TECHNOLOGYOnline detailing: The new way to sellDrug reps don't have to stop by your office anymore -- you can now opt to meet with them via your computer.By Tyler Chin, amednews staff. July 9/16, 2001. Several times a month, Edward Berman, MD, a solo internist in Ridgefield, Conn., logs onto a PC-based videoconferencing system in his office and enters a user ID and password to hold real-time video detailing sessions with pharmaceutical sales representatives. The image of the sales rep is displayed on one part of the computer screen. Information about appropriate use, efficacy, dosage, side effects, contraindications and studies about new and existing prescription drugs appear elsewhere on the screen as Dr. Berman and the sales rep discuss it. Dr. Berman is among several thousand physicians who are believed to be participating in "e-detailing" -- electronically accessing details, ordering samples and requesting visits from sales reps. But that definition has been evolving. Some observers broadly define e-detailing as any online marketing and learning program targeting physicians, including CME programs or electronic mail notifying them of a new indication or a meeting at a hotel with drug reps. Whatever the definition, online detailing is in a nascent stage. In the past few years, several technology startups whose business plans depend on serving as conduits between physicians and drug companies have sprouted. Their job is to help the pharmaceutical industry better target and deliver their sales pitch to physicians.
20,000 to 40,000 physicians are currently participating in pilot on-line detailing programs, according to industry estimates.
But these startups also claim to offer value to physicians. That's because online detailing lets doctors control the interaction with the pharmaceutical company, get information at their convenience and obtain more relevant information than they can from brief visits with sales reps. On the other end of the equation, online detailing potentially offers drug companies a more efficient way to reach physicians, says Mark Bard, director of health practice at Cyber Dialogue, New York, a customer relationship management company. For example, an electronic detail averages about 10 minutes, which is several times the 30 seconds to 2 minutes of "face time" sales reps typically get from physicians, assuming they even get that far, he said. Quite often, sales reps cool their heels for hours in the waiting room only to be told to return another time. Online detailing, however, minimizes those problems because it lets pharmaceutical companies reach doctors who are interested in getting drug information or don't see sales reps, Bard said. It also lets drug companies economically reach doctors who aren't a priority for them now because they aren't high prescribers. Online detailing "is the second, if not the first, priority [of every pharmaceutical company] for two reasons," added Josh Fisher, analyst at WR Hambrecht & Co., San Francisco. "One is the return on investment. Second, it's a case of everyone is doing it and we don't want to miss out for competitive reasons." Typically, drug firms give companies such as Physicians Interactive, Libertyville, Ill., and MyDrugRep Inc., Newport Beach, Calif., a list of doctors they want to reach. But most of these programs are in the pilot stage, Bard said, adding that pharmaceutical companies -- and physicians -- are trying to figure out what works and what doesn't. He estimates that 20,000 to 40,000 physicians are participating in those tests. No privacyJust as they do when you see a sales rep, pharmaceutical companies will know who you are and what you looked at when you participate in an online detailing program. Also, physicians may be profiled, and those profiles may be shared with third parties, according to the privacy policies e-detailers post online. Peter Lavine, MD, a solo orthopedic surgeon in Washington, D.C., who is interested in doing detailing online, wouldn't mind drug companies knowing of his interest in their products. But he would object if firms used their knowledge to dispatch a barrage of sales reps to his office. "That would be a misuse of the service and would inhibit doctors from using it," Dr. Lavine said. Some doctors aren't concerned about being profiled or pharmaceutical companies using that information to learn what they prescribe because that ship left the harbor long ago, they said. "Today, there is so much information out there that any company can buy information about what drugs physicians prescribe," said Sam Bub, MD, a family physician in Emmaus, Pa. "Am I happy about it? Not particularly, but that's the reality of the world." Given that their profiles and prescribing data already are available to anyone seeking those data, Dr. Bub and other physicians say the advantages of doing detailing online outweigh the disadvantages, which they see as minimal. "We can go online anytime we want [to get details]," said Walter A. Peterson Jr., MD, a family physician in Chattanooga, Tenn., who has accessed details through the Web site of Physicians Interactive, which says it coined and trademarked the term e-detailing in 1996. The firm is a division of Allscripts Healthcare Solutions Inc., based in Libertyville, Ill., which sells handheld prescription writing systems to physicians. "I determine the time and even the outcome by just telling the rep, 'I don't want to continue any more. Can we please discontinue the conversation and pick it up another time?' " said Bernd Wollschlaeger, MD, a solo family physician in North Miami Beach, Fla., who recently participated in a video-based detailing program through iPhysicianNet. The Scottsdale, Ariz.