1 Boring Old Man

^{Yet, as many have observed, an industry that should be hailed as one of the greatest contributors to health in our society actually ranks among the lowest in public trust.}

Glaxo Exec Concedes Drug Industry ‘Lost Its Way’ And Prescribes Changes
NPR
by Scott Hensley
January 24, 2011

The same day the feds said they recovered $4 billion related to health care fraud in the government’s last fiscal year, a leading drug company exec acknowledged the industry had gone off course. In a speech Monday to hundreds of people who make their living keeping drugmakers on the straight and narrow, GlaxoSmithKline’s U.S. President Deirdre Connelly noted the huge fines paid in recent years by drugmakers and the low esteem consumers have for the companies these days. Then she asked the obvious question. "So what went wrong?"

In the speech, whose prepared text we got from the company, Connelly said, "The answer, I believe, is that, in some ways, our industry lost its way." Nobody I know would argue with that. She faulted a "competitive selling model" that works fine for autos or candy, but just isn’t right for medicines that can save people’s lives…

Her prescription for change included focusing on patients’ needs and operating with greater transparency. One specific change worth noting: Glaxo won’t be paying drug reps bonuses based on increases in prescriptions in their territories anymore. Instead, Connelly said, Glaxo will base the compensation on specific scientific and business knowledge, customer feedback and performance of the business unit they’re part of. You can read the full text of Connelly’s speech here… 

^{Society holds our interactions with our customers – healthcare providers and payers – to a higher standard. And it should. Society expects our business to be conducted openly and transparently and in a way that does not create even a perception of inappropriate influence.}

^{What our critics either are unaware of – or choose to ignore – is that our industry adopted the PhRMA Code almost ten years ago, which serves as a baseline for how we should work with healthcare providers and institutions. The industry then strengthened the code in 2009, making additional changes in areas such as meals, continuing medical education, support for educational and professional meetings, and the use of consultants and speakers, among other things… But negative perceptions remain. Some of this has to do with long‐running government investigations, litigation over past practices, and the resulting news coverage that makes it look like we still take doctors on trips to exotic locations – which we don’t. Some of it is because we haven’t done enough to communicate what we do and don’t do. Some of it is because industry bashing is good politics. Some of it is because we still make mistakes. No matter the reasons, at the end of the day, we must regain the public’s trust in our industry.}

^{And what are those values? There are four we strive to live by at GlaxoSmithKline:}
^{• first, focus on the best interests of the patient,}
^{• second, be transparent about our working relationships,}
^{• third, operate with integrity}
^{• and, fourth, respect those we work with and serve.}

^{In the past, like other companies, we based the variable portion of the compensation for our sales force on the volume of prescriptions they obtained in their sales territory. That is no longer the case. We are now in the process of putting in place a new incentive compensation system in which individual sales representatives are not bonused on scripts, but on three factors: an assessment of their scientific and business knowledge; feedback from customers in their region, including demonstration of our values; and overall performance of the business unit they support.}

While I might quibble with some of her points about Physician Speakers or CME, I thought her speech was courageous and on the mark. But there’s a great big other point to make her. The ball’s in her court. Just saying the right things plus a nickle won’t buy a cup of coffee. She’s going to have to show it to us and keep at it. Her industry is right up there with the Derivative Traders as "worst in show."

At the risk of a charge of male chauvinist pigism, I have an anecdote to tell. Any Doctor can’t have failed to notice that drug reps changed dramatically over the years. Forty years ago, they were glad-handing, often red-nosed old guys who knew a lot and played it pretty straight. Nowadays, they are often women who are in the range of real lookers with slick patter and handouts. The change over the years is striking. I practiced in a group that was otherwise all women, and my partners enjoyed pointing out that the target in our office was obvious – me. Some of the reps were plenty knowledgable. Many weren’t. The point is that the drug industry has obviously learned the value of putting a pretty face on their product.

Deirdre Connelly is an attractive person with an attractive message, but what needs to be attractive is her performance in bringing these things off. One thing that would help would be to come clean about their past, rather than just asking us to forget it before ever saying what it was. She leaves that out of the reasons that their reforms haven’t been noted. They haven’t directly confessed to their sins [which are bountiful]. Tell us about STI, or Charlie Nemeroff, or Zach Stowe, or Martin Keller, or invading the medical literature. What did go wrong? They don’t have to admit it all, but enough to let us know that they’re serious about regaining trust. They came by their reputation fair and square.

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