Education Trumps Regulation

The SafeRx Act, legislation that requires licensure of pharmaceutical sales representatives in Washington, DC, is the latest in what looks to be a long line of efforts to regulate interactions between industry sales reps and physicians. Legislators in Maine, New Hampshire, and Vermont also are eyeing the relationship, proposing legislation that would further restrict pharmaceutical sales-and-marketing activities.

James E. Dutton

This movement is increasingly organized and has what appears to be a growing number of supporters. No Free Lunch, a not-for-profit organization of healthcare providers, recently made headlines by urging medical students to resist the free pizza offered by drug companies. A health system in Duluth, MN, reported ridding its offices of 20 shopping carts of promotional items from pharmaceutical representatives and shipping them off to Africa. The Massachusetts Prescription Reform Coalition—a newly formed alliance that includes the AARP, the American Heart and Stroke Associations, as well as insurers such as BlueCross BlueShield of Massachusetts and Neighborhood Health Plan—announced its intention to work to eliminate the "inappropriate marketing practices" it says are driving up the cost of healthcare. The Prescription Project, an effort funded by the Pew Charitable Trust, has similar goals.

Some groups advocate eliminating the pharmaceutical sales call altogether, and stories abound of healthcare systems that have banned or severely restricted sales representative visits to physicians—not to mention individual physicians who have decided they will no longer see reps in their offices or clinics. These and other efforts create the impression that more and more of today's practicing physicians and other providers see no value in any aspect of the pharmaceutical industry's marketing efforts and want nothing to do with sales representatives. But is that perception accurate? Do physicians really want to do away with the sales call by pharmaceutical representatives?

To find out, CMR Institute decided to go to the source—physicians and industry representatives—and ask them about their experiences. What we found is that most physicians we surveyed do value sales representatives—if they are well informed, have something new to say, and have a well-rounded body of knowledge that goes beyond the specific attributes of the products they sell. Based on our preliminary research, CMR concluded that more education, not regulation, is the key to improving perceptions of the pharmaceutical industry and, most importantly, adding value to the quality of patient care.

Docs to Reps: You Oughta Know

Asking the Questions

CMR Institute conducted a series of focus groups with primary care physicians and specialists across the country, as well as a quantitative online survey, in which doctors were asked what qualities were most important in a sales representative. When asked, fewer than 10 percent said they do not see sales representatives.

Our research suggests that physicians do value pharmaceutical representatives whose knowledge goes well beyond familiarity with a particular product. Yet, bringing representatives to a knowledge level where they are confidently conversant in all these areas requires a real commitment from pharmaceutical companies and their sales teams.

Rep Education: A Cost/Benefit Analysis

A standard already exists in Europe: Sales representatives have to meet strict corporate-responsibility standards set forth by the European Federation of Pharmaceutical Industries and Associations (EFPIA). EFPIA—the voice of 2,100 research-based European pharmaceutical companies—is committed to patient care and quality-of-life issues, with strong emphasis on research and development of new medicines. Its Codes of Practice, which all representatives must follow, regulate marketing tactics and require sales representatives to have "adequate training and sufficient scientific knowledge."

To deal with the current onslaught of criticism against the industry in the United States, it is time to think about proactive steps to mitigate criticism and convince outsiders and providers that there is real value in the information exchange between clinicians and representatives. Industry leaders need to work with those in education and medicine—and also with critics—to quickly develop a voluntary educational standard. This will ensure that industry sales representatives who call on physicians to communicate information about their companies' products are ethical, well educated, and knowledgeable—exactly what our research shows physicians want. The industry should be proactive and lead through voluntary self-regulation and education rather than be legislated at the local, state, or federal level. A voluntary industry-wide learning standard would improve physician and sales representative interactions and demonstrate the value that quality education can lend to quality healthcare.

The Future

With the increasing regulation of the industry, legislative requirements could quickly become a bureaucratic nightmare, creating an environment in which each pharmaceutical company would need to make certain that its sales representatives adhere to the myriad standards and guidelines in different states or even municipalities. How would these regulations advance patient care?

We're at a critical juncture in the way the pharma industry sells and markets its products. We must act now and with a very real sense of urgency. We must find ways to demonstrate to the public and to providers the valuable role that the industry and its R&D activities play in improving the health and longevity of our nation's citizens. By increasing education and setting voluntary industry-wide standards, the industry can show its commitment to professionalism while ensuring that sales reps go beyond marketing to enhance the quality of patient care.

James E. Dutton is president of the CMR Institute. He can be reached at jdutton@cmrinstitute.org