How to Use Industry Sales Representatives as a Resource
From research to patient education, sales reps provide a range of services.
BY ALAN ROBIN, M.D.

It was a warm spring evening over 15 years ago. A drug representative (TA) came unannounced to my office after an especially tiring and long day. I was running late. My wife had asked me to be home over an hour and a half ago. In walks a pharmaceutical representative of a major ophthalmic company.

There had been nothing new in the medical management of glaucoma for over 5 years. When TA walked in, he started the conversation with how he had a son, about to go to college. His son was bright and deserved to go to one of the best colleges. He wanted to pay for his son's college education, leaving his son debt free, but to do this he needed a bonus. His bonus was dependent on increased sales of drug "X" and I had not prescribed enough.

He used to be "higher" in my book, but this really was a low blow. I was interested in his son's advancement, but not at a perceived decline in my morals and patient care. I told TA I had to leave ... he said he really had to talk with me to explain the importance of my changing my prescribing habits. I explained that this was not a good time, could he come back some other time? He said he would just walk me to the car, to which I agreed. I was shocked when I unlocked my car, sat in the driver's seat, and then TA suddenly opened the passenger door, sat down and started ruining my evening. It took me a half hour to boot TA out of my car.

Industry Representatives Today

Today, the world of glaucoma is rapidly changing. With it, so have the roles and behavior of my local pharmaceutical representatives. Multiple new classes of medications and lasers have been introduced, which have been so effective that our rate of surgical intervention has decreased. We have seen a validation of IOP lowering as a way of preventing needless blindness, have learned that adherence to therapy is potentially a treatable cause of visual disability and have seen new classes of optic nerve visualizing devices that have changed our practices. What does this mean about our pharmaceutical representatives and what they have done.

Pharmaceutical representatives primarily are empowered with information to better help you learn about and evaluate their products. They supply information about efficacy, duration of action, efficacy when added to another medication and important side effects of their medications. If asked, they can help with med-line searches and supply articles on topics of interest to physicians. Many have realized that your office extenders (such as technicians) are very important in the doctor-patient relationship. To this end, representatives can sponsor educational lunches in which new products or programs are highlighted. This can better help your staff help both you and your patients deal with issues such as compliance.

Spreading the Word

The pharmaceutical representatives have been great at spreading the word about the National Eye Institute's multi-centered trials. Often, manuscripts appearing in peer-reviewed journals do not get the attention that they deserve. General ophthalmologists who are busy with day-to-day concerns such as staffing, coding, refractive issues and newer IOLs do not have enough time to adequately follow and read the information contained in the peer-reviewed, multi-centered trials. These trials have been quite important as they deal with the significance of IOP in lowering the risk of developing glaucoma and of glaucoma progression, the magnitude of central corneal thickness, interpretation of perimetry and perimetric progression and of the role of laser and surgical intervention in glaucoma therapy. We owe quite a bit to the pharmaceutical industry for their help in educating both newer glaucoma experts and general practitioners in an unbiased view with the facts and limitations of these crucial trials.

What Your Representative Can do for You

Many physicians have requested speakers or talks on specific topics. Pharmaceutical representatives have been responsive in arranging meetings and seminars. If you need a specific speaker, ask your representative and he or she will try hard to bring that speaker to your community. Do you need help with a specific topic such as how to best use antimetabolites in filtration surgery? Your representative will be delighted to try to either get information for you, or arrange for a seminar.

Your patients are having trouble affording medications? Each company has programs for needy patients. Your representative will gladly help you in the short term with samples until your patient officially qualifies. Your representative will give you the forms and help your staff fill them out.

If you use some products routinely, your representative will help you with prewritten prescription forms. In addition, the representative can give you pamphlets on glaucoma, and on various medications so that you can help to better educate your patients.

If you need help setting-up an ASC or determining if purchasing a new piece of equipment is right for you, your rep can put you into contact with just the right people without any obligations.

Representatives work primarily in harmony with leading ophthalmologists to answer questions important to us. The following are examples of questions that we have all asked about: Can we better identify patients at either greater or lower risk of developing glaucoma? Can we address the relative risks of various individual patients to help physicians help them define their chances of developing diseases? Can we identify those patients who are noncompliant and help them administer their medications more effectively? Can we better help local physicians learn how to better use the information that has come out in peer-reviewed journals? Your reps can help you find the appropriate person at their company who could help you develop studies, get appropriate patents and best explore your options.

Some physicians are extremely interested in clinical research. Both phase 3 and phase 4 FDA studies are available for physicians to participate in. If you let your representative know, he or she can put you in touch with the appropriate person at the company who can best inform you of the obligations and necessary patients for various studies.

In summary, your drug representative can offer boundless opportunities and information, help with patients, data on various clinical studies and product information, and contacts so that you can expand your horizons and learn more about a specific topic or learn how to lecture better. The best way to take advantage of this is to contact your representative and ask what resources are available. OM

Alan Robin, M.D., is a professor at the University of Maryland, associate professor, ophthalmology at Johns Hopkins University and associate professor international health at Bloomberg School of Public Health, Johns Hopkins University. Dr. Robin is a consultant to Merck, Pfizer, and Alcon. He can be reached by e-mail at glaucomaexpert@cs.com.