When you’re talking about trips and that sort of thing, it’s interesting. The industry did put in, over time, some self-imposed regulations. There were certain things you were not allowed to do, but in the end, it really didn’t matter. Maybe the really overt tactics of flying a doctor and his whole family out to the Bahamas for a weekend might have pulled back a little bit, but it was made up in other ways. Instead of just calling them trips it was called continuing education, or continuing medical education. That’s how they got around it from a PR perspective. Now we’re going on the trip, but we’re tying it to a lecture so we can call it continuing education. It takes on a lot of different forms.
Now, maybe what they’ll do is look at the top prescribers within the country. They’ll categorize those doctors as opinion leaders, go after those people and stroke their egos. They’ll say things like: “Because you’re such an opinion leader in the area of antidepressants and you’re leading the country in your use or your philosophy on this, we’d like you to come on board and be a consultant for our firm.”
So basically, we would hire them to be a consultant, which meant as a consultant, they’re now being paid and have a financial relationship to that company. With being a consultant, there were oftentimes trips because they’d have these think tank or brainstorming meetings. All that changed was how it was handled.
There were other things that went on like free samples, which was a very interesting way that the company would manipulate doctors. Doctors, unfortunately, would often see samples as the one act of benevolence that the industry provides. Really, the samples were a huge marketing tool. I was evaluated as a rep by how many samples I could push through my territory. There was a direct correlation between the number of samples you moved, and the number of prescriptions written for that drug. If you could get a doctor comfortable enough to hand out free samples, that doctor is now comfortable enough to pull up a prescription pad and write. It just makes really darn good business sense. Yeah, give out a week’s worth or a month’s worth of this antidepressant or this cholesterol-lowering medicine, because you know what, that patient oftentimes is now going to be on these drugs for a year, two years and in some cases a lifetime. We would even go to some doctors who had free clinics to give out these samples. We knew that if they became comfortable handing them out to the indigent patient population, that they’d come back to their private practice and then write prescriptions for those drugs.
Again, this is something I think people need to be aware of. Those samples often are for the most expensive and least tried and true drugs on the market. There’s a reason they’re giving them out for free. They want you to get hooked on them. They want you to take them.
In the next clip, she talks about off-label drug use, which as we all know is a HUGE part of psychiatric prescriptions, especially for children and adolescents...
Well, legally we were never supposed to be able to push them for off-label use. But again, there are certain tactics around that, because certainly with some of these drugs, the vast majority of the things that they’re prescribed for are not for the specific thing that they’re indicated. Physicians also have that liberty to be able to use drugs for purposes that they see fit.
We were often told in training sessions exactly what all the off-label uses were. It was always prefaced by, “We’re never supposed to talk about these things” – half wink wink – “But here are all the other ways that doctors are finding success with our drug.” We’d also get updates in terms of the studies or articles that were done on off-label use. Again, wink wink. You’re not supposed to use any of these in the field when you’re talking to physicians, or if you are talking to them you have to heavily preface it by, “Dr. Smith, this Drug A is not indicated for X, Y or Z, but I just thought you might find this article interesting.” You knew darn well that Dr. Smith is now going to read that article, because maybe it’s a patient type he’s struggling with, or whatever the case is, and that’s going to plant that seed in Dr. Smith’s mind.
So although you always had to be careful how you worded it, it was certainly known, I think, industry-wide that there were ways of planting those seeds. This is how the industry became so amazing at marketing their drugs. I mean that in a scary sort of way, because they use physicians to help them promote their drugs.
One of the key ways in terms of off-label use would be to find a doctor in a certain territory who was actually having a lot of success using a drug in an off-label sort of way. Then it was a matter of stroking that doctor, grooming him as an opinion leader, giving him the ego boost, asking him to come on board and be a consultant and then having that doctor hold round-table discussions with other doctors within the territory to talk about that specific drug, and the things that it’s indicated for. Since it’s peer to peer, that doctor is then going to bring up all the other ways he or she is using that drug and having success. And now, because they’re hearing it from another doctor, those ideas spread, and the other doctors are much more likely to take action.
Maybe you hold a dinner program where a doctor is giving a presentation on a drug or a disease state. You invite the doctor who’s using it for off-label use to come to that talk, and then maybe raise that use during a Q and A where he shares how he’s using it for all these other things. There were specific legalities, or specific guidelines that were in place, of things companies could or could not do. They were very, very effective at legally skirting those issues in many ways, because they were getting other people to talk about it.
Much other juicy inside gossip can be found in the full text of the interview here.
If this makes you think of how Neurontin was marketed illegally for off-label purposes, feel free to see my post here.