So why do physicians fall for pharmaceutical companies’ enticements? Why do they put all they worked for on the line, after all their schooling, the endless hours of residency, the difficulty of establishing themselves in their chosen specialty?
It’s pretty simple, says a medical marketing expert: sales reps exploit doctors’ weaknesses with flattery and friendship.
Drug company representatives are trained to assess doctors’ personalities, practice styles and preferences so they can influence prescribing, said Dr. Adriane Fugh-Berman, a professor of pharmacology at Georgetown University Medical Center. She’s the director of PharmedOut, which aims to educate doctors on the marketing practices of drug companies.
“Physicians are overworked, overwhelmed, buried in paperwork and they feel unappreciated,” said Fugh-Berman, testifying in September in front of a congressional committee looking into Insys’ marketing practices.
She said she warns that these sales gurus are indeed genuinely friendly but are not genuine friends.
“Drug reps are cheerful, charming. They provide both appreciation and information. Unfortunately, the information they provide is innately unreliable.”
Physicians respond by writing more prescriptions for the targeted drug, she said.
Few knew how to apply this psychology like Alec Burlakoff, the former national sales chief for Insys Therapeutics who hails from Boca Raton.
“When you are dealing with (doctors) who are around pain and cancer all day, an empathetic and caring salesperson is helpful,” he said in a rare interview with the Southern Investigative Reporting Foundation.
That was before Burlakoff and numerous other executives, managers and sales staff were indicted on charges of using a sham speaker program to bribe doctors to prescribe the fentanyl drug Subsys.
Court documents revealed how some Insys sales reps really viewed doctors. Here’s what Karen Hill, who has pleaded guilty to violating anti-kickback laws, told a colleague about the physician to target to prescribe Subsys:
“Any doctor that’s money hungry, or that are just going through divorce or doctors opening up a new clinic, doctors who are procedure heavy. All those guys are money hungry. Doctors that speak for other companies, if they’re known as like company whores, you know they speak for everybody, those guys.”
Dr. Elizabeth Gundersen, an assistant professor of integrated medical science at Florida Atlantic University in Boca Raton, said she tries to warn would-be doctors about how the drug companies look to manipulate them.
But she was taken aback by accusations made against Insys. The Arizona-based company offered physicians much more than the usual fare of fancy pens with drug logos, conference junkets and grants. It offered money, and sometimes, in a real sense, companionship, according to the criminal indictment and a bevy of civil suits.
“Usually pharmaceutical reps are attractive people, but they are also usually trained in the products they are selling,” Gundersen said. “They are salespeople, but they are familiar with the products and the risks and benefits and the research behind those products.”
Insys used untrained salespeople and managers — one a former exotic dancer from West Palm Beach — to lure doctors with perks, such as tickets to sporting events or what one sales rep described as “tequila dates.”
In the case of a Phoenix doctor, an Insys sales rep engaged in consensual sex, according to court documents.
In Alabama, Natalie Reed Perhacs said she was hired with no pharmaceutical experience because a doctor liked her looks and developed an affection for her, according to her plea agreement in which she admitted to violating the federal anti-kickback statute.
Her clients were Drs. Xiulu Ruan and John Patrick Couch, partners in running an Alabama pill mill. They pocketed more than $270,000 from Insys, mostly through speaker fees, according to ProPublica’s “Dollars for Docs” project. They quickly became some of the top prescribers of the fentanyl spray in the United States.
Both Ruan and Coach were convicted and are serving 21 and 20 years, respectively, in federal prison.
Perhacs augmented her $40,000 base salary, making $700,000 in about two years.
“She was not hired because of her experience or her knowledge of controlled substances,” federal prosecutors said in a court document. “Perhacs was hired to induce, and in exchange for Dr. Ruan continuing to prescribe Subsys.”
“Perhacs did anything possible to keep Dr. Ruan and Dr. Couch happy so that they would continue to prescribe Subsys,” prosecutors said.
PAY TO PRESCRIBE? THE FENTANYL SCANDAL