Pharmaceutical sales representatives must be licensed in order to work, according to a new law titled 

, which was approved by the Council of the District of Columbia 7-6 last week. According to the bill, reps will now need a bachelor's degree and must adhere to a code of ethics that includes strict rules against gift giving.

Reactions have been mixed. Some industry experts feel that the law is simply business as usual and won't change how pharma reps do business, while others expressed concern that the legislation is unnecessary and a misuse of money.

"The perceptive value of this bill is greater than the actual value—I don't think the legislation will change what pharma is doing and mandating within its own organizations," said Rick Keefer, chief operating officer at Publicis, a company that provides sales representatives to pharma companies. "The pharma companies already take compliance, governance, and appropriate promotional policies very seriously. If a rep violates any of those things, he or she is terminated immediately."

How this ruling will effect Publicis is yet to be determined, according to Keefer. The company will need to provide licensed reps to pharma companies that use its services. Keefer said that its existing training programs might need to be modified to match the new licensing rules. "Our reps would be operating under the same guidelines as our clients' representatives," Keefer said.


The biggest point of contention in the bill was eliminated from the final document. Originally, pharma reps would have been forbidden from targeting prescribers on the basis of data mining information and other prescribing data.

 in Maine and New Hampshire stating that data mining firms cannot be stopped from collecting prescription data played a part in bill cosponsor Councilman David Catania's decision to eliminate that passage, according to reports.

"I was surprised when I first read about the bill," said Mike Luby, cofounder of Target Rx, a consultancy that specializes in selling issues. "To me, this is a very disappointing movement that I hope we don't see followed anywhere else, because you are diverting resources that could be used to improve healthcare. They are putting an extra layer of regulation on something that is already regulated by the federal government."

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Sales representatives will now need a license to sell their wares, according to new legislation approved last week in DC. The new law creates a list of zero-tolerance regulations, but experts wonder whether they will do anything to improve sales rep/physician relationships.

(2)008: Licensed to Sell

 argues that the best way for drug manufacturers to market their drugs is to look at side effects. If the risks are high, push more spend into professional advertising and detailing. If the risks are low and the benefits are high, ramp up consumer spend.

The study—"The Debate on Influencing Doctors' Decisions: Are Drug Characteristics the Missing Link?"—"was done to determine the influence Big Pharma had on physician prescribing habits. More important, the study team sought to bring solid empirical evidence to the public concern that physicians are prescribing drugs on the basis of a sales rep's spiel and not on academic research.

What the team found was the complete opposite: Marketing directly to the physicians through sales force and indirectly through patients (who see the ads on television, etc.) wasn't a surefire way to get the doctor to prescribe a drug. "Doctors listen to the sales person and patient requests, but they are not necessarily influenced or swayed by the communication," said 

, assistant professor of marketing at Emory University and one of the authors of the study. "Instead, we found that doctors rely purely on science."

 on Monday that sales reps are most useful in helping physicians stay informed about new drug indications and to alleviate concerns regarding side effects. He said that if firms do not engage in using the sales force to communicate these findings, the physician would walk away thinking that the side effects are in fact quite severe and might choose not to prescribe the drug.

The report noted that overdoing marketing efforts can actually come back and bite a pharma company. Physicians who receive a lot of visits for a drug that is largely ineffective tend to prescribe far fewer units of that particular drug than if they receive fewer visits for a similar drug.


"There is concern that physicians are uninformed about what they are prescribing and that Big Pharma is taking advantage of them," Venkataraman said. "We find, from our data, that there is very little support for that theory."

The same goes for consumer requests for drugs. The study states that patients can inform doctors about drugs they saw in DTC advertising, but not necessarily sway them to prescribe the drug. If the drug information is favorable, doctors will be more inclined to respond to a patient request.

For older drugs, Venkataraman recommends that firms go as far as pulling the plug on DTC and put most of their efforts (and cash) into reeducating the physician population about the benefits of the drug.

"A pharma company with a big presence in a particular category, where the brand is effective, will get a far larger bump from sponsoring a meeting than it would if the drug was less effective," Venkataraman continued. "Physicians are using all these contact points with Big Pharma to learn more about the brand. Gone are the days where you could walk in after a free lunch and convince a physician to prescribe your brand. You have to educate. As soon as you stop educating, the physician is going to tune out and start paying attention to your competitors."

New report finds that neither sales reps nor patient requests are the deciding factor when it comes to physician prescribing habits, information is-the more the better.

More Prescriptions Through Learning: The Doctor's Choice

A new University of Georgia study by three health-communications professors found most consumer television wanting when it came to stating risks and communicating information about a drug to viewers. On the other hand, nearly all the ads in the study meet FDA criteria, and the authors state that it is difficult to test whether the ads meet fair balance rules because FDA does not give actual requirements.

To perform the study, the researchers had graduate students watch and code 106 television commercials. Some of the interesting findings:


57.8 percent of the ads mentioned how the drug works or its mechanism of action

19.8 percent included supportive measures, such as diet

86.8 percent included some form of risk disclosure

The average 60-second spot includes less than eight seconds devoted to risk disclaimers

90 percent of ads placed risk information at beginning or end of the spot

Side effects were presented in an average of 6.3 seconds

71 percent of side effects were presented in voice-over

Of the ads viewed, only two actually broke the law. Another 11 included the bare minimum information required by FDA, and 14 percent did not include side effects.

Study coauthor Wendy Macias, an associate professor in the UGA Grady College of Journalism and Mass Communication, agrees that some side effects are less serious than others and fair balance should be determined on the basis of the seriousness of the risks, but she said that pharma needs to communicate the information in a way that the consumer can better understand the level of risk. Macias said, "At this point, it doesn't seem like they are really doing that."

The report does have flaws; most of the advertisements used in the study were from the summer of 2003, before many of the false-advertising claims that came in the wake of the Vioxx situation.

"I think advertising has changed some since 2003, but most companies could still be doing a much better job," Macias told 

 on Monday. She cited Johnson & Johnson's Ortho Evra as a brand that is doing a good job focusing on side effects and education. The report does state that print advertising does a much better job communicating medical information to the consumer.

New study finds that risks and side effects don't get their fair share of time in television advertising. The authors cry out for more educational information in DTC ads--but is it necessary if the ads aren't breaking the law?

Pharmaceutical Executive-01-16-2008

(2)008: Licensed to Sell

More Prescriptions Through Learning: The Doctor's Choice

DTC Report Finds Consumer Ads Lacking