Drug reps in the slums - walking a fine line
Its inevitable that no matter which direction pharma steps in attempting to market its drugs, it will fall under fire at some turn with its broad host of critics. If it caters to the wealthy in developed countries, it is painted as ignoring those most in need of high quality medical care. But as it ventures into poorer nations with sales tactics developed in the west, it runs the risk of arming its critics with even more ammunition against it.
The path to the worlds poorest communities is littered with landmines for reps beating these streets. They are walking a fine line as they peddle their pharma wares.
A recent Wall Street Journal article (http://online.wsj.com/article/SB124691259063602065.html) tells of an effort by Pfizer to sell its drugs to the mostly poor residents of Petare, Venezuela. The article describes a strategic shift in the $770 billion pharmaceutical industry to target the working poor in the developing world. It is a story where the word target takes on the familiar negative connotations so often ascribed to the tactics of pharma.
Petare is as the WSJ quite accurately paints it: Caracuss largest shantytown home to more than one million people who live in colorful houses clinging to the side of a mountain overlooking the capitals downtown. And it is here that WSJ chronicles the work of Julio Rodriguez, a local man who once peddled womens undergarments, worked subway security and sold office supplies to make ends meet, but now represents Pfizers drugs to physicians, attends college and hopes to finish an accounting degree.
Without Pfizer, Rodriguez would clearly still be trying to scrap out a much tougher living for himself and his family. And without him, and others like him, the local health minister says Venezuela would not be doing as well at eliminating barriers to access to drugs.
But the industrys critics say Pfizers (and other multinational drug companies) sales tactics push local doctors and patients to pay more for branded drugs than they could get the same treatment for with a generic alternative. They argue the computers and internet access the company brings to doctors in these struggling communities unduly influences their prescribing decisions, despite the doctors assertions that it opens avenues for improved diagnosis and real-time collaboration and communication with colleagues in Caracus. Refurbishments to physicians decaying offices are seen as bribes for prescribing, rather than improvements to the healthcare system.
It is a debate that pharma and its reps have faced before, but for which it has seemingly yet to find a counter argument. As long as it seeks to make a profit, which every viable business must to survive and for which pharma is no exception, anything it does is viewed as opportunistic and predatory.
Nevermind the satellite dishes and air conditioners that the WSJ freely say dot Petare. It does not paint the media providers and power companies as opportunistic and predatory for eating such a large percentage of the average citizen of Petares income for their services, despite telling us that a construction laborer paid $240 to get his phone turned back on and $51 for his satellite TV subscription out of his $750 monthly salary. It is the $100 to $125 cost of a monthly Lipitor prescription that comes under fire.
Yes, the drugs are expensive, but disproportionately so in comparison to other services? Is telephone service worth twice the price of Lipitor? The chastizing is reserved for the pharma companies, who are expected to bring life saving medicines to the world at little or no cost and still pay their employees handsomely, while reaping vast rewards for shareholders. It is a minefield that most days it seems only pharma must walk through in Petare and everywhere.
Pharma must find a way to do all that it can to make its medicines as affordable as possible - especially for those most in need and most vulnerable. Has it done all that it can in this regard? Almost certainly not. But its critics must understand that the life saving advances that the world needs, and that pharma funds and drives forward, come at a price that the industry can't simply absorb or it will cease to exist to continue bringing new medicines to market.
We must all work together to find viable, sustainable solutions - and to keep in mind that perhaps singling pharma out ,and holding it to what often seems to be a different standard, may only broaden the gap between the industry and the table.