Pharma reps from another planet

August 28, 2008 1:07 PM

Feast your senses (including, perhaps, your sense of outrage) on this Merck Vioxx sales training video, presented in 3 parts without commercial interruption (heh) by the often interesting Pharmalot.

Vioxx was pulled from the market a few years ago because of cardiovascular risks (increased incidence of MI associated with Vioxx in clinical trials and post-marketing reporting). There is currently a huge class-action suit going on over Vioxx deaths, so it is interesting to see what Merck brass was telling the reps back in the early 2000's. Of particular interest is the bit about Vioxx and MI (heart attack) about 2:15 into the second clip.

posted by Mister_A (42 comments total)

I would kill myself painfully before I ever let myself become a pharmaceutical representative. Seriously.
posted by Slarty Bartfast at 1:19 PM on August 28

Oh dear god, I just got to "safety concerns" at 2:15. Fucking disgusting.
posted by Slarty Bartfast at 1:23 PM on August 28

Yes, it is, Slarty, but it's important to remember that FDA let them get away with this. I read a paper in 2001 or '02 that clearly indicated that there was an increased CV risk associated with Vioxx in the (tightly controlled, idealized) clinical trial population. Yet FDA did not require them to add any warnings about CV risk to their labeling.
posted by Mister_A at 1:26 PM on August 28

Next up: Vytorin!
posted by Guy_Inamonkeysuit at 1:30 PM on August 28

One of the arguments against "universal healthcare" is often "why would the pharma companies continue to invent new medicine if we did that?"

As if you would want scum like this creating anything at all that you would let near your body.
posted by DreamerFi at 1:32 PM on August 28

Scumbaggery aside, I found these really amusing.
posted by Mister_A at 1:35 PM on August 28 [1 favorite]

Wow. Just wow. It must suck to be a pharmaceuticals sales rep, but how much WORSE must it be to be the actors that have to sink to taking these kinds of jobs? You know your career is in a slump when you are doing cheesy Vioxx training videos. Sheesh.
posted by msali at 1:43 PM on August 28

I read a paper in 2001 or '02 that clearly indicated that there was an increased CV risk associated with Vioxx in the (tightly controlled, idealized) clinical trial population. Yet FDA did not require them to add any warnings about CV risk to their labeling.

I remember that paper coming out in 2001, there was also one that quantified the real (and not all that significantly lowered) risk of GI bleeding, also in 2001. The data was out there. Yes, in an ideal system, the FDA makes all the hard decisions for us. But we always find out new things about drugs once they are out in the market. (I acknowledge that Merck suppressed clinical trial data). New drugs should *always* be prescribed cautiously.

To me, the biggest crime here is that busy doctors are allowing themselves to be misled by drug companies with high pressure and sometimes nonsensical marketing information. I once heard a particularly aggresive rep say that you should prescribe Zyprexa because it makes your patient a "better person!" Is that what has replaced critical literature review? Honestly, I don't know why *any* one would let the pharmaceutical reps in their office. Have a little self respect, doctor.
posted by Slarty Bartfast at 1:45 PM on August 28

Honestly, I don't know why *any* one would let the pharmaceutical reps in their office.

To get product samples that can be given to those who otherwise could not afford treatment due to the abysmal healthcare system?

But other than that... I'm coming up dry.
posted by -harlequin- at 1:48 PM on August 28 [5 favorites]

Free pens, -harlequin-
posted by Mister_A at 1:50 PM on August 28

Scumbaggery aside, I found these really amusing.

They are well done, indeed. Yet what an aftertaste! That's pure salesman indoctrination, depicting rational concerns as whimpy senile grannies who are basically afraid of anything, but would buy in a blink if you provided them with enough reassuring facts, regardless of their accuracy.

Obstacles indeed, not humans. Christ, what assholes. Pretty much a piece of evidence that some pharma company in a competitive environment doesn't "naturally" , as some suggest, concentrate efforts into creating better product for the benefit of the buyer. They instead resort to make-believe, not because it's less expensive, but because it's more effective at avoiding "obstacles" on the path of the holy grail, the _bottomline_.

I can't help thinking that some of that money was taken away from research.
posted by elpapacito at 1:51 PM on August 28 [1 favorite]

I can't help thinking that some of that money was taken away from research.

You go to market with the products you have, not the products you want. :-/
posted by -harlequin- at 1:54 PM on August 28 [1 favorite]

Related article: "'Seeding' Sales and Science" from The American.
posted by NotMyselfRightNow at 1:54 PM on August 28 [1 favorite]

Other than the fallacious information - which would've come from marketing higher-ups and I wouldn't think very many of the marketing or sales people involved would have been able to check on their own (but correct me if I'm wrong on that count, medical and/or pharmaceutical people in the room) - these don't seem like especially scummy training videos to me.

