The Future of the Doctor-Pharma Relationship

March 24, 2011

Patient care is increasingly under third party control.  And as a consequence I make fewer decisions regarding the brand of medication used in my patients.

So the role of a pharmaceutical rep comes into question.  If I don’t choose which medication my patients will use, why would a representative call on me?  And as American medicine becomes more centralized and standardized, I wonder how and why industry will connect with treating physicians.  Pharma it seems is asking the same question: Of the core medications I prescribe, I see far fewer reps these days and our relationships are markedly different from a decade ago.

I don’t miss the pitch.  But I find the element of human support to be important.  For example, recently the FDA issued a black box warning for the concomitant use of Remicade and 6-MP.  My representative visited to be sure that I was aware of the changes in the product insert.  Sure the information was in my mailbox – along with 6 inches of pulp spam.  It’s basic attenionomics: I’m more likely to hear a person than a letter.

Going forward I suspect that our future encounters with industry will be more permission-based and contextual.  Pharma and medical device manufacturers will evolve to embrace a more open, social business design that cultivates a supportive rather than sales relationship with physicians.  I suspect that my information about these products will come from digitally facile humans who know me and understand how I get information.  Responsible doctors and industry professionals should open their dialog so that the social public can see that the conversations are properly centered on the patients.

While my political incorrectness may awkwardly quiet the room, I believe that providers should have some kind of balanced, transparent relationship with those who create the stuff that fixes our patients.  As medicine becomes progressively dependent upon advanced diagnostic and therapeutic technology, I might suggest that to avoid the discussion is irresponsible.


Melissa (aka DrSnit) March 24, 2011 at 10:48 am

I’m conflicted about this discussion. Conflicted as an academic and scholar. Conflicted as a patient. And conflicted because so many physicians DON’T seem to keep up on medications without the reps “educating them” in advance. I have story after story of doctors “telling me research” they have CLEARLY learned at the behest of pharm reps.

It gets MORE complicated because I have multiple specialists – and it seems that they are often working at cross-purposes instead of as a team.

I have friends who are pharm reps. They TRULY believe in their products. But believing in a product doesn’t make it effective for all demographics. And WISHING something is a better fit using slick techniques doesn’t make it always work. It is MY JOB to be skeptical with my friends, even though I love them and they need their jobs.

I don’t have a dog in this fight. I watch from the outside and I’m fascinated with how it plays out. But I would TRULY caution everyone to do their own research up front and on the back end. Because even when someone is giving you “facts” and “evidence” – there are still multiple cross-purposes at stake. And, it is HARD to keep up with the research, especially when people TRULY BELIEVE they are doing the best thing for all involved.


Jody Schoger March 24, 2011 at 11:05 am

This does not seem politically incorrect at all to me. On the contrary – it’s profound common sense.

There are times as a patient that the work of a pharma rep is all too apparent – when a PA prescribed the (then) new ADVAIR when I had a bronchial wheeze for example – or the dematologist’s office walls are banner ads for AB&C skincare. Those are obvious. It’s the not so obvious I’m more than willing to learn about to better understand my healthcare, and best decisions I can make.

Thanks for another great post.


ruben March 24, 2011 at 12:18 pm

Great post, Bryan.
Made me think harder about a recent experience with my PCP. He gave me a link to a new startup company who is developing a mobile/social educational service for my condition. The startup must be REALLY new, because their site was empty! He is an advisor to the company.

Do you see physicians ‘prescribing’ patient-centered social online destinations or tools as a rising trend and potential benefit to patients, caregivers and the healthcare system in general?

Wade March 25, 2011 at 10:02 am

Just recently discovered your blog – great content, very interesting.

I walked away from my 10-year career as a drug rep because I could no longer tolerate being used only as a 30-second Coca Cola commercial. When I started, I was ‘educated’ about the disease and given information so that I could be (gasp!) a source of information for my physicians! For the first several years it worked and I actually felt I was bringing more value than just a bunch of samples. But the pod mentality arrived and suddenly there were several of us walking in with a canned pitch. Marketing not only took over our discussions but they told us who we were supposed to talk to. We became square pegs looking for a round hole. The physicians hated it and we despised it. So I did the only logical thing I could think of . . . I bolted and took over my Dad’s clinical research company – much happier now!

I love your take on medicine and social media – I’ll definitely stop by often!

Celeste Hackett March 25, 2011 at 11:20 pm

Great blog and I love that you take the time out of what must be an insane schedule to write it. What I’d like to see is more doctors approaching patients in the use of their own minds to release negative emotions (very stressful to the body) to assist in healing them. Also educating clients on the use of positive thinking and suggestion to help make medicine and treatment work better. Hippocrates said, “Natural forces within us are the true healers of disease” and to that end negative forces (stress emotions) held subconsciously, when removed, allows those natural forces to flow again.

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