know they are not allowed to disturb me when I am seeing patients,” Dr. Crutchfield said. “If they do bring samples, I have a nurse who will bring the pad back to me so I can sign it. I will not see or talk to reps when I’m in clinic.”

Ari Silver-Isenstadt, MD, persuaded the four other doctors and office staff in his Baltimore pediatrics practice to adopt, in January 2008, a “no soliciting” policy for drug reps. Dr. Silver-Isenstadt is a member of the National Physicians Alliance, whose Unbranded Doctor Campaign urges physicians to refuse industry gifts and stop seeing drug reps.

Despite the new survey figures showing that doctors are cooling to drug reps, he said physicians should be more aggressively addressing the conflict of interest detailers pose.

“More than half of us doctors still just have a feeding frenzy of reps in our offices,” he said. “We should be ashamed of ourselves for allowing such an intertwining of our patients’ best interests with the convenience and niceties of drug reps.”

Not all doctors share Dr. Silver-Isenstadt’s hard-line view.

Most are simply pressed for time. Drug companies are trying to reach out to doctors via the Web, experts said. About 45,000 doctors meet with detailers using online video, and 300,000 physicians say they are open to doing so, said a September 2008 study from Manhattan Research, a drug marketing research firm.

Visits by drug reps will not disappear entirely, experts said. Rather, the sales force that survives the layoffs will be better trained and have a greater depth of clinical and scientific knowledge.

Detailers “reach the customer in a way that other promotional techniques do not,” said Wright, of the ZS Associates consulting firm. “And for many of these doctors, the choices they make about what to prescribe are worth a considerable amount of money.

“When that’s on the table, it makes sense to send a highly trained person to make sure the doctor knows about the medicine before making those choices.

Kevin B. O’Reilly – American Medical News

The patient-physician social media triangle

There is an interesting discussion going on in the blogosphere surrounding a New York Times piece from last month titled, “Medicine in the age of Twitter.” It talks about the time constraints of physicians and how in the world of the internet and instantaneous media, a physician can provide offline consultation to patients when time is at a premium.

The piece was written by Dr. Pauline Chen, who is a proponent of social media interaction with patients. She states,

There continues to be anecdotal evidence regarding social media’s potential to strengthen the patient-doctor relationship. “One way I see that power is through education,” said Dr. Christian Sinclair, a physician for Kansas City Hospice who has created a palliative care network through his blog and Twitter. “I can help to inform the public, I can put the knowledge I have out there. And if there are patients or families who need this knowledge, I can help them because of this network.” Dr. Sinclair has, for example, helped individuals he has met through Twitter connect with local hospices, a process he believes was expedited by Twitter’s particular platform.

Obviously there are numerous positives and negatives to taking the patient-doctor relationship offline. But it would be interesting to see which type of physicians and patients were pro or against. You would assume that early-adopting or younger physicians and patients would be more in-tune with the changing outlets to medical information (61% of patients go online for health information). But the conversation developing at the Well Blog begs to differ. Some of the highlights are below.

“I am a physician and find the concept of augmenting patient care through social networking idiotic. Facebook, Twitter and similar venues are not an appropriate place for the sensitive nature of a patient physician encounter.”

“My doctor is not on Twitter (but he is on e-mail with me) but I do see a huge value in social media–as a rare disease patient, I’ve learned a lot from other patients and their lived experiences, and sometimes taking that knowledge into the exam room (or an e-mail) can really help us sort through decisions about treatments.”

“Initially, I was reluctant to communicate via email with patients; being an old-school internist it was seen as too impersonal. I’ve since changed my mind, and now wholeheartedly endorse electronic communications.”

“Outrageous. I can’t get my doctor to return a phone call, and yet he has time on his hands to gossip on the Internet and exchange tweets.”

“This piece and the MD postings are excellent testimonials confirming the 2006 WSJ HarrisInteractive research showing that 75% of patients want more access to their doctor online, while 75% of physicians don’t. What is missing from this commentary is that the options are not limited to Twitter or Email or Facebook.”

What do you think? Weigh in on the NYT or here.

If you don’t think there is a trust issue in pharma, then you haven’t seen this

What needs to be done? Start here.

Is this the future of patient education?

It seems like new boundaries are being broken everyday in the ever evolving world of engaging users through different mediums. Whether it be a technological advance (crohn’s app) or a new way to use a traditional medium (visual dictionary), marketers are finding new ways to deliver relevant content to consumers. So what’s next?

YouTube has provided fertile ground for Pharma and patient education (JNJ, Sanofi, GSK, Astra Zeneca) but they have only tapped the surface with this platform (videos). Enter BooneOakley (Charlotte agency). Their new website using YouTube as a platform brilliantly shows how you can apply the annotations and hyperlink features of YouTube for narrative purposes. Additionally, it brings life to video and introduces an unlimited amount of possibilities for patient education. What do you think? (you have to visit YouTube to get full experience)

The 20 most popular health websites | March 2009
March 16, 2009, 3:16 pm
Filed under: patient | Tags: , , , ,

Where are patients finding the answers to their health-related questions? When it comes to searching  the web, a whopping 19.1 million people looked to WebMD for answers last month.  The rest of the top 20 (via www.ebizmba.com)are below.