This is totally conventional stuff than any sales rep in any industry would do: confront obstacles, repeat the marketing messaging. It's certainly interesting to see a pharmaceutical sales video, especially a ridiculously cheesy one, but I was hoping for more dirt - I have seen way sleazier sales advice given than any of this.

But behead the higher-ups who approved mendacious messaging, for sure, and three cheers for doctors not even letting pharma sales reps in the door in the first place, as Slarty says.
posted by XMLicious at 2:03 PM on August 28

Those pesky safety concerns! What a bunch of pussies.
posted by 2sheets at 2:07 PM on August 28

Yeah it's pretty much par for the course, XMLicious, as far as these things go, but very very high on the cheese scale.
posted by Mister_A at 2:34 PM on August 28

I love science as much as the next guy, but I think we, as Americans, put way, way too much faith in drug companies to provide us with the best options for our health.

When you become aquainted with the VIOXX scandal, you start to realize that companies like Merck would probably offer Asbestos Inhalant as an anti-depressant if they could get away with it.
posted by Avenger at 2:36 PM on August 28 [1 favorite]

You go to market with the products you have, not the products you want. :-/

If you meant to say in one smart one liner that you seldom have self-selling products, that's seems to be pretty much true, as a the audience needs to be reached somehow. That's what advertising was made for, letting the customer know a product exists while describing its properties. Positively nothing "wrong" with that and my sympathy goes to representatives who usually have an hard time winning the attention of potential customers.

Yet as their performance (and compensation) is likely to be measured either by volume of sales or value of sale, they have an significant incentive to use any trick in their sleeves. That also makes the representative pretty much "guilty" , as the company just ordered the person to "go present" and will eventually claim that the representative _misguided_ or conned the customer, NOT the company, putting the blame squarely on the rep. If the legislation opposes that, but still at the end punishes the rep, then the rep compensation should be at least 50% of the sale, but that's unheard of or very rare , unless circumstances allow to shift all the extra cost on the customer ( customers pays to be convinced, that salesorgasmic!)

But would you accept being sold a bad drug? If you do, go ahead sell similar drugs and don't complain (but you will ) if you are outsmarted. Oh wait you will be dead or in pain and dead people don't complain much or for long enough.
posted by elpapacito at 2:37 PM on August 28

the actors that have to sink to taking these kinds of jobs

I'm not in pharma myself, but in my limited experience these are not actors, but actual sales reps shanghaied by the marketing dept.

XMLicious has it right about fallacious information coming from above. Before anyone starts calling these people "scum" and "not human", remember that these people often have less than perfect knowledge of what they're selling. They are people trying to do a job in good faith in a system that sucks while working for corporations and shareholders whose interests are not always in line with the public good. Just like so many other people working out there. Getting pissed at drug reps for their products is about as useful as screaming at your tv during commercials. Tell your congressperson to restore funding to the FDA if you want to see less of this crap, and demand universal healthcare. You can find them here.
posted by kuujjuarapik at 2:39 PM on August 28

Oh no, kuujju, those are almost certainly professional actors. That is a professional production, believe it or not. If you were watching real reps, it would be even more hilariously bad.

They might not even be bad actors; they've been encouraged to ham it up here, to be very broad. This is for a rah-rah sales meeting, remember.
posted by Mister_A at 2:44 PM on August 28

Side note, the Glengarry Glen Ross sales speech [NSFW] by Alec Baldwin; classic. IMDB
posted by sluglicker at 2:44 PM on August 28

I love science politics as much as the next guy, but I think we, as Americans, put way, way too much faith in drug companies to provide us with the best options for our health.

Not intending to be snarky despite my use of strike-out, but "science" is a terrible choice of words. The scientific process did not fail here - it sounds like the dangers of the drug were correctly identified and quantified quite early. The drug went to market regardless. At that point the ball is in the courts of business and politics and law, not science.
posted by -harlequin- at 2:48 PM on August 28

All the wanker comments here start from the assumption that Vioxx is poison and that Merck and its reps knew that all along. What total crap. I am no fan of Merck, but when COX-2 inhibitors came out they seemed like the holy grail. Millions of patients suffer from inflamation related conditions such as arthritis, and traditional NSAIDs pose serious risks. I bet they have killed far more people than any COX-2 inhibitor. The data on cardiac issues was there but inconclusive. Most likely the marketing and sales people were not given the worst news at least in the early days. So they sold on the best available data. These videos on their face do not promote off label uses, mislead about the side effects, or promote illegal behavior. Are you shocked that sales people are pushed to sell hard?
posted by caddis at 3:22 PM on August 28 [1 favorite]

"when COX-2 inhibitors came out they seemed like the holy grail"

To who? See, that's the problem and I think the reason for the so-called "wanker" comments.
There is no holy grail. And anybody trying to sell me one is the wanker.

