Thursday, December 30, 2010

A reflective thought to close out 2010

"We seem to be a very adverse nation.  We are fast becoming the stupid giant of planet earth.   We're big, we're powerful, and we seem to be steadily growing less intelligent." * ---Leonard Pitts Jr., Miami Herald Pulitzer Prize Winner

(*From a public address on the decline of truth in journalism and the growing "stupidification of Americans" - phenomena he attributed to Americans' unquestioning allegiance to their political ideologies and fabrication of the truth.)

A business acquaintance, turned friend, included this quote on a note that he sent me, thanking me for being a valued business partner since we first met in 1999. You know the type: one of those people you just like doing business with.

His type -- reasonable, modest, accommodating, measured, understanding -- is quickly disappearing. His replacement -- one who would expect something in return for a small gift of appreciation. He possesses few, if any, of the aforementioned attributes.

And the crime of it is, his type is not confined to the business world. If we were only that lucky. We are, my friends, fast becoming a nation that is dividing itself and forcing people to choose sides. More of us need to start taking the 30,000 foot view, and looking at what we, as a species, are becoming. The ugliness of our politics, the mud fights in the press regarding KOL conflicts of interest, the lack of decorum in just walking down the street, need I go on?
Somewhere along the line we have lost the spirit to come together. Our government leaders and corporate executives are not willing to invest in people, but if not us, who or what else? The U.S. citizenry is -- always has been -- the backbone of our strength, power and wealth.

As we reflect on this past year, we at BioPharma Advisors want to thank all those who have made our company a success and continue to support our long-term goals. We wish nothing but the best for the new year!

Thursday, December 23, 2010

Merry Christmas and Happy New Year!

We hope you have enjoyed our step into the Social media.  We want to hear from you though!  Tell us what you are interested in, let us know what topics you would like to see in our future blog posts. Complete the survey if you like, we are going to strive to be more interactive in the future.

We all like to follow certain issues. Ours will continue to be Patient Adherence, Key Opinion Leader Development, Social Media and eMarketing in the coming year.  All very different spaces, but certainly the wave of the future given the cost constraints of life science marketing and the new regulations facing us today.
Best wishes to you and your family for a Merry Christmas and prosperous New Year!

Tuesday, December 21, 2010

KOLs, Background Checks, and Unintended Consequences

We look forward to the day when industry members will no longer have knee-jerk reactions to bad press – we just wish we had a reliable crystal ball to tell us when that will be.

Our bemusement stems from some members’ announcement that they now will conduct background checks on physicians – prior to their becoming consultants and speakers. This statement comes in the wake of ProPublica’s original story showing that some industry members hired physicians with tainted backgrounds. In the subsequent story, ProPublica only discusses the relatively serious infractions, like “prescribing unjustified or excessive medications and making serious medical errors.”

The industry members who made this announcement – AZ, Lilly, and Merck – did not provide lots of details on how these checks will be made, other than they plan to review state records. Nor did they discuss what kinds of infractions, if any, would be acceptable. One that comes to mind is failing to keep up with continuing medical education courses.

As we noted in a previous blog, the original ProPublica story found that of 17,700 thought leaders checked out, just 1.4%, or 250, were found to be tainted in some way. Of course, all industry members should have been looking at state and federal records from the get-go. This is something we encourage our clients to do as part of the normal contracting process.

A final thought: Will industry critics be happy with just a state and federal records check? Will they want something more intrusive? If so, we wonder if and how this will negatively impact the practice of medical research. We know this is the right thing to do, but what are the unintended consequences?  How will industry members change how they work with exceptionally influential KOLs?

Let us know what you think.

Saturday, December 18, 2010

Patient Bloggers and the "T" Word

What an opportunity for industry to regain the public’s trust – or at least some of it.

We’re talking about industry’s use of social media to promote and market product, an excellent way to bypass mainstream media and hone the message. Even though the FDA is expected this month to present guidelines on how pharma can market medicines on Twitter, Facebook, and the like, the agency really has no say on what individual patient bloggers may say about their relationships with industry members.

To quote Pharma Marketing Blog's John Mack: “FDA cannot enforce transparency -- it has no authority over patients who are free to do and say what they like without mentioning any relationship they may have with pharma companies.”

According to Pew Research, about 61% of adults turn to the web for health information, and no doubt some of those people read those blogs. But do those bloggers disclose their relationship with pharma members, if one exists? We think they should.That is why like Sally Church (@maverickNY) we are going to create a disclosure section of this blog and our web site. Trust can be re-built one brick at a time.

And that goes for industry as well: The pharma member who ensures that the blogger discloses the connection is that much closer to establishing company loyalty among the readership.

It’s the T word, folks.  But stay tuned, because the storm around content creation in the industry is the next chapter in this story.  

Thursday, December 16, 2010

The World Market: What's on the Horizon

We took part in a survey with McKinsey Quarterly. We thought the ensuing model put into context the current global thinking as the U.S. pharma market begins to change. This is primarily meant for you global strategy types, but we think you'll agree with us that Scenario #3 -- constrained markets with unbalanced domestic fundamentals --
is the leading indicator of where the global markets are headed.

What does this mean for our clients in the U.S.? It means they need to deal with the idea that we are no longer the top market in the world. As a result, business practices and attitudes should change accordingly. To further that notion, maybe things like patient adherence should be more of a focus for in-line commercial marketing teams in the U.S.

Let us know what you think.

Which of these scenarios is most likely to happen in the next 6 months?

Scenario 2:
Stable fundamentals underpin global economic outlook
·         Careful, effective removal of fiscal and monetary stimuli
·         Strong growth in emerging market economies
·         Modest corporate-sector growth in medium term (emerging markets, productivity, developed world)
·         De-leveraged consumers in developed countries remain weak in near term until income and job growth recover in medium term
·         Reduced potential for financial inflation

Scenario 1:
Robust global markets remain susceptible to shock
·         Fiscal and monetary stimulus-driven economies
·         Strong growth in emerging market economies
·         Strong corporate sector growth (very strong in productivity and developed world)
·         Stable U.S. consumer sector (job growth returns, slow de-leveraging, modest income growth)
·         High potential for financial inflation, resulting in rapid currency movements, commodity prices and stock/bond markets
·         Failure to re-balance debt ratios, energy policies, health care expenditures, and pension obligations

