The Insider has long puzzled over the way controversial drugs become industry favorites in the workers comp system. In a previous blog, we described the fancy dinners sponsored by drug companies, where doctors listened to a colleague describe symptoms and the presumed prescription cure. At that point, it appeared that the path to the doctor's brain (where prescriptions are determined) was through the stomach. A recent article by Stephanie Saul in the New York Times (subscription required) suggests that the path might actually run a bit lower in the doctor's body.
"Give me an O!"
You probably don't connect drug sales with cheerleading. But that's because you assume that doctors operate to a higher standard than the usual "sex sells." Medicine is still a largely male profession - and sex really does sell. Ms. Saul points out that sales reps for the pharmaceutical companies are frequently female and invariably good looking. Less recognized is the fact that a good many are recruited from the ranks of college cheerleaders.
"They don't ask what the major is," says T. Lynn Williamson, a cheerleading advisor at the University of Kentucky. Proven cheerleading skills suffice. "Exaggerated motions, exaggerated smiles, exaggerated enthusiasm - they learn those things, and they can get people to do what they want." What a terrifying thought: that hyper-cuteness can directly influence a doctor's choice of medication!
Some industry critics view wholesomely sexy drug representatives as a variation on the seductive inducements like dinners, golf outings and speaking fees that pharmaceutical companies have dangled to sway doctors to their brands
There are about 90,000 drug representatives across the country. Among these, cheerleaders stand out. Ms. Saul quotes Jamie Reidy, a drug representative who was fired by Eli Lilly this year after writing a book lampooning the industry, "Hard Sell: The Evolution of a Viagra Salesman."
In an interview, Mr. Reidy remembered a sales call with the "all-time most attractive, coolest woman in the history of drug repdom." At first, he said, the doctor "gave ten reasons not to use one of our drugs." But, Mr. Reidy added: "She gave a little hair toss and a tug on his sleeve and said, 'Come on, doctor, I need the scrips.' He said, 'O.K., how do I dose that thing?'" How do you dose it, indeed!
So it appears the answer to the question of how oxycontin and Vioxx rose to the top of prescribed medications in the workers comp system may be simpler - and more troubling - than we suspected. It's just a matter of waving the pom poms!
Just how far does the inappropriate influence go? There is a federal lawsuit pending against Novartis involving a saleswoman encouraged to exploit a personal relationship (AKA, engage in sex) with a doctor to increase her sales. Novartis denies the charges. A doctor in Washington pleaded guilty to assault last year and gave up his license after forcibly kissing a saleswoman on the lips.
So here is the anatomy lesson for the day: the road to prescription choice runs at least at times through the stomachs and lower regions of the doctors who prescribe them. Any strategy for controlling the costs of prescription drugs in the comp system needs to take that cynical lesson into account.