"Are you shocked that sales people are pushed to sell hard?"

No, I'm disgusted when reminded that they are behind the scenes prior to my arrival at the doctor's office trying to peddle the latest holy grail. Especially if all I need is a little ibuprofen or aspirin.

And I have family on both sides of this business so I've heard much worse.
posted by 2sheets at 3:41 PM on August 28

Are you shocked that sales people are pushed to sell hard?

Not at all, but those are not selling candies either. A generalization ecompassing ALL or almost all salesman as sleazy dishonest cons wouldn't represent them fairly and indeed most of them are, I believe, in good faith and really trying to satisfy their customers, as a satisfied customer is the most likely to come back for more.

Actually they sometime take the blame, as I pointed above, for company. Sometimes they become "windshields" for times in which shit hits the fan.

For instance in my country some big telco tried to sell subscription by outsourcing part of their sales to call centers, some of which produced false documentation and mislead customers, who later complained with the big telco. The utterly incompetent telco reps tried to sneak out of the hot situation by blaming the call center, stalling for time, hoping the customer will just settle or give up as litigation was reasonably too expensive when compared to the cost of the plans, basically exploiting the fact the legal system does formally protect, but doesn't make the procedure affordable to _many_. Class action suits are still not legal over here, but we kind of expect some legislation starting from January.

When selling drugs, why should , for instance, a customer be pushed to consume some drug when there is no need to? Hence the idea of calling , for instance, a vitamin deficiency "a syndrome" or something "bad sounding" that can be cured with Vitamin C , repackaged as "Brawndo the plague mutilator" ?

It seems to me that some of these pharma salespeople, unaware as they might be, are not selling on satisfaction of harmless enough desire, they sell on fear and need and sometimes on insecurities too, such as plastic surgery.
posted by elpapacito at 4:01 PM on August 28

remember that these people often have less than perfect knowledge of what they're selling. They are people trying to do a job in good faith in a system that sucks

1. Each rep is responsible for pushing one to three drugs at most, and they work for the people making the drug. They damn well better know pretty much everything there is to know about the drug. Don't blame me if I expect to hold them to that standard.

2. It's impossible for me to believe that these people are not conscious that what they do is way, way overvalued in the health care system when compared to what doctors, nurses, pharmacists, and other care givers do and make. I realize corporations have a right to market what they manufacture, I just don't like the fact that drug companies spend so much time and money training reps to push drugs with selective information while most doctors are lucky if they get an hour or two in a week to objectively review *all* the new drugs. Ultimately, it's the doctors' responsibility to seek unbiased information, but it's increasingly difficult to do so.
posted by Slarty Bartfast at 4:16 PM on August 28

If there had been a more honest approach to Vioxx we might still be prescribing it, albeit more along the lines of other drugs such as DMARDs (disease modifying anti-rheumatic drugs) such as Enbrel. The times I prescribed Vioxx, as well as when I used it personally for some back trouble, it was undoubtedly one of the best non-opiate pain relievers I ever came across, and patients said so as well who had tried a number of other NSAIDS, and I don't think it was really a placebo effect. We were never pretending it was some holy-grail drug with them, just that it was in a new class and might work better.

I agree with Caddis - drug companies are all mendacious and driven to increase their bottom line. In this case, they went to a point where they shouldn't have, but every year I spend in this business, I become more circumspect and cautious around new drugs, and for the most part won't touch them for at least a year or two to see what sort of fallout inevitably shows up once they are in wider circulation.

As far as drug reps go, it strikes me as a really, really tough way to make a living. In a smaller community you are going to know these people from your school or kid's sports team, so in our clinic they do come through but there is zero face time with the doc. They leave a sample and move on. And the samples themselves are something that also you learn quickly is a pointless exercise. You waste time fetching them and forever after the patients ask you for them. I can't remember the last time I gave some out. The exception is Cialis. I grab those anytime my old guys ask for it, god love em.
posted by docpops at 4:21 PM on August 28 [1 favorite]

2. It's impossible for me to believe that these people are not conscious that what they do is way, way overvalued in the health care system when compared to what doctors, nurses, pharmacists, and other care givers do and make. I realize corporations have a right to market what they manufacture, I just don't like the fact that drug companies spend so much time and money training reps to push drugs with selective information while most doctors are lucky if they get an hour or two in a week to objectively review *all* the new drugs. Ultimately, it's the doctors' responsibility to seek unbiased information, but it's increasingly difficult to do so.
posted by Slarty Bartfast at 4:16 PM on August 28 [+] [!]

