Pharmaceutical Industry Being Pressured to Change Marketing Strategy

Expert Interview With Shahram Ahari, MS

Neil Canavan, MSc

March 24, 2011

March 24, 2011 (Washington, DC) — Editor's note: Shahram Ahari, a second-year medical student, was formerly a sales representative for a major pharmaceutical company. Speaking here at the American Medical Student Association (AMSA) 61st Annual Convention, Mr. Ahari shared some of the tactics industry once used to influence physicians' prescribing habits. Although many of these practices are now off-limits, Mr. Ahari encouraged students to consider the source of any medical information they receive. Full disclosure is the order of the day.

The AMSA is currently in the process of creating a PharmFree fellow position, which will ultimately be a paid full-time position at the association's national office. They will soon be accepting applications.

Medscape: How long was it before you became uncomfortable with your career in sales?

Mr. Ahari: I started having misgivings about a year into it, when I realized that some of the physicians I worked with — practices that saw a lot of homeless patients — weren't eligible to receive free samples. I couldn't provide them with a lot of the perks that the company provided because there was very little market incentive. That's when it became clear to me that this is a profit-driven business.

Medscape: The pharmaceutical industry is, after all, a for-profit business. Is there an ethical role for the sales representative? Don't you sometimes need to know more about a product?

Mr. Ahari: Absolutely, and the business has something of a cycle to it. In the past, drug reps were predominantly pharmacy trained and had a deeper level of understanding of the science behind [the drug]. These days, it seems that drug reps aren't there to inform physicians, they're being paid to sell product.

Going forward, a better model is what's coming out of the Harvard School of Pharmacoepidemiology and Pharmacoeconomics, and that's the idea of drug reps working independent of any company and educating physicians on a class of drugs, not a brand. It's called academic detailing. Under this approach, because a rep would remain objective, they can disseminate information with no particular company allegiance. Studies have shown that this has actually created a cost reduction in terms of prescribing within Kaiser Permanente, as well as other groups.

Medscape: Do you accept the premise that medicine is first a business?

Mr. Ahari: Certainly it is a business, but not first and foremost. If you talk to med students, they come into this field not because it's going to be lucrative, although that is a factor, but the most common theme you find is that the primary motivation for doctors is they want to be able to help people.

Medscape: Are physicians supposed to be immune from the admonition "buyer beware"?

Mr. Ahari: There still needs to be caveat emptor for physicians, because part of that fiduciary responsibility is acknowledging what the pros and cons of each product are, but that responsibility is on their shoulders [and they should not be giving the greatest weight] to a skewed data source — even if you're seeing reps for competing products. You can't look at something from a left-disordered field and then a right-disordered field, and then average the 2 out to gain an accurate picture. Granted, there is going to be some bias in every source of information — for example, negative trials generally do not make it into the literature — but your job as a physician is to recognize the most objective sources of information.

Medscape: What is the mission of PharmFree?

Mr. Ahari: PharmFree deals with 2 types of issues. The first set of issues is to address conflicts of interest in evidence-based medicine, to understand the impact that marketing can have on the practice of medicine. Partly due to our efforts, a recent survey has shown that half of all medical schools now have conflict-of-interest policies. The second set of issues is how we develop our drugs and who actually gets access to those drugs.

Mr. Ahari has disclosed no relevant financial relationships.

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