-based firm gives doctors a free computer, ISDN line and Internet access if they agree to join its detailing network. "I'm able to get more information from the videos, go over more details, and they tend to be more educational," said Dr. Berman, who also uses iPhysicianNet's video detailing system. That's because he has more time to question sales reps when using the videoconferencing system than he does when they visit his office, Dr. Berman said. Luring doctors with giftsTo encourage doctors to participate in online detailing, pharmaceutical companies are extending their highly controversial offline practice of giving gifts to get doctors to hear their sales pitches and prescribe expensive drugs to the online world. For example, sales reps today must routinely buy lunch for doctors and their employees to get inside an office. Drug companies also drop lavish dinners, trips, tickets to sporting events and other expensive gifts on doctors. Last year, the industry spent $13.2 billion marketing prescription drugs to physicians, up from $12 billion in 1999, according to IMS Health, a pharmaceutical research firm based in Westport, Conn., that also sells physicians' prescribing data to the drug industry. E-detailers say that the honorarium their pharmaceutical clients offer to doctors complies with gift-giving guidelines from the AMA and FDA and doesn't involve cash. Under the AMA's ethics guidelines, physicians may accept gifts of minimal value, defined as valued at $100 or less. Also, any gift physicians accept should be primarily for the benefit of patients or connected to their practice, said Herbert Rakatansky, MD, chair of the AMA Council on Ethical and Judicial Affairs. "No gift should be accepted if there are strings attached to it," Dr. Rakatansky said. "If you can sign on, get your gift and sign off without even looking at the detail, that is a gift. But if you have to do anything else, such as respond to questions or be online for a number of minutes [to get the gift], then you can't do it." Some doctors say the possibility of getting an honorarium influenced them to get details online, but that gifts -- whether resulting from online or offline interactions with sales reps -- don't influence their prescribing. "I never found that influenced my behavior," said Dr. Bub, who recently received a $25 gift certificate to Amazon.com for accessing a detail online. He used the gift, from MyDrugRep, to buy two paperbacks on stress management. Dr. Berman said he signed a three-year contract under which he agreed to have a video detailing session monthly with each client of iPhysicianNet because the latter offered as incentives a free computer and high speed Internet access via an ISDN line. The opportunity to receive an honorarium from the pharmaceutical companies also appealed to him, he said. But the bottom line is that "if I didn't think that sitting through a [video] discussion wasn't of value, it wouldn't be worth it just to have a free computer," Dr. Berman said. "I'd just get my own computer." Expressing a similar view, Dr. Peterson said receiving a gift for participating in an online detailing program isn't comparable to what doctors receive at the numerous social events that pharmaceutical companies host for them at expensive restaurants and other posh places. "This is quite different from going to a boat, being wined and dined, and 'just to make it legal, we'll give a little [educational] talk,' " Dr. Peterson said. Jettisoning the sales repSome physicians hope that online detailing will help them eliminate or reduce the number of office visits from pharmaceutical sales representatives, which have increased substantially as the number of sales reps has doubled in the last five years. "Why should I have the rep in the office when I can have [the detail] online?" Dr. Wollschlaeger asked. "I don't like to have too many reps in my office because some of them are just horrible. They are not trained or they are trained just on one product. You ask a question that is beyond the scope of their experience and they say, 'Oh, I'll come back or send you something.' " Still, he doesn't expect to banish sales reps from his office any time soon. Not all pharmaceutical companies are doing online detailing, Dr. Wollschlaeger said. And those that are don't do it for all their products. Unlike Dr. Wollschlaeger, other doctors don't plan to replace sales reps with online detailing because they find sales reps useful too. "The days are so long and stressful that I enjoy seeing the reps because they break up the day," Dr. Berman said. "They have a tough job, and I'm sensitive to that." ADDITIONAL INFORMATION:E-detailersSome companies that facilitate communication between physicians and pharmaceutical and medical device companies through the Internet, video or the telephone include: MyDrugRep Inc.
(http://www.mydrugrep.com/)
Physicians Interactive
(http://www.physinteractive.com/)
iPhysicianNet Inc.
(http://www.iphysiciannet.com/)
RxCentric Inc.
(http://www.rxcentric.com/)
marketRx.com Inc.
(http://www.marketrx.com/)
WeblinkAMA CEJA guidelines on gifts to physicians from industry" (http://www.ama-assn.org/ama/pub/category/4263.html) Copyright 2001 American Medical Association. All rights reserved.
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