MERCK WINS IN COURT: VIOXX WARNING WAS SUFFICIENT!

FYI, in NO CASES are sales reps in the pharm industry people w/o secondary education and, in most cases, they are far more knowledgeable about the product and disease states they are addressing than pharmacists or MDs. They are experts on the 3-5 drugs that they are selling and can run rings around virtually every healthcare provider on the efficacy and side effects of that product. There is no possible way that a general practitioner or pharmacist can know every product on the market today inside-out the way a rep can. He lives it every day and has to go through intense pharmacological training and is tested on a regular basis. I could stand toe-to-toe with any of the Specialists that I called on when it came to the pharmacokinetics and pharmacodynamics of my drugs and the rest of the drugs in their class. If I couldn't, they wouldn't waste their time talking to me. They are far too busy to listen to someone who isn't on their level of expertise. And please don't try to rebut with the "wining and dining" arguement. We would bring pizza or sandwiches in for the staff maybe once every few months and I truly doubt anyone can be "bought" for a few slices of pizza, especially when other companies are doing the same thing. For the last 5 years it has been against AMA and the industry guidelines to take a physician to any recreational activity outside of his place of work. Reps don't have any inside knowledge of adverse side effects if it's not on the label or published by their companies. The companies can deintely be faulted for witholding pertinent information but don't go after the reps who are way down on the company food chain and assert that they are turning a blind eye to fatal side effects. The vast majority of reps would be more upset than the pharmacists or MDs when this came out because it is their reputation and integrity that's on the line. Are there reps who mislead practitioners? Sure. What industry with tens of thousands of people don't have some that flunk the ethics test? MDs? Pharmacists? Bad apples in every group but the vast majority of reps are out there trying to convince practitioners to use the right med for the right patient. I was in the industry for 15 years, my father for 35 and my wife for 20. We never, repeat, never misled anyone on side effect profiles.

P.S One of my partners in my territory has a degree in microbiology and the other has a masters in nursing. I was the "undereducated" one with a bachelor degree in economics.

I'm sure those with nursing and microbiology degress are highly educated - just not in pharmaceuticals. My husband worked as a detail rep while also practicing pharmacy. He says he was in the minority - 2 pharmacists in the whole company of reps. (but he made better money as a rep than as a pharmacist - with better hours)

Regardless, pharmacists are still the most educated and knowlegable on medications of all kinds. Even medical doctors spend a minimal amound of time studying pharmaceuticals in med school compared to the depth of education pharmacists receive on the subject. Then after one receives a degree in pharmacy, the education continues - forever - or at least as long as they practice pharmacy. They must keep up on the lastest information on all medications. It's their job, and people's lives depend on it.

A medical doctor should not rely on pharmaceutical sales people for all their informational needs, and I'm sure most of them seek more information if they have really serious questions. There is no doubt that detail reps of other educational backgrounds can be educated sufficiently in the scope of their new profession, but the bottom line is still the sale.

FYI...in most cases, they are far more knowledgeable about the product and disease states they are addressing than pharmacists or MDs......They are experts on the 3-5 drugs that they are selling and can run rings around virtually every healthcare provider on the efficacy and side effects of that product

FYI - my husband was a pharmacist, a detail rep and is an MD. He is in a position to comment on your statement and he says it is simply not true - particularly the statement regarding the disease states. He states that the drug rep is educated intensely, but the education comes from the company whose bottom line is sales. Since the company is providing the education, the rep is educated to the extent of what the company wishes them to know. Yes, he says sales reps can be very knowledgeable on a particular medication. However, A pharmacist has the educational background on all the aspects and mechanisms of pharmacy and pharmacology. Your reaction doesn't suprise him, in that it's just something that a person with any other background simply cannot appreciate.

There is no possible way that a general practitioner or pharmacist can know every product on the market today inside-out the way a rep can. He lives it every day and has to go through intense pharmacological training and is tested on a regular basis.

It appears I've touched a nerve with you and don't intend to discount your knowledge. But claiming what you do - I'm sorry, but according to one who has been all those things you are commenting on, and has been an "insider" he feels strongly otherwise. He agrees that he doesn't feel detail reps will knowingly mislead a doctor on side effects, but since the extent of the detail rep's pharmacological eduction is provided by the company, it's not known if the rep has a true independant knowledge.

Oh and by the way, I hadn't thought of the "wining and dining" angle, but since you brought it up, I do know docs who love their freebies. But while it will get you in the door to the office, it doesn't mean they feel you stand "toe to toe" with them.