Bears repeating.

I really think the drug rep paradigm is a sinking ship.
posted by docpops at 4:22 PM on August 28

"PUT THAT COFFEE DOWN.

Coffee is for CLOSERS only."

(awesome scene. quoted by sales guys the world over...especially biopharma sales guys, strangely enough.)
posted by ThusSpakeZarathustra at 5:14 PM on August 28

I used to work for a small corporate media house as a production coordinator/line producer. These kinds of scripts went through rewrite after rewrite after rewrite at the agency, thanks to the clients' legal and marketing departments' incessant wrangling. What won a pitch to these companies was a creative script and storyboard, which was then painfully picked apart and turned into something one could shoot in one's living room with a home camcorder and no one'd be the wiser.

As for the actors, they're chosen by the client and not the agency. So if my boss thought an actor was terrible, but the client sitting in at the casting session felt the actor fit in with their image, that actor was in. Lots of third-tier character actors I recognized from L&O do these to make that mortgage payment on their overpriced Hell's Kitchen condo. The worst would be when a charisma-free executive was required to speak on-camera. Take after take after take... The director more or less directed in tandem with the client, who reviewed each take and had final approval.

Even those clients who did know media and storytelling had higher-ups to answer to who would put the kibosh on a piece everyone else was happy with. Very few of our clients allowed the company free reign, and if that happened, it was because the job was recurring, like a quarterly sales targets video for a beverage conglomerate or financial services company where we'd worked with them long enough to just churn out the video without too much input.

A lot of these companies have their communications departments in-house now (this contributed to me losing my job) with even tighter control over how their message is presented. But the feeling is that for sales meetings, you've got to have opening videos, "comical" sales videos, rock bands, the stiff executives wheeled out once a year for the pep talks and closing megatrips with Peter Thomas doing his "Voice of God" routine at the end; somehow, in tandem with the group exercises and PPT presentations, it all works! ::shrugs:: At these meetings, people bonded, were jazzed to sell stuff and cheered wildly at the end of these videos, even if they'd previously joked amongst themselves about how cheesy they thought everything was going to be. By the end they were True Believers. Go figure.

I've only worked on one project that I was proud of and that was an interview with a guy who did an extraordinary physical feat given his disease thanks to a certain drug. I learned more about actual production in a few months in this position than I did in 5 years as a feature film and network TV PA/production secretary. But overall, I wasn't proud of working in this branch of media and I'm glad I'm out of it.
posted by droplet at 5:15 PM on August 28 [2 favorites]

They damn well better know pretty much everything there is to know about the drug. Don't blame me if I expect to hold them to that standard.

They damn well ought to know everything that they are told about that drug, that is the standard that they are held to. To blame the sales force for the cover up of the danger of vioxx is barking up the wrong tree.

It's impossible for me to believe that these people are not conscious that what they do is way, way overvalued

I said no such thing.
posted by kuujjuarapik at 5:32 PM on August 28

I'll be damned and dipped in shit. My comment got posted on their website.

I would thought it had been "scat-cammed" no, whats the word "vioxxed" dammit...uh Slashdotted! They should have been slashdotted by now.
posted by Xoebe at 7:55 PM on August 28

Oh wait, and I forgot - hell in another thread I was just thinking of the classic paradigm - corporation as psychopath.

I don't know why in the hell this doesn't get more play. Of course there are the [deleted] asswipes that come out and whine about the "shareholders" nyah nyah nyah blah blah blah, but they are just [deleted] asswipes and they deserve no respect, except to recognize that Jesus Himself would be first in line to give them a really, really hard wedgie.

I mean really. To come out and moan about "the share holders"??!! The anti-semitic genocidal maniacs that ran Nazi Germany were the "shareholders" in that little perversion of Democracy. Pissing and moaning about your precious shareholders merits as much sympathy as...um.... someone who merits no sympathy at all...like... uh....whatshisname.

oooo did I Godwinize?

dammit the oven is beeping and I can think no longer
posted by Xoebe at 8:24 PM on August 28

They damn well ought to know everything that they are told about that drug, that is the standard that they are held to. To blame the sales force for the cover up of the danger of vioxx is barking up the wrong tree.