Scenario 4:
Troubled global markets overwhelm domestic fundamentals
·         New shocks derail emerging market economies, stalling growth
·         Market driven curtailment of fiscal and monetary stimuli in developed countries
·         Sustained weakness in global consumer sector
·         Public sector is neutral to negative impact
·         Corporate sector is neutral to negative impact
·         Potential for raid currency devaluation in developed countries

Scenario 3:
Constrained global markets perpetuate imbalances
·         Strong growing emerging market economies
·         Fiscal- and monetary- stimuli-driven economy, although with ballooning deficits; fundamental policies are not repaired
·         Stable corporate sector (emerging markets growth and productivity surge offset by stagnation in developed world)
·         Weak U.S. consumer sector (structural loss of jobs, continued de-leveraging, declining per capita consumption)
·         Slow devaluation of dollar relative to commodities and emerging market currencies and commodity based inflation (dollar/euro terms)

Monday, December 13, 2010

Industry and Social Media 101

In November, FedEx and Ketchum released this study that benchmarks the best practices of 60 leading companies who are leveraging social media to drive internal cultural, brand performance, and reputation management. "Companies are using social media to change the way they communicate with their employees and customers, indicating a convergence of external and internal communications." They have set up a website to discuss the survey.

Both organizations suggest in this survey that social media is disrupting the way the world communicates and companies must continue to evolve how they interact with people to remain relevant. In our view, this recognizes the lack of in-depth research regarding how social media impacts the way companies program, budget, and set up their marketing teams.

Ketchum used a standardized interview protocol to guide 30-minute conversations with chief communications officers or their social-media leads at 60 leading companies across most major industries. Interviews occurred between August and October of 2010.

Here are some insights derived from the study:
  1. If you’re not open to feedback, you’re not ready to play.
  2. Organizations should recognize the rise of citizen journalism and the need to engage bloggers to support brand development and reputation management.
  3. Participants conveyed significantly greater focus on external rather than internal social media applications, but expressed strong interest in building up internal capabilities—primarily via enhanced intranets—in 2011 and beyond.
  4. Organizations are trending towards more formal collaborative social media oversight models that are inclusive of diverse business units and functions.
  5. Most organizations do not have formal internal learning programs established to promote the development of social media expertise.
  6. Companies continue to see the value in partnering with third parties to develop and execute social media programming.
  7. Participants most frequently estimated spending between 5% and 15% of their overall communications budgets on social media programming in 2010.
  8. The pace and scope of change as new tools and technology emerge demands an unparalleled degree of organizational nimbleness.
  9. As digital and social tools become the go-to resources for everything from news and information to friendship and love, smart brands will continue to figure out better ways to add value to the online experience—internally and externally.
While these conclusions may not be news to pharma's social media veterans, they are still valuable: They can be used in discussions with senior management about social media trends and to leverage those difficult discussions on social media operations in their companies. For us, these study results demonstrate just how much more work the industry has to accomplish to even be a participant in this growing communications channel.  

But like other business issues, regulated content may inhibit the industry's ability to even participate in the leading edge of social media discussion.  We think it is time for industry to focus on insight #1, "If you're not open to feedback, you're not ready to play."

Our recommendations for anyone in industry in this space:  Use these 9 insights as your strategic building blocks for the next 3 to 5 years. 

Wednesday, December 8, 2010

CER: Learn How to Love It

Comparative effectiveness: It’s a concept that payers like, and like a lot. Case in point: Britain’s National Institute for Health and Clinical Excellence. NICE has rejected paying for drug after drug over the past year, claiming it couldn’t see paying high costs for brand drugs that don’t deliver much more than other medicines of lesser value. The latest rejection was Roche’s Avastin; another rejection was Novartis’ Afinitor.

For those industry members whose attention has been riveted on other business matters – and that’s understandable – it’s important to appreciate that comparative effectiveness isn’t going away. Tucked into the health care reform bill was $1.1 billion to study comparative effectiveness research.

According to the Annals of Internal Medicine, CER is “the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care." While the point is to "assist [stakeholders] to make informed decisions that will improve health care at both the individual and population levels," all this information affords interested parties "the opportunity to address hitherto unexplored topics in clinical decision making.” In other words, how to save money.

Now, industry members could argue, and rightly so, that clinical trials produce data that come from homogenous groups. In The Health Care Blog, Norton Hadler, MD, wrote, “The science that the FDA reviews does not speak to the effectiveness of the drug, but to its efficacy… CER asks whether an intervention works better than other interventions in practice where the patients and the doctors are heterogeneous.” His argument: Redesign trials so they are more efficient. Good point, but considering industry's current reluctance to embrace this topic and FDA's current focus on safety, that argument will likely not be a top priority anytime soon.

Our advice? Take a look at PharmExec’s article The Fruits of Comparative Effectiveness

It’s a thoughtful, well conceived piece on how industry members should approach comparative effectiveness. Quoting a Lilly exec, the article says, “The companies that survive and thrive in this new environment will be those that embrace comparative effectiveness research."

Fighting CER, friends, is not helping demonstrate the value of medicine.

Monday, December 6, 2010

The Midei Investigation: Get Your House in Order

Considering all the criticism against industry lately, this is not a good time for companies to be procrastinating about changing some of their business practices. Case in point: What an Abbott Labs division may be doing with Mark Midei, MD.  He is the cardiologist accused of implanting hundreds of more stents in patients than apparently were necessary.

When Dr. Midei was barred from his Baltimore-area hospital last year for allegedly performing the unnecessary surgeries, Abbott hired him as a consultant.

A Senate report -- investigating because of alleged Medicare fraud -- says that Abbott “showered” Dr. Midei with gifts and other handouts, and that he performed more stent surgeries than any other cardiologist in his area, suggesting that the two items are directly related. While we have discussed COI extensively in this blog, the Midei situation is yet another example of how industry needs to continually evaluate and update its contracts with Thought Leaders.

We think a big-name corporation is getting dragged into a situation it did not think was possible, but is becoming more the unintended consequential norm because of heightened scrutiny on the industry. Our advice to clients is get your house in order. Make sure your divisions and affiliates are reviewing their Thought Leader contracts.  Make sure you are taking the appropriate steps to improving your Sunshine Act compliance efforts.

If this is a challenge for you, let us help.


Friday, December 3, 2010

Are Tougher Rules the Real Reason Behind Fewer Gifts?

We have a slightly different read on that Archives of Internal Medicine study showing that fewer physicians are accepting gifts or money from industry. 