If physicians are so up to date on their prescribing information, then please explain to me why the 2 most prescribed drugs in pediatric asthma are 1. albuterol and 2. oral steroids? They continue to treat these kids with the practice of, "Rescue, rescue, rescue,(albuterol)until they crash (then dose them with oral steroids) instead of treating the underlying disease. This, quite simply is a fact, backed up by prescibing data throughout the US. And also please explain why the vast (and I mean VAST)majority of asthmatics, under the treatment of physicians in this country, refill their albuterol every 6 weeks when, in fact, a properly controlled patient should only refill their albuterol a maximum of twice per year and realistically should only need one canister per year.
And I would guarantee you that I read more articles and parsed more articles in JAMA, Chest and every other peer reviewed respiratory journal than any retail pharmacist or general practitioner in America. I called on 3 separate teaching institutions with vast educational libraries and was in there constantly to stay on top of the latest information. I easily spent 20% of my time in the library. When does the average pharmacist or physician have time to do the research and how many have access to all the current literature that comes into these libraries? It is virtually impossible for pharmacists or general practitioners to read journal upon journal for every disease state they are treating. This is by no means a slam on either of those groups. There simply is not enough time in anyones day to possibly keep up with every single piece of literature being published on every single disease.
And please don't use my words to take 2 separate statements about wining and dining vs standing toe-to-toe with a specialist and link them together.
And what sort of "goodies" do these doctors you know get these days? A pen, scratch pads, a couple of slices of pizza? I hope they aren't friends of yours because if they are, your friends are pretty easily bought and should do a lillte reflection on their own ethics. Reps are not allowed (my last 2 companies) to do anything at conventions except man the display booths.
If your husband is not being educated by certain reps, then he should only meet with the ones that help him stay up to date on the latest articles. It's pretty easy to separate the wheat from the chaff. If they're giving info that isn't from respected peer-to-peer journals, then they aren't worth his valuable time. But to say they can't be used as a resource is selling alot of people short and seems pretty arrogant. I mentioned tht one of my partners had a masters in nursing and he also ran alarge oncolgy clinic as a nurse. Are you contending that he couldn't be an extraordinarily valuable resource to oncolgy nurses and oncologists? Please, that would be the height of arrogance on the part of any physician. Finally, please provide me with the name of any company that doesn't require a minimum of a bachelor degree in order to get a job. They don't exist. This was the first sentence of your opening statement. I'm sorry; a few more points: Do you know what operation was the single most performed operation in America in the late seventies? Answer - Gastric surgery for the treatment of ulcers and patients (or insurers) needed to pay around $20,000 along with missing weeks, if not months of work. Then, the evil pharmaceutical companies came up with a little pill by the name of Tagamet, for which the researcher earned the Noble Prize in Medicine, and virtually eliminated the need for any surgery. Next, the total share of health care costs in this country that goes to company PROFITS is, literally, one tenth of one percent and the total expense of pharmaceuticals is 9%. For the same reason I wouldn't argue that your husband should reduce his medical fees once his med school loans are paid off, I wouldn't argue that companies and their shareholders should reduce their profits once they discover a breakthough medicine. I also worked for Amgen and saw the life saving effects of our biologics on cancer patients. Our $2,000 shot of Neulasta let patients receive more chemo on-time which, in turn, increased their chances of beating their cancer by many fold. How would you set the price on that drug? BTW, there is a relatively rare disease called chronic neutropenia where patients need to be on either Neupogen (first generation, short acting GCSF) or Neulasta (second generation, long-acting GCSF) for the rest of their lives. From the day Amgen discovered Neupogen, they have never charged one of these patients a dime for their medication. And any cancer patient with an annual income of less than $60,000 and no insurance has always been able to receive Amgen drugs for free. What an evil corporation I worked for! Please, also, let me know how many pharmacists and MDs have a deep understanding of the cellular behavior and the use of GCSFs and erythropoietic stimulating proteins (Procrit, Epogen and Aranesp). I would love to meet them because they are few and far between. If your husband isn't an oncologist, then we wouldn't have anything to talk about.

Firstly, this entire conversation occured because a medical doctor on this board stated that he could not get sufficient information from the detail reps on Vioxx. I replied he should speak to a pharmacist to get an unbiased and more educated response. This is simply a statement of fact in this case. I'm sorry if you found it offensive. I did misspeak in regards to my comment of secondary education. I meant postsecondary education.

"And also please explain why the vast (and I mean VAST)majority of asthmatics, under the treatment of physicians in this country, refill their albuterol every 6 weeks when, in fact, a properly controlled patient should only refill their albuterol a maximum of twice per year and realistically should only need one canister per year".

This statement alone reveals much. You deal with literature. Physicians deal with actual human beings who all react differently. THIS is where their knowledge and education eclipse whatever training you've received. I can't begin to answer the questions you ask regarding albuterol and oral steroids - since I am not a physician. They can most probably be explained by the physician who is presribing the medication. Have YOU asked any of your clients why this is so? Perhaps you could have an enlightening conversation. If it were all so easy and "black and white", then everything would be OTC and we could all treat ourselves by simply looking it up in a book. However you keep saying "general practitioners" and I agree with you there. They deal in "general" medicine and one cannot be an expert in all things.

But even so, and although I do have a medical background, I certainly don't claim to know more than medical specialists - even in the field of my expertise. I know from my own experience working in a hosptial. We would roll our eyes and question physicians (privately of course) on why they ordered what they did and why they did what they did. After years of experience and some well needed maturity, I found I didn't know the whole story. Maybe as a medical doctor, they had a depth of understanding the complexities of individual cases that I - with my few intensive years of training - could not possibly understand. I am not so arrogant to claim that my meager knowledge - thorough though it may be, can compare with years and years of intensive study in a university setting, followed by many more years of residency and fellowship training. I knew based on the literature and the extent of my training what the recommendations were, and if this is "x" then you do "y". Well, the reality of medicine is not black and white - unfortunately some new physicians find this out the hard way. In many cases it takes years to fully understand the subtleties of human life and the various ways the same medications can affect people so differently.

If pharmaceutical sales reps had a superior knowledge - above that of pharmacists and physicians - of all things related to their medicines - efficacy, disease state, etc. then you should be licensed to treat and prescribe. There is a reason this is not the case. Finally, my husband was really pretty disturbed last night after reading your comments. He thought your company - and your clients - while they would be happy you are so well read and familiar with your products, would not be entirely pleased with your assertions, and that it might be in your best interest to take a more humble approach - at least publicly - message boards such as these, notwithstanding. Please, I don't mean to be offensive to you - I'm sure you are very capable and knowledgable in your profession. But it's important to keep in mind the limitations of one's profession - be it doctor, pharmacist or sales rep.

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