Critical Condition - December 7, 2005

Big Pharma is hiring cheerleaders while you should be rooting for the generic team.

By Kate Steadman, UC-Santa Cruz

The last week of November, The New York Times published an article detailing a peculiar hiring practice among pharmaceutical companies: recruiting cheerleaders as sales representatives. The article quickly jumped to the top of the “Most Emailed” list on nytimes.com as readers and bloggers alike took notice of the pepped-up piece. The author interviews several cheerleaders-cum-sales reps who swear that their experience cheering on others serves as great background for convincing doctors to prescribe their products. One gushes, “I would think, essentially, that cheerleaders make good sales people.” And she’s right – all the qualities needed to be a star cheerleader – enthusiasm, people skills, leggy good looks and a a short skirt winning smile– go hand in hand with selling products.

Considering the lax regulations surrounding doctor-pharmaceutical rep interactions, it should be no surprise that the tiny girl on top of the pyramid is now among the pharmaceutical industry’s ranks. It’s no secret that attractive people can be more persuasive than their less lovely counterparts. But do the ranks of reps really resemble the cast of Bring It On or did the article make a trend piece mountain out of a molehill?

As the New York Times admits in its article, “There are no statistics on how many drug representatives are former or current cheerleaders.” One pharmaceutical researcher, who works for Eli Lilly (and asked to remain anonymous) simply pointed me to the company’s morning memo, which said: “The Times contacted Lilly about the story recently, but did not include comments from the company. Ed Sagebiel, manager for corporate communications … said that Lilly seeks a diverse workforce of employees with necessary educational and business backgrounds who have a high degree of professionalism and passion for their work.” Tight-lipped, indeed.

As fun as it is to mock cheerleaders, there’s no way to know if the Times article is anything more than speculation based on a few individual testimonies. But one thing is for sure: the industry is struggling. With a slew of negative press in recent years, ranging from increased risk of suicide in children taking anti-depressants to elevated risk of heart attack and stroke from Vioxx, pharmaceutical companies are on the defense. A number of blockbuster drugs, including Merck’s cholesterol-lowering Zocor, will go off-patent in 2006. Apparently, the cheerleaders aren’t rousing the crowd like they used to as sales are falling as well: 3 percent at Bristol-Myers Squibb, 4.5 percent at Johnson & Johnson, and 15 percent at Pfizer.

And that’s not for lack of trying. Pharmaceutical companies do much more than develop curative medicines, they enlist a veritable army of people to push their products. In fact, the industry as a whole employs 34,638 more people in marketing than research. Further, the industry spends $20 billion annually to promote new drugs. To be sure, these efforts manifest themselves in ways far beyond the ubiquitous Viagra pens and mouse pads. There are coffee mugs, visits from former cheerleaders, payments for reviewing clinical trials and serving on advisory boards, paid travel accommodations to exotic locations… the list of perks is endless.

The public is less than sympathetic to the industry’s troubles. A recent Harris poll found that only 9% of Americans believe the pharmaceutical industry is honest and trustworthy. The popularity of the Times cheerleaders article is but one of many examples of the public’s low-as-dirt opinion of the industry. Do Americans have good reason to dislike the industry so completely? Certainly, drug prices and aggressive marketing tactics earn the scorn of more than a few. Probably, the only industry held in lower esteem than Pharma is oil.

But if the thought of former cheerleaders urging your local doctor to prescribe the most expensive pharmaceutical options causes you to lose sleep, here are some steps to stifle the cheers in your head.

One step is using generic drugs whenever possible. Generic drugs aren’t like the Best Choice alternative brand toilet paper at the grocery store – they’re truly chemically identical to their brand-name counterparts. The only difference is that generic versions cannot be manufactured until the name brand drug’s patent expires, which is 11 years on average after it first becomes available on the market. That and they’re significantly cheaper – about 80% less after 3 years. (For more information on generic drugs, you can visit the Federal Office of Generic Drugs here.) If you go to the doctor and need a prescription, always ask if there is a generic version of the drug. Even if cost isn’t a concern for you, it is for your insurance company and your employer. Many of us feel intimidated by doctors (surely some doctors give ample reason to feel that way) and awkward requesting certain medications or treatments. The bottom line is that it’s your body and your money, and you should never feel afraid to ask for generic.

You can also educate yourself (like reading this column, hint, hint) about changes the government and pharmaceutical industry can make to become more transparent. As the Vioxx debacle and Plan B’s purgatory illustrate, there is more than enough room for transformation in these organizations. Rules surrounding rep-doctor relations can be altered, like placing limits on the dollar amount of products that can be donated to physicians every year. That $20 billion spent cheering on new drugs could be funneled into other avenues.

If you’re worried about the safety of the drugs reps are cheering on, there are policy changes to advocate for. Here is a crucial two-fold change that could protect against unsafe drugs is two fold: legally mandating disclosure of all clinical trials (not a current requirement under law), and creating an agency to compare the risks and benefits of various drugs. As it stands, the pharmaceutical industry enjoys a virtual monopoly on safety and efficacy information. A registry of these trials will do more than help avoid the tragedy of unnecessary deaths due to pharmaceuticals – it will change the way the industry makes drugs. A study by the National Institute for Health Care Management (NIHCM) found that only 25% of all new drugs submitted to the FDA between 1989 and 2000 had important advantages over products already on the market. An agency that pits new drugs against old, as well as creating an easy to use registry to get the information, would cause shock waves in the methods pharmaceutical companies use to conduct research and market products. The presence of solid clinical data readily available on the most effective treatment would ease over-zealous marketing to physicians.

Although it can be infuriating to read about the little things pharmaceutical companies do to perpetually push their products in doctor’s faces, the problem isn’t hiring cheerleaders or other sexed-up sales reps. It’s their monopoly on safety and efficacy information and the development of drugs that don’t provide any additional benefit. As health care costs continue to spiral out of control, it’s helpful to recognize some key areas that contribute to waste and inefficiency (I’ll give you a hint – they don’t involve doing high kicks). By asking for generic drugs, pushing for full disclosure of clinical trials and research comparing pharmaceuticals, literally billions of dollars could be saved. Which might make the industry take itself a little more seriously and quit recruiting sales reps without solid scientific knowledge. But I’m sure they’re experts at reciting the Pfizer fight song over and over and over.

 
Kate Steadman, a native of the reddest of red states, Kansas, graduated from the University of California, Santa Cruz in June with a B.A. in sociology and pre-med requirements fulfilled. Kate has worked at the National Women’s Health Network in Washington, D.C. and the Venice Family Clinic, the largest free clinic in the nation, in Los Angeles. She has an unhealthy fascination with health care and will be moving to Washington , D.C. to work in health policy. When she’s not reading about health issues, she enjoys staring at her computer, listening to NPR, and knitting.

If you have a question or suggestion for Kate regarding Critical Condition, contact her at ksteadman@gmail.com.

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