The study’s author seems to attribute the drop to the tougher rules that hospitals and medical schools have adopted over the past few years regarding such gifts. “The data clearly show that relationships have dropped dramatically,” Eric G. Campbell, director of research at the Mongan Institute for Health Policy, in Boston, told Bloomberg. No doubt, to a certain extent, he’s probably right. There were 1,891 doctors who took part in the survey.

But there could be more to it than just tougher rules.

Another article caught our eye. It seems that more doctors are getting out of traditional private practice. They’re entering the highly lucrative concierge business, or becoming hospitalists.  The reasons for entering either specialty are plentiful – and we believe a contributing factor is that physicians are not happy with the excessive scrutiny their profession and medical practices has come under.

Unintended consequences: We think there is a fundamental shift in medical practice back towards the hospital-based model.  Doctors now will be willing to live "under the protection afforded by hospitals." It is no longer prudent or profitable to practice medicine in the ambulatory setting. Care in these settings will be delivered by allied health professionals, who we think are very competent. 

But what does this mean for industry marketers?  Focus your development efforts, if your product, device or service, is a niche/specialty product, on the physicians.  If your product, device or service is ambulatory based, focus on the PAs and NPs.    

Monday, November 29, 2010

Pharma's Brave New World -- Patient Adherence

And so it continues. The pharma world persists in shedding jobs, despite signs – admittedly wobbly signs -- that the economy is recovering.

Bayer recently joined the job-shedding queue, announcing it planned to eliminate 4,500 positions – but would recreate more than 2,000 jobs when it expanded into emerging markets, primarily in Asia.

Bayer’s announced reasons for eliminating the positions were spiraling research and development costs, competition from generics, and costs from health care reform.  Not really a surprise ….

Interestingly enough, pharma members expanding into China and India will face similar business challenges in those countries eventually.

It’s time for the 30,000-foot view. From our vantage point: America is no longer the glory market. The industry is undergoing a paradigm shift; members are looking for other places to make their fortunes. The huge markets of China, India and other Asian markets are exactly where they should be going. Shareholders will only put up with so much for so long.

So where does that leave the industry staffs in United States? Where should pharma members focus? Our answer: Patient medication adherence! More to follow.

Monday, November 22, 2010

Pharma’s Wake-Up Call: More Individuals, More Often

Today’s topic of conversation: Why the DOJ has begun focusing on pharma execs -- and not just their companies.

Just recently, the feds announced they don’t want pharma executives doing business with the U.S. government if their company has been convicted of ripping off Medicare -- which is above and beyond existing legal restrictions.

According to the Washington Post, the new DHS guidelines say executives can be barred from doing business with the federal government from the time they knew about the fraud, or if the inspector general determines the executive should have known about the fraud.

And, in an unrelated, highly unusual move, the DOJ charged a former GSK attorney of various counts of fraud, alleging that she lied to federal authorities about what she knew regarding off-label promotion of Wellbutrin SR.

Let’s look at the numbers. According to these attorneys, who specialize in representing whistleblowers, “Over the past two years, the Department of Justice has collected over $2 billion from big pharmaceutical companies in fines, damages and civil penalties for defrauding Medicare and other health care programs funded with tax payer dollars.”
 That’s just the companies. Just think what the DOJ could collect if it also went after the execs. Think Jeff Skilling, Bernie Madoff, Michael Milken – who paid $600 million in fines for his financial sins.

According to the whistleblower attorneys, the DOJ doesn’t have to get personal. Under the False Claims Act, the offending pharma company could be forced to pay a $10,000 penalty for each script written under the offending scheme.

That’s certainly a lot of money – but it doesn’t have the same impact as being personally charged with a crime, or crimes.

"The current administration is feeling that they want to increase enforcement in this area, and they're of the belief that monetary settlements aren't sufficient, and they need to charge individuals to deter the conduct," Jeffrey Senger, former acting chief counsel with the FDA, told the Washington Post.

“The theme of [a] drug-law industry conference last month was ‘more individuals, more often,’” wrote the New York Times.

For those industry members who aren’t reading the writing on the wall, it’s either time to get new glasses or a very good translator.

Wednesday, November 17, 2010

Prescription Abandonment: Opportunities Lost

It’s a shame that industry’s rep is in tatters right now. Pharma should be delivering an important message to American businesspeople, but they likely won’t pay attention – one, because of the messenger, and two, because it would cost them money – initially -- to fix the problem.

We’re talking about prescription abandonment. A new Annals of Internal Medicine study confirms what common sense tells us: people with limited resources will not pay for prescriptions they cannot afford. The study – conducted in tandem with CVS Caremark over the summer – shows that if a co-pay hits the $40 and above range, people are more apt to forgo the drug, especially if it’s a new script.

An accompanying editorial  also notes the obvious: Someone who doesn’t fill a prescription undermines his treatment, faces increased healthcare costs down the road as well as potentially life-threatening results.

That someone also affects the workplace – in terms of days off, reduced productivity, and so on.

The Annals study isn’t the first. A WSJ blog, citing a Wolters Kluwer study, notes that nearly 10% of new scripts for brand-name drugs weren’t filled in the 2nd quarter of 2010 – an 88% hike over the same time period in 2006.  Comments to this WSJ blog were Scrooge-like. “The bottom line is that people are too unaware of what the actual costs are for health care,” wrote one. “If you don’t think your health is important enough to spend any of your own money [even when insurance is available to you], why should the taxpayers, your employer, or anyone else think it’s important?” wrote another.

Let’s look at a map. Folks at Kaiser Permanente figured out how many prescription drugs people take in the U.S. In two words, it’s stunning. In Tennessee, people between 19 and 64 take an average of 16 medications; in North Dakota, it’s 13, in California, less than 9. We argue that this map shows that people will fill their prescriptions – when they can.

But if big employers do what they’re threatening – shift more healthcare costs to workers – what will happen to those employees at the bottom of the payroll?

A little forethought is needed here. Think about those diseases that are relatively symptomless at first, like type 2 diabetes. Regular doctor’s visits and blood draws would show creeping A1C levels. Diabetes under control is cheaper than diabetes out of control.

Are employers and government agencies being penny wise, pound foolish? We’d say so! We’d also urge industry marketers -- despite pharma's current reputation -- to use these data to help solve the problems and focus on medication adherence solutions that work!

Monday, November 8, 2010

Reporters, Pharma-Sponsored Seminars: Keep the Brick in the Wall

From the should-we-create-another-shade-of-gray department: Are journalists who attend seminars underwritten by corporate sponsors still objective?

