The Unselling of Brand-Name Drugs

Roberta Collier sweeps into the doctor's office wearing a big smile and wheeling a briefcase filled with glossy brochures. Dressed in a wool suit and classic pumps, Collier looks every inch the successful pharmaceuticals sales rep. Indeed, when drug reps encounter her, they frequently mistake her for one of their own.

But beneath Collier's corporate exterior beats the heart of a rebel.

A former drug company salesperson, she now works for the state of Pennsylvania as one of 10 highly trained "unsales" reps whose job is to help doctors prescribe medications for their patients based on the best scientific evidence—not on the best commercial sales pitch.

"Our pitches are about safety and efficacy, which therapies work best for which patients," says Collier, a registered nurse who visits about 150 doctors in the Scranton-Wilkes-Barre area. "We offer nonbiased research summarized in an easy format. And once we get in to talk to them, doctors love it."

Thomas Snedden, director of Pennsylvania's drug assistance program for older residents, launched the unsales force in 2005, as a foil to the reps who tout the latest brand-name drugs. Snedden believed providing objective information would improve care for patients in his program and could also save money, since new drugs are not always the best drugs.

Snedden enlisted Harvard Medical School's Jerry Avorn, M.D., to train the unsales force. Avorn, a professor and author of Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs, pioneered the Independent Drug Information Service at Harvard to give doctors impartial drug data.

Collier and the other unsales reps visit doctors with large numbers of patients in the state drug assistance program. Their pitches—dealing with high cholesterol or stomach acid suppression—have been tailored by researchers at Harvard, where the reps receive continual training and updates.

Pennsylvania's unsales program is costing $3 million over three years and is already helping to pay for itself. Avorn says a new state study reported that the unsales pitch on acid suppression drugs alone saved state programs about $572,000 a year as more doctors switched from brand-name Nexium to generics, antacids and other over-the-counter drugs that work as well for many patients.

South Carolina recently started an unsales program, and Avorn says California, Colorado, New York and Massachusetts are also considering them. He's working with Vermont, Maine and New Hampshire to set up a New England collaborative.

Ironically, the unsales reps have found they still need to bring lunch to gain entrée with some doctors. Michelle Spetman, project manager of the Harvard training program, says, "We had to budget for lunches because food is so much a part of the culture that's been created."