I said no such thing either. In decreasing order of responsibility, the blame resides with the FDA first, lazy doctors second, and the marketing executives at Merck third. I think you and I probably agree and I don't mean to dehumanize drug reps. This FPP focuses on the tactics that Pharm reps are taught to push their drugs and that's what I have been commenting upon.

In every case I have personally encountered, these people do represent themselves as being experts on all of the published, peer reviewed scientific literature concerning their drug. They come armed with reprints of articles and they speak of studies in progress. In cases where I have done my homework ahead of time and point out flaws in studies, they are prepared to refute my arguments. These people do know their drugs.

My point is that I believe these people know what they're doing and are complicit in the problem of unsafe, inappropriate prescribing and the easiest, best solution is to do what we did in my office: put a sign on the door that says "This office does not receive pharmaceutical representatives and does not accept drug samples."
posted by Slarty Bartfast at 9:17 PM on August 28

put a sign on the door that says "This office does not receive pharmaceutical representatives and does not accept drug samples."

i've worked in medical offices for years and have pushed for this, but I've never gotten agreement on it. I remember well how the Vioxx rep assured us and the doctors over and over that earlier reports of cardiovascular issues were overblown and misunderstood.

They're really aggressive about free samples (which end up in the hands of the people most able to pay or have them covered) and free lunches. I'm pretty much viewed as the killjoy for not participating, and it's not like you can really blame hardworking people for wanting a free lunch; I just don't think it's free, in the end.

What I dislike most is that pharmaceutical reps have access to the pharmacy prescribing records, so they come into the office with the full knowledge of how much and how often their particular brands are being prescribed by that doctor, and they turn the screws accordingly.
posted by troybob at 10:25 PM on August 28

i've worked in medical offices for years and have pushed for this, but I've never gotten agreement on it.

You know what the best part of it is? The patient reaction to this has been *100%* positive. Like 50 people have personally thanked me for doing this and we haven't had a single person asking what happened to the free drugs.
posted by Slarty Bartfast at 10:44 PM on August 28 [1 favorite]

I've always been curious as to whether local law could mandate that physician offices be required to post a sign indicating that they accept freebies from pharmaceutical or other companies. Such a relationship could be interpreted as potentially having an influence on the medications or treatments a doctor offers, so it seems appropriate that patients be informed of such, if only for the sake of asking appropriate questions.
posted by troybob at 11:33 PM on August 28

I agree with docpops–if Vioxx had been promoted more responsibly, with full disclosure of risk information, docs would still be writing Vioxx scripts. It would be a healthy niche drug, instead of a product with a meteoric rise that turned into a catastrophe. (I have never understood that use of "meteoric"–I have yet to see one rise. I digress.)

The fact is, most people who were prescribed Vioxx didn't need it. An OTC NSAID or prescription-strength ibuprofen would have done the trick for most. The highly touted advantage in gastrointestinal side effects was exaggerated. The real holy grail for pharma companies is a drug that you can put a patient on at $3-$5 per day for the rest of his/her life. That is why there was such heavy (and successful) promotion of this drug. It really was a useful, effective drug; it was just not being used properly considering the risk-benefit profile. It was being sold as an all-around workhorse analgesic, and that was its downfall.

With regard to the video featured here, I did not find it particularly pernicious, just laughably bad and, although it did presage the downfall of Vioxx with the business about MI risk.
posted by Mister_A at 7:49 AM on August 29

Check out Prescription Project for info on action pertaining to industry/physician relationships and more.
posted by Mister_A at 7:56 AM on August 29

I like this site for similar information, and they do it with a bit more humor: No Free Lunch
posted by Slarty Bartfast at 12:10 PM on August 29

(I have never understood that use of "meteoric"–I have yet to see one rise. I digress.)

My one and only real laugh of the day.
posted by docpops at 1:16 PM on August 29

One more little ditty about the "research" that drug companies do. "Seeding trials" conducted by pharmaceutical companies are clinical studies that are primarily marketing tools but seem designed to answer scientific questions. The apparent purpose of such trials is to test a hypothesis. Their true purpose is to get physicians into the habit of prescribing a new drug. I could go on for days about this industry...the one that used to refer to "The Purple Pill" as "Purple Jesus" form all the money they made on it. It really makes it tough on docs to take good care of their patients when they are always battling a well oiled marketing machine that puts profits before patients. I work for the Indian Health Service which is basically what a national health care system would look like. We have pretty much one drug from every category and no drug reps. Our folks do just fine on ibuprofen.
posted by mbigouben at 10:41 PM on August 30