Some journalists say yes, some say no. What do we think? We think a good friend, a first-rate journalist, hit it on the head: If it’s a trade association, then that would be okay. Why? It’s an amorphous group, she says. You know what you’re getting, you know what the agenda is. If it’s a sole company, “you don’t know what they have in mind.”

The sole company that’s raised the stink in the blogosphere is Pfizer.

Here’s the background. The National Press Foundation offered a four-day seminar to a small group of journalists to learn about covering cancer. It’s the second year that the seminar’s been offered. Pfizer, one of NPF’s sponsors, underwrote the seminar both years. According to the NPF’s Web site, the foundation’s mission is to educate journalists about complex issues. It has numerous corporate sponsors, including Toyota, Gannett, Allstate, Merck and Pfizer – the latter donating $100,000 plus. (Prudential Financial, another sponsor, underwrote a seminar on retirement, but we were hard-pressed to find any media stink about that seminar.)

Politics Daily argued the ethical dilemma that such a connection creates; the NPF, on the other hand, argued that newsrooms are stretched for cash so that training journalists in these difficult topics isn’t taking place. NPF controls the agenda, it said, so it is confident that church and state, so to speak, are kept in their respective corners.

We can appreciate what the NPF is doing. A conscientious journalist who doesn’t have a solid background in writing about cancer will be frustrated in dealing with this topic. And attending pharma-underwritten seminars is one way to become educated.We just think it is importance that independence of educational content be refereed by NPF. 

This operating principal helps NPF and journalists feel confident the "firewall" is trustworthy. Maybe we’re na├»ve, but it seems we are very concerned these days with assuming people/situations are guilty until proven innocent.

Friday, November 5, 2010

Pharma, COI, and Principled Interactions

One thing’s for sure: Pharma members are going to need scorecards to keep track of what kind of industry-thought leader interaction each academic institution allows. For example, the University of Iowa does not permit the distribution of drug samples, nor can its faculty use ghostwriters. They can’t appear on speaker bureaus, either.

In Boston, physicians who work for Partners Healthcare – Brigham and Women’s Boston, Massachusetts General -- face similarly strict rules. If you recall, one Brigham faculty member resigned in protest over the fact that he could no longer earn money, speaking on behalf of pharma. But its rules on CME aren’t as stringent as those at Stanford University, or at Memorial Sloan Kettering, according to this same Globe article.

But at Yale, leadership there has adopted a more nuanced approach to dealing with perceived conflict of interest issues and interaction with industry.

“We rejected the idea that all interactions [with industry] are wrong and the notion that any relationship is a conflict of interest,” Ronald Vender, MD, chief medical officer for the Yale Medical Group and associate dean for clinical affairs for the Yale School of Medicine told Medical Marketing and Media. “[I]t's not that we are promoting interactions. But if one is going to have [them], we are promoting the concept of ‘principled interactions.'”
Well, what do you know -- a realistic approach. At Yale, these principled interactions require that faculty pay attention to the rules. Yale has established an “enforcement mechanism,” MM and M says.

Yale faculty must follow the rules regarding speakers’ bureaus, gifts, meals, interactions with sales reps, and so on. The one COI area that Yale put its foot down about is ghostwriting – it’s not allowed. Good for the Bulldogs. As we’ve said in this blog before, ghostwriting in this business is wrong. If a researcher needs an editor – and all writers need editors -- give that person credit at the end of the article.

About those scorecards. With academic institutions everywhere adopting new COI rules, the wise pharma member will want to know which institution requires what before making any contact with any institution. But who has time to get all that information? Maybe BioPharma Advisors can help you.

Wednesday, November 3, 2010

CBI KOL Management Conference-Princeton, NJ

We are attending the CBI KOL Management Conference in Princeton, NJ.  Click link for the agenda, follow our tweets by hashtag #kolmtg. 

We are part of Workshop presentation on Centralized KOL Management.  Send us an email if you would like a copy of that presentation

Monday, November 1, 2010

European Commission and Its Good Practice Recommendations

Et tu, EU? The European Commission has announced that it wants to see just how good a corporate neighbor pharma really is. The EC wants, says InPharm, “to examine corporate responsibility in the pharmaceutical industry with the aim of developing a series of good practice recommendations.”

What good corporate responsibility would entail seems to boil down to three areas, according to The Pharma Letter: ethics and transparency; access to drugs in Africa; and access to medicines in Europe. Further details, at least from scanning articles about this on the Web, are sketchy at best.

Are our European cousins piling on?

First, let’s define corporate responsibility. One definition says it’s “a voluntary approach that a business enterprise takes to meet or exceed stakeholder expectations by integrating social, ethical, and environmental concerns together with the usual measures of revenue, profit, and legal obligation. In another, it’s a “firm's sense of responsibility towards the community and environment ...

One says voluntary, the other says sense. Neither says obligatory. Are we suggesting that pharma should not be conscious of its moral and ethical obligations? Of course not. What we are suggesting -- and will continue to do so in this blog -- is that industry critics should be mindful of the unintended consequences of this constant drum-beat of criticism. (In the InPharm piece, the EC official does make note of pharma’s enormous economic contribution to the EU.)  As we have said again and again, let's focus on solving the problem!

Disruption of Research and Development of innovative medicines is serving no one!

Friday, October 29, 2010

With Patient Non-Adherence, Use a Little Psychology

My mother always said to get resistant people to do what you want, use a little psychology. That’s exactly what MicroMass Communications says in a recent white paper that discusses patients with chronic diseases and their unhealthy habits. MicroMass says if you want these patients to lose weight, take their medications, adopt positive attitudes, and so on, then it’s essential to find what will motivate them to do just that.

In their white paper, called “Understanding and Changing the Metabolic Mindset” researchers at MicroMass interviewed 1,500 patients with type 2 diabetes, obesity, high cholesterol and hypertension. They started out wanting to know the differences among the patients, so they could understand how to sell to them more effectively. But in the interviews, MicroMass researchers began seeing similarities among these people – the patients’ barriers to changing their behaviors were not all that different.

The researchers organized the patients into four groups: those on cruise control; those who take charge; those who are disengaged; and those who are overwhelmed. The last group is the largest; in a video, MicroMass’s director of behavioral services says patients in this group lack confidence to do what they need to do -- healthcare providers often mistake this lack of confidence for indifference. Encouraging the completion of baby steps is important here, she says.

Healthcare providers who can identify which group their patients belong in will see more success with those patients, MicroMass says. “Programs built around behavioral models have been successful.”

