Drug pushers

Marketing Pharmaceuticals: Legal Drug Money

Pharmaceutical marketing representatives in the medical world account for about 58,000 sales positions in the United States. They provide direct marketing of everything from Viagra to the latest toe fungus treatment. Physicians depend on these reps' extensive knowledge so they as doctors can provide the most sought-after medications to their patients. It's a marketing job best suited those natural born salespeople, but requires the stamina and business skill fostered through an MBA degree.

Online Business Degree: Do It Anywhere!
Becoming a drug rep sounds super, but what if you don't have the time to pursue it? One of the best features about this position is that all the numbers and direct marketing strategies can be studied at home through an online business degree. While background knowledge of the health care industry is helpful, an MBA degree provides you the most important tools for the pharmaceutical world--not to mention an edge above your competitors:

* You'll learn the basics of business: accounting, finance, direct marketing and management and you will apply them to real life scenarios. This will help prepare you for the direct sales experience in medicine.
* Develop your ability to analyze your market and make equitable decisions with your company's product.

Get Your Foot in the Doctor's Door
The drug world is competitive and being strong in sales and direct marketing alone simply isn't enough. Pursuing your online business degree helps you network within the pharmaceutical market as drug companies witness your credentials and your drive. Once you're in, the side effects aren't half bad. In fact, the competitive salary and benefits will probably keep you coming back for more.

Accidental drug-poisoning deaths on the rise

Unintentional deaths due to drug poisoning -- primarily with prescription drugs -- increased by 68 percent between 1999 and 2004, and is second only to motor vehicle crashes as a cause of death from unintentional injury in the US, investigators at the Centers for Disease Control and Prevention report.

The annual poisoning-death rate increased from 4.4 per 100,000 population in 1999 to 7.1 per 100,000 in 2004.

Of all sex, racial, and ethnic groups, the greatest increase was among non-Hispanic white females. The age group most affected was persons aged 15 to 24 years.

The state with the largest relative increase was West Virginia, where rates rose 550 percent. Increases ranged from 195 percent to 226 percent in Arkansas, Montana, Maine and Oklahoma. Accidental poisoning mortality rates actually decreased in Delaware, Maryland, New York, and Rhode Island.

The drugs most responsible were psychotherapeutic drugs, narcotics and hallucinogens, and unspecified drugs.

In an editorial note, the CDC researchers write: "Effective response to increasing fatal drug overdoses requires strengthening regulatory measures to reduce unsafe use of drugs, increasing physician awareness regarding appropriate pharmacologic treatment of pain and psychiatric problems, supporting best practices for treating drug dependence, and potentially modifying prescription drugs to reduce their potential for abuse."

Pharmaceutical marketing

The marketing of medication has a long history. The sale of miracle cures, many with little real potency, has always been common. Marketing of legitimate non-prescription medications, such as pain relievers or allergy medicine, has also long been practiced. Mass marketing of prescription medications was rare until recently, however. It was long believed that since doctors made the selection of drugs, mass marketing was a waste of resources; specific ads targeting the medical profession were thought to be cheaper and just as effective. This would involve ads in professional journals and visits by sales staff to doctor’s offices and hospitals. An important part of these efforts was marketing to medical students.

Physicians are perhaps the most important players in pharmaceutical sales. They write the prescriptions that determine which drugs will be used by the patient. Influencing the physician is the key to pharmaceutical sales. Historically, this was done by a large pharmaceutical sales force. A medium-sized pharmaceutical company might have a sales force of 1000 representatives. The largest companies have tens of thousands of representatives. Sales representatives called upon physicians regularly, providing information and free drug samples to the physicians. This is still the approach today; however, economic pressures on the industry are causing pharmaceutical companies to rethink the traditional sales process to physicians.

Pharmaceutical companies are developing processes to influence the people who influence the physicians. There are several channels by which a physician may be influenced, including self-influence through research, peer influence, direct interaction with pharmaceutical companies, patients, and public or private insurance companies.

There are a number of firms that specialize in data and analytics for pharmaceutical marketing (Yellowikis).

