Will industry follow Pfizer lead on drug rep cuts?

Pfizer Inc.'s announcement last month that it will cut 20% of its 11,000-member U.S. sales force has left physicians and pharmaceutical sector experts wondering if the move portends an industrywide troop reduction in the armies of drug reps who descend on doctors' offices daily.

Pfizer's cuts reportedly could save the country's No. 1 drugmaker about $400 million annually. The announcement came just days before the company said it was ending phase III study of a cardiac drug. Many expected the drug to soften the financial blow due when Pfizer's Lipitor (atorvastatin) said in announcing the cuts.

Wyeth was the first to opt for unilateral disarmament in the drug rep arms race last year when it slashed its primary care sales force by 15% to about 2,400 full- and part-time employees. Wyeth spokesman Douglas Petkus said cuts have not hurt sales and that doctors appreciate the change.

"The dynamic of the marketplace has changed," he said. "Physicians in offices are very busy and don't have time to see a large number of reps."

None of the leading drugmakers contacted for this story said they plan to follow Pfizer's lead. Swiss firm Novartis International AG, in fact, plans to add 1,000 drug reps to its sales force in anticipation of a handful of new drug approvals. Hussain Mooraj, a drug industry consultant at AMR Research in Boston, said moves like Pfizer's and Wyeth's are primarily driven by sales, patent expirations and the state of a company's pipeline. Over the next two years, Sanofi-Aventis' Ambien (zolpidem) and Merck & Co.'s Fosamax (alendronate) go off patent and could send more drug reps to the unemployment office, Mooraj said.

"The sales force is the engine behind the pharmaceutical company vehicle," Mooraj said. "You've got to overhaul it from time to time."

Overhauling also is coming in forms other than cuts. Mooraj said visiting doctors' offices and delivering a "two-minute infomercial" is still a great way to influence doctors' prescribing, but many drugmakers are exploring new and less costly ways to reach physicians. Eli Lilly and Co., for example, has hired a group of "portfolio specialists" who serve as a single, highly knowledgeable point of contact for physicians seeking information about the company's products. Greater use of technology such as timely physician prescribing data and Tablet PCs have helped sales forces become more efficient, Mooraj said.

Doctors' attitudes changing, too

Tighter rules on gifts from industry, overbooked schedules and ethical worries about drugmakers' influence have combined to make doctors less open to meeting with drug reps, physicians say. But whether this trend will lead to a permanent shift in drugmakers' promotional efforts is unclear.

"It's just about time management," said Joseph C. Perkinson, MD, a Victoria, Texas, family physician who avoids seeing drug reps. He still receives free samples by mail and occasionally signs for samples from behind an opaque barrier in his office to avert an extended visit with a rep.

Dr. Perkinson said drug reps rarely impart any new information and tend to repeat well-honed sales pitches. He relies instead on independent, electronic sources of drug information as well as drugmakers' Web sites for package inserts.

"The older doctors who have always seen reps will continue to do so," said Dr. Perkinson, who is 40. "And there are younger doctors who have never seen reps and probably won't start."

Peter E. Lavine, MD, an orthopedic surgeon and past president of the Medical Society of the District of Columbia, said the 2001 AMA ethical guidelines on gifts from industry and the 2002 Pharmaceutical Research and Manufacturers of America rules governing drug reps have significantly dampened interest in seeing detailers.

The rules "have had a chilling effect on physicians being educated about products," Dr. Lavine said. For example, under PhRMA rules, companies cannot pay for spouses' meals; AMA rules allow meals costing about what doctors would pay themselves. "It's hard for physicians to tell their spouse after a long day at work, 'I'm going out to have a steak dinner with a bunch of drug reps.' "

Dr. Lavine added that brief drug rep encounters are not usually informative and that the number of visits to his office has dropped off considerably in recent months.

While drug reps' time in the office may be waning, experts say doctors feel the impact of firms' direct-to-consumer TV, radio, print and niche online advertising in the exam room.

"I am constantly being asked to prescribe the newest medication because it's the drug that's being advertised," said Marc M. Sadowsky, MD, a psychiatrist and president of the New Hampshire Medical Society. "The patient has seen a 30- or 60-second ad and is convinced that this is the magic pill for them. People feel like they're being cheated if they're not getting it."

The advertising works, according to a February 2005 Kaiser Family Foundation survey of patients. Nearly a quarter of adults reported asking their doctors about a drug they saw advertised. More than half of those patients said their doctors wrote them the prescription. That said, widespread predictions that direct-to-consumer marketing would mean the death knell of detailing proved untrue. After a dip in the early 1990s, drugmakers were back to detailer hiring sprees by 1996.