Nobody in this reading audience needs the dollars lost to patient non-adherence repeated here. A few pilot studies certainly seem in order.  To my friends at Micromass, Great Work! Others in your business should be making similar investments in their marketing strategy recommendations as well.

Thursday, October 28, 2010

Pharma Ethics: It’s Time for Constructive Ideas

The criticism of pharma continues. One of the latest salvos: “White Coat, Black Hat: Adventures on the Dark Side of Medicine,” by Carl Elliott, MD, professor at the Center for Bioethics at the University of Minnesota. In an interview with Pharmalot, Dr. Elliott spoke about industry ethics, and said that industry money has undermined trust. “The difficulty with the way things are done now is that you don’t know if you can believe what’s in the medical literature anymore,” he said.

His views on transparency: “I don’t think disclosure solves the problem. That seems to be the approach and I think it’s totally misguided. The more doctors who do it and the more widely known people know about it, the more widely it will be done and the practice will become normalized and nobody will feel any compunction about taking money from industry anymore.”

I think Dr. Elliott is right -- maybe time can correct some of these problems. Maybe some of the recently implemented regulations and the court proceedings will change poor behavior. 

But, friends, the criticism leveled at industry hasn’t been exactly constructive. What's needed are suggested solutions. We still do not have answers, we need operational leadership on where to go from here. We continue to suggest that we all move beyond the "industry/HCP relationship is dirty."  We suggest that you cannot highlight a problem unless you also offer a solution going forward.

Monday, October 25, 2010

Pharma: Is It Time To Answer the Critics?

It’s a question that’s begging to be asked: How can pharma get its groove back? Bad news, much of it self-inflicted, continues to besiege it. There’s the Pharmalot DOJ whistleblower’s story, which said that eight of the ten largest healthcare fraud cases involved drug makers. Says Pharmalot: “The scrutiny has been eating away at pharma’s reputation and gradually forcing changes in business practices. But attorneys say many more lawsuits are in the pipeline and the willingness of the federal government to pursue them - selectively - remains unabated.”

Then there is the ProPublica story. Reporters at ProPublica used industry-compiled databases containing the names of physicians and other thought leaders who have spoken on behalf of pharma and checked them out. What they found: Not all the thought leaders are worthy of the job. Some weren’t board certified. Others had “serious sanctions."

It sounds ugly. But if you do the math, it’s a small percentage: of 17,700 thought leaders checked out, 1.4% -- 250 — were found to be tainted in some way. (The story says more than 250, but doesn’t give a specific number.)

On the one hand: Some industry members interviewed by ProPublica reporters admitted that they didn’t do the background checks that they should have.

On the other: That 1.4% wasn’t in the story, but it doesn’t matter. The PR damage continues to be inflicted -- from within, and without.

In 1970, an American man or woman could expect to celebrate a 71st birthday. In 2003, that person could expect to live another 6 years or so. Pharmaceutical, Biotech & Medical Devices are a huge reason for those extra years. But few people – including pharma itself – seem to acknowledge that truth. Kinda of like some in Congress & the administration who do not take pride in the Healthcare Reform act. While Americans do not like this large entitlement program, in general we believe overall healthcare of the US population will be more improved.

Maybe it's time for pharma and others to speak up? Maybe. Being silent sure hasn’t helped the industry (or even the Democratic Congress for that matter).

Thursday, October 21, 2010

Financial Disclosures and Journal Authors: Enough Rhetoric

When President Obama signed the healthcare reform act into law, part of the legislation package included the Physicians Payment Sunshine Act. We’re all familiar with it. Sometime soon, Industry will have to make public its financial transactions with industry consultants.

So, why are the media still acting like every undisclosed transaction – especially ones that are years old -- between physician and industry is like an unheard-of immoral outrage? Case in point: the 2007 study showing that 25 of 32 consultants to medical device companies didn’t reveal their connections in published journal articles. Those connections were worth millions, the Times says.

A constant critic of the industry-thought leader connection was quoted as saying that the study was “one more indication of the widespread corruption of the medical profession by industry money.”

It’s not clear from the article how many journals were involved in the study. The study apparently doesn’t name individual doctors or their articles. Two journal editors were quoted, each saying that yes, they must get stricter on disclosures. We’re not sure how these journals are funded, but if those sources are medical device companies, it won’t be easy biting the hand that feeds them.

We support transparency – our blog readers know this.

We do not support incomplete journalistic reporting – a check on even some of these journals in 2008, 2009, and 2010 would have rounded out the story. What were their disclosure records then? Did disclosure improve, stay the same, get worse? Is there a basis for comparison? If this record check did happen, it’s not mentioned in the Times article.

The article quotes the study’s author as saying he didn’t “know how often the journals required disclosures in 2008, but he said the lack of results showed ‘a broken system’ regardless of who was to blame.”

Physicians have battled over the question of financial disclosure for years – this NEJM editorial is from 1993.

Again, the unintended consequences of this constant, where-is-this-getting-us criticism: The effect on physician education! Physicians need to be educated in the latest research, newest drugs, newest medical devices. Industry use to be a trusted source of that information. Could we tone down the rhetoric, and begin a conversation?  We have to figure out solutions that improve healthcare overall and continue to recognize the value of medical innovation.

Monday, October 18, 2010

Ghostwriting and Full Disclosure: When the Critics Get Caught

A friend and I were discussing the problem of ghostwriting in industry – she was lamenting its demise. My friend, a journalist by profession, didn’t see a conflict of interest problem – she saw a conflict with clarity problem. She had worked for one of the major pharma houses, and one of her jobs was helping a researcher with writing his papers. Scientists generally can’t write, she said.

Anybody who writes for a living who’s seen what a researcher can do to the English language will agree with her. By definition, a ghostwriter is someone who writes for another – he or she doesn’t alter thoughts, tone, meaning, wit. The ghostwriter just makes the prose clear. BioPharma Advisors even uses ghostwriters for some of its own work.

Which brings us to the Wyeth, Prempro, Adriane Fugh-Berman, PLoS Medicine, conflict-of-interest drama. Wyeth (now part of Pfizer) is being sued by women who took the HRT Prempo and contracted breast cancer. The drug maker recently was slammed by Fugh-Berman in PLoS for hiring a communications firm, DesignWrite, to “ghostwrite” articles that touted Prempro’s benefits and smoothed over the risks. These documents – more than ghostwritten -- had been released as part of the court record.