Currently, there are approximately 100,000 pharmaceutical sales reps in the United States [3] pursuing some 200,000 pharmaceutical prescribers. [4] A pharmaceutical representative will often try to see a given physician every few weeks. Representatives often have a call list of about 200 physicians with 120 targets that should be visited in 4-6 week cycles.

Because of the large size of the pharmaceutical sales force, the organization, management, and measurement of effectiveness of the sales force are significant business challenges. Management tasks are usually broken down into the areas of physician targeting, sales force size and structure, sales force optimization, call planning, and sales forces effectiveness.

Since the 1980s, new methods of marketing prescription drugs to consumers have become important. Patients are far less deferential to doctors[citation needed] and will inquire about, or even demand to receive, a medication they have seen advertised on television. In the United States, recent years have seen an increase in mass media advertisements for pharmaceuticals. Expenditures on direct-to-consumer (DTC pharmaceutical advertising) have more than quintupled in the last seven years since the FDA changed the guidelines, from $700 million in 1997 to more than $4 billion in 2004.[citation needed]

The mass marketing to consumers of pharmaceuticals is controversial. It is banned in every western country except the US and New Zealand, which is considering a ban.

Influence of direct to consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey (2002)

Only the United States and New Zealand allow advertising of prescription drugs directed at patients. US spending on such advertising grew rapidly during the 1990s, reaching $2.47bn (£1650m) in 2000.¹ The dramatic increase in investment by the US pharmaceutical industry is evidence of an expected effect on sales. On the rationale that such advertising provides important information to consumers and patients who may benefit from advertised products, pharmaceutical manufacturers have campaigned in the European Union² and Canada³ for the relaxing of current regulatory restrictions. We examined the relation between direct to consumer advertising and patients' requests for prescriptions and the relation between patients' requests and prescribing decisions.

We carried out a cross sectional survey of a cluster sample of primary care patients in Sacramento, California, from March to June 2001 and in Vancouver, British Columbia, from June to August 2000. We used questionnaires to determine the frequency of patients' requests for prescriptions and of prescriptions resulting from requests. Seventy eight physicians participated in the study, 40 in Vancouver (all family physicians) and 38 in Sacramento (14 general internists and 24 family physicians).

Patients were all 18 years and over, spoke English, and provided informed consent. The unit of analysis was a matched set of patient-physician questionnaires covering a single consultation. We estimated adjusted odds ratios using a generalised estimation equation. We classified drugs as advertised to consumers if they were among the 50 drugs with the highest US advertising budgets⁴ or were described as advertised to consumers in Canadian media reports⁵ in 1999-2000, or both.

Patients requested prescriptions in 12% of surveyed visits. Of these requests, 42% were for products advertised to consumers. The table provides details of factors associated with requests. Physicians prescribed the requested drugs to 9% (128) of patients and requested advertised drugs to 4% (55) of patients. The prescribing rate was similar for advertised and non-advertised drugs (about 74%).

We asked physicians: "If you were treating another similar patient with the same condition, would you prescribe this drug?" An answer of "very likely" indicated confidence in choice and "possibly" or "unlikely" indicated some degree of ambivalence. Physicians were ambivalent about the choice of treatment in around 40% of cases when patients requested drugs (advertised and non-advertised, 62/143 v 62/500, 5.4, 3.5 to 8.5) and about half the cases when patients had requested advertised drugs (30/60 v 62/500, 7.1, 4.0 to 12.6) compared with 12% for drugs not requested by patients.

Patients' requests for medicines are a powerful driver of prescribing decisions. In most cases physicians prescribed requested medicines but were often ambivalent about the choice of treatment. If physicians prescribe requested drugs despite personal reservations, sales may increase but appropriateness of prescribing may suffer. Concerns about the value of opening up the regulatory environment to permit direct to consumer advertising in the EU and Canada seem well justified.

See: Direct-to-consumer advertising

Direct-to-consumer advertising in the United States

Unintentional Poisoning Deaths --- United States, 1999--2004


Prescription Drug Marketing Act (PDMA) (1987)

Generally