1 | WebMD.com
12,792,178 – Inbound Links | 17,556,340 – Compete Monthly Visitors | 15,900,000 – Quantcast Monthly Visitors | 738 – Alexa Ranking. | Page Rank: 8

2 | NIH.gov
17,987,993 – Inbound Links | 7,544,012 – Compete Monthly Visitors | 9,100,000 – Quantcast Monthly Visitors | 375 – Alexa Ranking. | Page Rank: 9

3 | MedicineNet.com
1,155,253 – Inbound Links | 5,107,809 – Compete Monthly Visitors | 6,400,000 – Quantcast Monthly Visitors | 1,665 – Alexa Ranking. | Page Rank: 7

4 | MayoClinic.com
522,897 – Inbound Links | 5,408,744 – Compete Monthly Visitors | 6,700,000 – Quantcast Monthly Visitors | 2,106 – Alexa Ranking. | Page Rank: 7

5 | everydayHealth.com
531,535 – Inbound Links | 6,971,593 – Compete Monthly Visitors | 4,100,000 – Quantcast Monthly Visitors | 2,879 – Alexa Ranking. | Page Rank: 7

6 | Drugs.com
601,853 – Inbound Links | 3,757,524 – Compete Monthly Visitors | 4,700,000 – Quantcast Monthly Visitors | 2,632 – Alexa Ranking. | Page Rank: 7

7 | Yahoo! Health
230,616 – Inbound Links | NA – Compete Monthly Visitors | 3,900,000 – Quantcast Monthly Visitors | NA – Alexa Ranking. | Page Rank: 8

8 | RightHealth.com
420,532 – Inbound Links | 4,634,475 – Compete Monthly Visitors | 3,100,000 – Quantcast Monthly Visitors | 3,944 – Alexa Ranking. | Page Rank: 5

9 | MedHelp.org
86,183 – Inbound Links | 2,861,357 – Compete Monthly Visitors | 2,400,000 – Quantcast Monthly Visitors | 3,125 – Alexa Ranking. | Page Rank: 6

10 | RxList.com
908,330 – Inbound Links | 2,005,295 – Compete Monthly Visitors | 2,700,000 – Quantcast Monthly Visitors | 6,017 – Alexa Ranking. | Page Rank: 8

11 | Healthline.com
117,801 – Inbound Links | 1,895,259 – Compete Monthly Visitors | 2,000,000 – Quantcast Monthly Visitors | 5,425 – Alexa Ranking. | Page Rank: 6

12 | RealAge.com
92,515 – Inbound Links | 2,200,677 – Compete Monthly Visitors | 1,400,000 – Quantcast Monthly Visitors | 5,292 – Alexa Ranking. | Page Rank: 6

13 | QualityHealth.com
53,224 – Inbound Links | 2,669,640 – Compete Monthly Visitors | 1,100,000 – Quantcast Monthly Visitors | 5,214 – Alexa Ranking. | Page Rank: 4

14 | wellsphere.com
271,033 – Inbound Links | 905,820 – Compete Monthly Visitors | 2,300,000 – Quantcast Monthly Visitors | 6,970 – Alexa Ranking. | Page Rank: 6

15 | RevolutionHealth.com
210,310 – Inbound Links | 2,385,918 – Compete Monthly Visitors | 491,000 – Quantcast Monthly Visitors | 5,710 – Alexa Ranking. | Page Rank: 7

16 | familydoctor.org
603,506 – Inbound Links | 997,338 – Compete Monthly Visitors | 1,400,000 – Quantcast Monthly Visitors | 9,619 – Alexa Ranking. | Page Rank: 7

17 | Prevention.com
203,132 – Inbound Links | 1,426,613 – Compete Monthly Visitors | 904,000 – Quantcast Monthly Visitors | 8,480 – Alexa Ranking. | Page Rank: 6

18 | eMedicine.com
2,989,159 – Inbound Links | 635,075 – Compete Monthly Visitors | 633,000 – Quantcast Monthly Visitors | 6,131 – Alexa Ranking. | Page Rank: 5

19 | healthcentral.com

444,449 – Inbound Links | 993,814 – Compete Monthly Visitors | 984,000 – Quantcast Monthly Visitors | 9,901 – Alexa Ranking. |Page Rank: 6

20 | Health.com

256,751 – Inbound Links | 907,696 – Compete Monthly Visitors | 904,000 – Quantcast Monthly Visitors | 11,446 – Alexa Ranking.| Page Rank: 7