But it was no coincidence that Fugh-Berman wrote the piece, and that PLoS published it. Fugh-Berman, at the time her article was written, was on the payroll of the plaintiff’s law firm. That fact wasn’t disclosed in the article. Another hidden bit of info: PLoS had sued Wyeth for the DesignWrite documents.

Fugh-Berman told Pharmalot that she had never made a secret about her status as an expert witness, and would clarify her position. PLoS editor Ginny Barbour told Pharmalot, “We intervened in the Prempro case solely because of our interest in unmasking this [ghostwriting] practice. We have no professional, financial, legal or other relationship with the plaintiffs or their lawyers in any of the cases that Wyeth is defending, or in any other past or ongoing legal case." Checking Google, very few media outlets covered this part of the story, compared to the splash the PLoS article made. We continue to lament the media’s current lack of parity in covering industry.

The DesignWrite articles ran between 1997 and 2003. Did Wyeth do the right thing? No. Are there reasons that nearly all crimes have a statute of limitations? Yes.

Pharma has said that ghostwriting, as done in the past, will stop. And it should in the context in which it is currently practiced, for at least two reasons: One, it’s not completely transparent. Two, as long as pharma continues to make itself a target, it will be guilty until proven innocent, and its research will continue to be viewed skeptically, and that affects us all.

But please, pharma members – for your researchers who can’t write, hire an editor, and give the guy or gal credit at the article’s end for work done.

Monday, October 11, 2010

Pharma and University Collaborations: On the Rise

Pharma members and university researchers have increasingly formed collaborative partnerships to develop new medicines, according to a Business Insights report.

But you don’t need a report to tell you that. Just one media account, like this FierceBiotech story – about AstraZeneca and the University College of London --
tells you there are many other collaborations right behind it. AZ and University College signed a three-year deal to create drugs that use stem cells to mend the damaged eyesight of those with diabetes. GSK also has a deal with University College. 

A quick rundown of reasons for these partnerships: Pharma needs fast and furious ways to beat patent expirations; all the low-hanging, cheap developmental fruit’s been picked; and the remaining developmental fruit is costing, and will continue to cost, huge amounts of money. As for why the universities are signing on, they need cash too – endowments are down, public financial support is down. Both sides have good reasons to partner up. 

There’s every reason to think that good outcomes can happen. Consider the trove of information -- all being shared -- recently uncovered about Alzheimer’s disease when academia, government, and pharma researchers collaborated. 

But on second thought: We shouldn’t be too hopeful. It’s likely just a matter of time before pharma critics start complaining about these collaborations. 

For what legitimate reason? We've no idea.

Friday, October 8, 2010

Pharma and the Travails of Social Media

What a world. One of the most regulated industries on earth – pharma – is trying to learn how to communicate with its “new” customers – patients – on the anything-goes media, the Web. According to a PharmExec blog, industry is hiring all kinds of Web gurus to teach them about the “minefields” of YouTube and Facebook.

One – Novartis – already has gotten burned. The FDA said the company permitted conversation to occur about its leukemia drug, Tasigna, on Facebook and sent Novartis a warning letter about it. Jonathan Richman, founder of Dose of Digital, said in response to the PharmExec blog that Novartis was encouraging people to comment about content that it knew wasn’t compliant and to share it. According to Dose of Digital, industry has 50 sponsored pages on Facebook.

It begs the question: In a business as heavily regulated as this one, in which the DOJ publicly announced its attentions to investigate it for alleged off-label violations – and then did so – would industry be more cautious about inviting more trouble?

Maybe because it has no choice. Pharma’s customers are interacting in this world in the ways the FDA did not even think possible.  Is this foray into the cyber communications minefield an unintended consequence of the heavily regulated world of medical communications? We think so.

Next question: How does this impact public safety? More to follow. 

Wednesday, October 6, 2010

Clinical Trials: Is Full Disclosure Necessary?

Here’s a hypothetical: Your 85-year-old mother, who has Alzheimer’s, has the chance to enter into a clinical trial for a new Alzheimer's disease drug. Possible dilemma: The type of drug your mother will receive is similar to one that just failed in another trial – in fact, it caused harm. Do you want to know about that failed trial? Is the trial sponsor under any obligation to tell you about it?

The New York Times, which recently discussed the pros and cons concerning full disclosure in clinical trials, said Alzheimer's disease patients and their caregivers may be different than other patients. Cancer patients may want to know all details if a trial is stopped; Alzheimer's disease caregivers, too tired from the daily grind, may not. Certainly, we’re talking about different diseases here: People can survive some cancers. For Alzheimer's disease, there is no cure.

The basis for the article was Eli Lilly’s decision to stop its huge trial on semagacestat because patients showed worse cognitive functioning than those on placebo, and increased skin cancer risk. According to the article, Lilly's drug disrupted gamma secretase, but was an older generation of this drug class. The newer disrupters, the article said, may be safer.

Of course, trial participants sign consent forms. They acknowledge that the drug may not help; there may be side effects; they may not get better -- or even worse. But our point is that industry members could help themselves in the court of public opinion if they take a few more steps to notify trial participants about why a trial was canceled. Leaving this to the clinic that recruited the patient initially is one of its responsibilities, but it should not fall just on that clinic.We encourage industry to consider this approach as a way to invest in its depleted "trust" bank account with patients. 

Monday, October 4, 2010

A “New” Venue for MDs, Sales Reps

Talk about unintended consequences. Even though some physicians and medical institutions may not welcome industry sales reps into their offices during business hours, they seem to have no problem getting together at educational events.

A recent survey found that 71% of those who shut their doors to sales reps while they are working will meet with them at these live events.

Pri-Med conducted the survey, which comprised 1,100 doctors who attended seven medical education meetings nationwide. Pri-Med says it’s about choice. Sam Bishop, director of research for Pri-Med, told Medical Marketing and Media that “[the physicians] have personally chosen to come to this event. If industry is there, the majority will choose to opt in. If they are in their practice, working with patients, struggling through the day, typically they don't want to be intruded on” in reference to the current rep calls that take place.  

Okay, maybe it’s about choice. But maybe it’s also about the need for physicians to learn about the R&D that industry is up to. And, maybe physicians don’t want to be hassled with new rules governing a rep in their office. Or, maybe they just want to chat with business associates who have become friends.

Humans are funny. If they don’t like a rule, they’ll find a way to work around it. The question is then, does industry still need more than 65,000 sales representatives in the U.S. detailing these doctors? 

