This past week, my Novo Nordisk representative dropped by to discuss Victoza. One of my first questions concerned his company’s response to Public Citizen’s request that the FDA pull Victoza from the market. The representative had not heard about this and was both shocked and rather embarrassed. This was no fault of the Novo rep, who I know to be quite knowledgeable and pleasant. Even though the news of Public Citizen’s request had only made headlines earlier that morning, if I were Novo’s CEO, I would have ensured that all my reps knew about this before the story broke and had prepared statements ready to go.

Whether the information is late-breaking product news or simply pipeline updates, it appears that the company’s pharmaceutical representatives are usually the last ones to know. My perception is that suppression of information to field representatives is done purposefully, in order to ensure that representatives do not say something they aren’t supposed to. In light of multi-million dollar lawsuits, the industry’s sensitivity to off-label promotions is certainly understandable, but the majority of this type of information is publicly available and has absolutely nothing to do with off-label promoting.

REPS MUST BE VALUED INFORMATION RESOURCES

Given that there are fewer branded products to discuss and/or samples to leave behind, pharmaceutical representatives will have an increasingly difficult time bringing value to physicians. Yet, it is exactly this type of information that physicians find useful. As physicians, we are supposed to be experts in the medicines we prescribe, but this has become increasingly difficult with so many studies to keep up with, many of which make the headlines well before the abstract finds its way to our mailboxes.

Using the Novo example, if I had prescribed Victoza to a patient without knowledge of the Public Citizen warning (which the patient might have already heard about or will certainly find out when they Google the medication after their appointment), I’d look like an idiot. On the other hand, if I am able to discuss this concern at the time of prescribing (e.g., “Now you may have heard…”), then I look like a genius.

Similar logic can be applied to knowing which products will soon become generic, which products will soon be approved (i.e., expected PDUFA dates), which late-breaking abstracts will soon be presented (e.g., “Doctor, our ABC study will presented at tomorrow’s cardiology meeting.”), and any other nuggets of information regarding a product or disease state that may make medical or (especially) lay press headlines.

KEEPING REPS IN THE DARK

Conversely, if representatives are kept in the dark about what’s going on with their company, not only do representatives become limited in the value they can provide physicians, but this also creates distrust between the physician and the industry. Had I written a prescription for Victoza and received a call back from the patient regarding the Public Citizen issue, I would likely be pretty upset and distrustful of the company that had not informed me about this issue.

My understanding is that the hiring process for pharmaceutical sales representatives is pretty rigorous. Candidates must score highly on a series of test items to even be considered for employment. In other words, it appears the pharmaceutical industry does a very careful job in hiring very smart people. It is therefore about time they trusted their own representatives to provide the kind of valuable information physicians desire, without crossing the line of off-label promotion and/or lack of fair balance. “Drug reps” is the common term that physicians and the lay press use to refer to pharmaceutical sales representatives. As the full name implies, however, they should be representatives of the company, not just salespeople. The pharmaceutical industry would be wise to let their representatives actually be representatives of the company first.

  • Matthew Mintz, M.D.

    Matthew Mintz, MD, FACP, is Associate Professor of Medicine and Director, Premier Access and Executive Services at The George Washington University School of Medicine in Washington, DC. Visit his blog at www.drmintz.com.

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