I just saw this You Tube Video by PharmedOut, an independent physician-run project funded through the Attorney General Consumer and Prescriber Education grant program. This Video interviews a gentleman who was previously an Eli Lilly Drug rep about is experience marketing olanzapine.

With my day job, working in psychiatry with a team that treats real patients, conducting and publishing clinical trials, and producing educational activities for psychiatric nurses and psychiatric clients, I have had considerable experience with drug reps, antipsychotics and pharmaceutical advisory boards. With that said, in my opinion, this gentlman does accurately discuss the marketing mentality of the company during the time he served. However, I am pretty dismayed and considerably annoyed at the subtle message that “all prescribers are idiots and will believe whatever Drug Reps tell them.”

Most prescribers know that drug representatives in the past had a pharmacy background. Now, drug representatives come mostly from a marketing or business background. Especially in the case of schizophrenia and bipolar disorder, where there still are a number of significant questions about what really goes wrong in the brain to create the diseases. We certainly understand the diseases better than 10 years ago, but we cannot claim to understand everything. So…. unless, I’m wrong– this lack of clinical background among most current drug representatives creates a serious scientific credibility problem when talking about advanced interpretations of information included in the package insert and clinical studies (like mechanisms of action for efficacy and adverse effects as well as the projected health impact of side-effects and management suggestions).

Many also understand that drug representatives are rewarded for the number of prescriptions filled in their territory for the agent they market. While not every Rep is soley focused on number of prescriptions, this “moving product” reward system places these individuals squarely in the “Extraordinarily Biased” bucket of individuals who have the potential to influence care.

So I think it is utterly rediculous to think that any clinician would adopt any behavior or prescribe any treatment based solely on what a drug rep said. Much less, continue to do so when it is not working or there is significant risk of hurting a patient.

Now– I realize that the case of this medication also involves some accusations of important side effect information being supressed and withheld. Honestly, I don’t take sides here.
However, clinical experience is a powerful force in the practice of doctors, nurses and other health professionals. There may not be ready explanation, but trends and patterns can be seen. Afterall, where there is smoke there is usually copious oxidation occuring and if left to continue there will soon be a fire. It has been the dogged determination of independent clinician researchers to understand the trends and patterns that have brought this issue to the forefront.

My emphasis has always been that patients have the ability and responsibility to become more active in the selection of their treatments. Part of being empowered is understanding the players in the game. Marketing of treatments to practitioners does play a role, as does, accurate interpretation of research findings, dissemination of those findings and clinical experience and knowledge of the practitioner. Patients should feel free to ask questions to make sure that the proper amount of consideration is given to all the voices.