Friday, October 1, 2010

Internet Marketing: The New Line Item

“I believe every brand team should have a dedicated Internet marketing person assigned to them.” So writes Richard Meyer, of Online Strategic Solutions.

All we can say is: We wish we had said it first.

A recent House episode featured a 105-year-old-patient, who told the crusty Dr. House that he had searched the Web for something or other. At first, it seemed odd that a centenarian would be comfortable with the Web, and then on second thought, it didn’t.

There are internet marketing professors. There are people who teach about the history of the Internet.

Our point? The Web is as much a part of our lives as cars, toothpaste, and Thanksgiving. The Web, and any subsequent versions of it, are here to stay. Having marketing specialists in this medium makes absolute sense. We don't need to tell you where patients are turning to get their medical information.

To us, having dedicated Internet marketing personnel assigned to each brand team is a business necessity!

Wednesday, September 29, 2010

The FDA, Transparency, and Reality

As we have stated in this blog many times, transparency, as in nearly all matters, can be a good thing.

So by all means -- a 21-gun salute for the FDA’s 21 proposals that allow the public a better view at what transpires between the agency and industry, including summary safety and efficacy data from pre-approval and marketing applications.

Why the touch of tone? Because what the FDA wants to do will cost money and eat up valuable time. And skeptics might ask: Will these new rules really improve the public's health?

We actually think so! But, industry insiders may not be looking at it that way. In our view, transparency will uncover those issues in which the agency and industry have differences -- now, those problems will get thrashed out, but usually during the time compressed approval process, when conflict avoidance is the word of the day and if conflict occurs is usually not a positive outcome.

We all know consensus is not reached without significant debate -- and that typically does not happen quickly. Why does industry panic?  Is it because these business constraints seem to happen only at critical moments in their business cycle?  It seems like the age old going to the gym argument. Maybe if we went to the gym and worked out before we needed to desperately do it, maybe the change would not be so hard. 

Because we live in a sound-bite world, a full explanation of these problems will rarely be published, digested, and carefully considered, and most likely will be misconstrued. Does this help improve public health? Not likely, because again the presumption is that medicines are generally safe and people may not care until after the fact. 

No man-made system works perfectly – who isn’t shocked when something goes off without a hitch?

While it seems like each party should fight for its point of view, people just want their various afflictions solved.

We just think this transparency issue needs to be moved forward. These 21 proposals are not perfect, but they do begin that process. Please engage in discussing the solutions.  

Saturday, September 25, 2010

Is Conflict of Interest Pushback Begining to Happen?

Is it possible that physicians and clinical researchers are beginning to push back against their Conflict of Interest (COI) critics? We'd like to think so.

The proof? The Association of American Medical Colleges (AAMC) and other university associations recently asked the National Institutes of Health to loosen up its proposed financial reporting requirements, which have few exceptions. The AAMC et al essentially said that the NIH’s proposed transparency rules are unnecessarily strict. This new opinion differs from the AAMC’s earlier support.

In its letter to the NIH, the AAMC said:

“There is a paucity of evidence that the disclosure and management of financial conflicts of interest affect objectivity and integrity. In the absence of such evidence, onerous regulations are not only unwarranted, but could create a glut of policies that increase activity without adding protections and at the same time erode the trust between the regulators and those being regulated.”

Let’s look at the numbers. In its letter, and we’re essentially quoting, the AAMC says it represents 150 U.S. and Canadian medical schools; about 400 teaching hospitals and health systems; and 89 academic and scientific societies. That’s 125,000 faculty members and 106,000 resident physicians. And that’s only the AAMC. The Association of American Universities represents 61 research universities.

You get the point. That’s a lot of physicians who have chosen a life of medical research or is the place where they develop their medical training. It’s possible that those physicians raised a concern about what the NIH was proposing – and the AAMC leadership listened. A good example of a group listening to what its constituents want for policy and not letting someone in government dictate their way of life.

And maybe that’s the way this COI crisis will resolve itself. Not in a public forum, for all to hear, but in back rooms, away from glaring eyes and media attention. It happened earlier this summer, if you remember, with the AHA and the ACCME drama.

It’s not how we would like it – the unintended consequence is that the public is not hearing the full-throated discussion, but we also think that not everyone cares about how this "sausage" policy is made, but that these COIs do not harm or cause inappropriate care to be delivered.
But at least, if we're right, physicians on both sides of this issue are talking to one another, thrashing this whole thing out.  The next question is how those talks will impact industry collaboration.

Thursday, September 23, 2010

The Foreign Corrupt Practices Act and Industry

As promised last year -- the Department of Justice is following where industry members conduct their business. At last count, [that we know of] the DOJ had notified at least 12 industry and device manufacturers that they were under investigation for possible violations of the Foreign Corrupt Practices Act. The feds want to know if these 12 tried to influence how physicians would determine the results of industry members’ overseas trials on any drugs that came back to the U.S. market. (To get the Lexocology article about the investigation, you'll need to register.)

Getting specifics on what the DOJ has found hasn’t been easy: As this WSJ story on Merck points out, Merck wasn’t charged with anything. The Financial Times reported that the DOJ "was looking at whether pharma companies had ignored a 'systematic risk' inherent in the global drugs business and ignored obligations under local and US anti-bribery law."

What ostensibly rattled the DOJ’s proverbial cage was that report this summer from the Inspector General of the Department of Health and Human Services. You all saw it – the one that said 80% of all FDA approved drugs in 2008 were based on trials conducted in foreign countries. And of course, the FDA had conducted very few inspections of those sites.

We say ostensibly because of what the DOJ said last year. The feds said they were interested in looking at industry through the legal lens of the FCPA. In that speech [second paragraph], the assistant AG talked about how much money the department made in other cases it had tried -- $1.6 billion in one, $579 million in another. The assistant AG mentioned that the department has brought more prosecutions since 2005 (58), than between 1977, when the FCPA was passed, and 2005.

We think the DOJ will continue to examine industry practices in a manner that will make it more difficult to operate, cost more to complete innovative drug research, and challenge or change the way the industry conducts business. Maybe it’s time to say, enough.

Monday, September 20, 2010

The Variability of Patient Care

Back in May, Hospitals and Health Networks Magazine published an article by John Glaser, CIO of Partners Healthcare in Boston.  He is now CEO of Siemens Healthcare's Health Services unit, and a thought leader you might want to watch.  We thought this article was particularly relevant because it discussed the two types of care that EMRs need to account for, sequential care which follows certain processes and iterative care or the discovery/ diagnosis of disease.

Why is this relevant to pharma marketers?  Because industry marketers need to think differently!  They need to comprehend that electronic barriers are going to impede their product's prescribers and subsequently adoption of their product. And depending on the product, many marketers are only focusing their messaging on that iterative care piece.  But the real dollars are in the sequential care processes that follow the initial diagnosis. This we believe is where many companies and their agencies need to be focusing their message development.

We think this article begins to help marketers understand the issues going forward and offer some examples of other industries that adapt to situations.  Glaser says, "We may be able to learn from other settings in which iterative and sequential activities are occurring simultaneously —for example, soldiers in combat situations, pilots landing planes in the Hudson River and scientists conducting experiments. These settings must also balance the information technology needs and the implementation mindset."

Even Neil Versel at FierceEMR said, "Ever notice how so many examples of how EHRs can improve care focus on diabetes? That's because diabetes care has many clear protocols, copious amounts of scientific evidence that gets included in clinical decision support and clear quality measures."

Our summary point to all of this suggests, EMRs will have a tremendous impact on the future of product selection for prescription medicines and medical devices.  If you do not know a lot about this now, you may want to learn more quickly.

Thursday, September 16, 2010

CRMs: Reaching Physicians in Cyber Space

In our conflict-of-interest focused world, industry critics are doing their best to keep industry members away from one of their prime customers: physicians. But e-marketing, specifically customer relationship management systems, may be one good way to reach physicians.

Hospitals, always in the market for paying customers, are starting to invest in these CRM systems, according to this American Medical Association story.  Hospitals are primarily looking for ongoing relationships with patients. After the CRM software gathers a patient’s information, it can create personalized Web content for patients, targeted mailing campaigns, and phone support services.  Something the industry has done for years and not ever gotten much credit for it!

But unlike industry, hospitals have never really done a good job of fostering or empowering the physician-patient relationship. The article speaks of one hospital in Illinois in which its marketing team speaks with doctors about the types of content and tools the physician wants to include on patients’ personalized Web sites.

But certainly these CRMs are also geared towards physicians.  Some CRMs specifically are used as recruitment tools. Has the industry missed another opportunity to get involved in this “evolving e-physician community?” Hospitals are wary of the future these days, perhaps partnering with them would make excellent sense, from many vantage points. Again, this whole thing is not called Customer Relationship Management for nothing!

Monday, September 13, 2010

Mobile Health Tech Study: Get Linked

A new PricewaterhouseCoopers' Health Research Institute survey says that physicians recognize that mobile health technologies can help with patience adherence issues, physician shortages and other long-standing healthcare problems.

The results of the Healthcare unwired survey, which involved 1,000 physicians and 2,000 consumers, suggest that physicians and the public alike are ready for mobile health technologies. But PWC says various stakeholders, including some in industry, are essentially ignoring this news. The primary reason: The way the U.S. health care system makes its money. Because only in-person consults are reimbursed, the system is dependent on volume to make its money, so it is not likely to embrace the idea of reducing that volume or transferring that model to lower-cost care -- Americans feel they are entitled to the best healthcare.

According to the survey results, most physicians said they would like to receive healthcare data from their patients’ smart phones or cell phones. (Three out of 10 consumers surveyed were good with tracking it that way.) While these might not seem like big numbers, this is the start of the innovators' curve and this country will reach the tipping point. Our goal is to make our readers aware this "IS" coming and like many other changes, try not to let these opportunities slip by.

We believe that receiving such data could help with patient adherence, 88% of the physicians polled said they would want their patients to monitor certain numbers at home, especially blood sugar levels, blood pressure, and weight. Moreover, 57% of the physicians said they’d like to receive similar data from discharged patients under their care -- this lack of data is one of the biggest issues in medicine today and causes millions of dollars in inefficient care.

A few years ago, physicians, as a group, were not technologically in tune. But that has changed. In this survey, 63% said they are using personal devices to help their patients – and these devices aren’t connected to hospitals or their practices. Of those using smart phones and cell phones, 56% said the technology quickens the decision-making process, and 40% said these tools shave time spent on administration.

And time is what it’s all about: 45% of the doctors said Internet visits would allow more patient access, and 43% said mobile health technologies like e-mail and texting could reduce actual office visits. The gains, PWC says, would be huge. They could:

• help with physician shortages;

• reduce costs of hospital readmissions; and

• increase access for those patients who put off care because they won’t wait for an appointment.

The actual study (you'll need to register to get it) points out two (pharma and retail pharma) members that are tapping into this market: Bayer and CVS Caremark. Bayer has integrated its digital glucose monitor, DIDGET, into the Nintendo game console. And CVS has an iPhone app that allows members to get information on refills and other pertinent information.

Our point is that the industry needs to embrace change, especially technological change like the ubiquitous use of mobile phone technology.  

Friday, September 10, 2010

Are Pharma Reps Robots or Salespeople?

We're wondering about the wisdom of it all. Back on July 7th the WSJ Blog asked the question of whether pharma reps are robots or sales people.

At issue: Does Novartis owe some reps OT under federal law for working more than 40 hours per week?  According to the law, it depends on the work. If the salespeople are closing deals away from the office, then it doesn’t owe them the OT; if the salespeople aren’t closing deals, then money is owed. Novartis obviously argued the former. But the blog post and one of the reps bringing forth the lawsuit actually contend they are more like “robots,” because they lack the “discretion and independent judgment” needed under the definition of outside sales representative to fit that description.

We understand why the company would not want to provide back pay, and why sales reps feel like they’re entitled to their back pay. But let’s face reality, this case highlights something we must all come to terms with and the customers the industry speaks with may be telling us as well.  Reps are like robots, they no longer possess or are given the "discretion and independent judgment" once seen in this profession 15 to 20 years ago.

When we speak with family and friends who are in the industry today, it is clear they do not like their jobs because it is so programmed, so heavily regulated, and to be honest, risky. The majority of good sales people just want the ability to converse with their clients and customers.  So much of this has been clouded for so long, we really question the value a rep brings to an interaction with a physician today.  And to be honest, maybe market forces are solving that problem for us.

Our whole point in bringing this up is to appeal to the legions of sales executives in the industry. Do some self-examination, make some reasonable fact-based decisions on reducing the troops.  Realize that the U.S. market is not the favorite marketplace any longer, and that customers demand more from your organization.  Help to make that a reality.