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Medical Forum / General / General / December 2005it's continuing medical education
November 28, 2005 Gimme an Rx! Cheerleaders Pep Up Drug Sales By STEPHANIE SAUL http://www.nytimes.com/2005/11/28/business/28cheer.html?adxnnl=1&adxnnlx=1133284 534-RhBmgxg2P8y5q4USBjeYQA Known for their athleticism, postage-stamp skirts and persuasive enthusiasm, cheerleaders have many qualities the drug industry looks for in its sales force. ~~~~~~~~ But there have been accusations that a pharmaceutical company encouraged using sex to make drug sales. In a federal lawsuit against Novartis, one saleswoman said she had been encouraged to exploit a personal relationship with a doctor to increase sales in her Montgomery, Ala., territory. In court papers responding to the lawsuit, Novartis denied the accusation. The company has also said it is committed to hiring and promoting women. ~~~~~~~~ "There's a saying that you'll never meet an ugly drug rep," said Dr. Thomas Carli of the University of Michigan. He led efforts to limit access to the representatives who once trolled hospital hallways. But Dr. Carli, who notes that even male drug representatives are athletic and handsome, predicts that the drug industry, whose image has suffered from safety problems and aggressive marketing tactics, will soon come to realize that "the days of this sexual marketing are really quite limited." (snip) > "There's a saying that you'll never meet an ugly drug rep," said Dr. > Thomas Carli of the University of Michigan. He led efforts to limit [quoted text clipped - 4 lines] > to realize that "the days of this sexual marketing are really quite > limited." I've met several very ordinary-looking drug reps. I wouldn't say ugly. ;-) Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > I've met several very ordinary-looking drug reps. I wouldn't say ugly. > ;-) I remember being at a convention many years ago and seeing three reps from some company or other who were all so astoundingly attractive they all looked like they'd been picked right off of a pro-football cheerleader squad, indeed. The effect was enhanced by the 3 out of 3 beauty. I was so astonished I can't remember what drug they were selling or what company it was. Probably some of this is self-defeating. Some of these women would probably be more effective if they wore granny glasses. Anyway, yes, in general, sex does sell. That's today's newsflash. I hope everybody isn't too shocked at the idea. SBH > > I've met several very ordinary-looking drug reps. I wouldn't say ugly. > > ;-) [quoted text clipped - 12 lines] > > SBH Ahhhh yes. If we don't like it we must be prudes. They were in there with you in the warm instead of on a street corner but the transaction was the same. > > Anyway, yes, in general, sex does sell. That's today's newsflash. I > > hope everybody isn't too shocked at the idea. [quoted text clipped - 5 lines] > They were in there with you in the warm instead of on a street corner > but the transaction was the same. And so also at the wedding altar, if you insist on using the streetwalker metaphor for any social situation in which sex and economics are mixed. Which they usually are. But that's a narrowminded view of the world. Trade is not an intrinsically degrading human interaction. I would argue the opposite, in fact. Theft and charity are where one person tends to look down on the other. Business may be clean by comparison. SBH SBH > > > Anyway, yes, in general, sex does sell. That's today's newsflash. I > > > hope everybody isn't too shocked at the idea. [quoted text clipped - 18 lines] > > SBH Oh more rrationalizing. I'd like to see this business transaction returned to the business of medicine. > Oh more rrationalizing. I'd like to see this business transaction > returned to the business of medicine. COMMENT We've had this conversation before. You're not going to get rid of advertising. And as for the advertising to people you pay to consult, that's something you have to worry about in every business. When you fly, do you spent a lot of time ruminating about whether or not your safety is compromised by what sort of shady deals and pressures and ads and outright bribes were used on the airline execs to buy a plane made by Boeing? Versus, say, Airbus? I suggest you save your ire for the real problem here, which is the war on drugs which succeeded in making doctors the gateway for most of the pills you want. When in reality, the State really has no more business in regulating these things than it does who gets to buy alcohol or cigarettes or compressed air or whatever. Which is to say, perhaps there's an argument for keeping minors and mental defectives away, but that's about it. The only good argument I can make for prescriptions, is for antibiotics, which truly are a matter of public safety (due to the breeding of resistant organisms-- a form of polution like any other). Everything else you should be able to buy at the liquor-store. Don't blame me that you can't--- blame your nosey neighbors. In a libertarian world where adults are treated as adults, if you suspect doctor A is being bribed or enticed into recommending drug Y, then go and buy drug X. Problem solved. If you need more info, pay to consult doctor B and C. It's only when you get third party payors and the law involved that you now have to regulate and watch all of this, as though it was a bunch of politicians deciding which highway contracts to let with public funds. Politicize medicine and make it a function of the state, and you get all the problems of political bribery. Such bibery always being one reason to keep government as small as possible. SBH > > Oh more rrationalizing. I'd like to see this business transaction > > returned to the business of medicine. [quoted text clipped - 33 lines] > > SBH We weren't talking about advertising, exactly. But anyway the product being advertised wasn't the product being sold, nor is it under FDA scrutiny. Letrozole was, but was allowed off-label use to predicted devastating effect. I'm not necessarily against the idea of drugs being open market. But are you telling me letrozole, to take one example, should be sold OTC? Is it enough to make sure the couple sitting in front of you have been read the relevant parts of the PDR in order to protect you from litigation? As a society I think we have a responsibility to protect the consumer as much as possible (seat belts, brakes in another context) and as a physician I think you have an obligation. "Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things-to help, or at least to do no harm." ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Novartis issues breast cancer drug warning Associated Press WASHINGTON - The manufacturer of a breast cancer drug, letrozole, is warning fertility doctors that it has been associated with birth defects, a caution prompted by reports that the drug was being used to help a woman become pregnant. Letrozole is approved for use only in postmenopausal women with breast cancer. But there is evidence some doctors have prescribed it as a fertility treatment because it suppresses estrogen and can promote ovulation. It is marketed under the name Femara. Swiss drug manufacturer Novartis is sending letters to fertility doctors worldwide to reiterate a warning that the drug should not be given to women who may be pregnant, said spokeswoman Kim Fox. The U.S. label on the drug already warns that it has been associated with birth defects, but concerns arose when a researcher in Canada published a report noting cases where the drug had been given to pregnant women. After the report, Novartis reviewed its safety database and found 13 reports of pregnant women receiving the drug worldwide, contrary to its warning label. Of those 13, at least two had miscarriages and two had children with birth defects, Fox said. It was not clear how many of these women were given the drug to increase their fertility as opposed to some other reason. Health Canada, the country's health care agency, issued the warning jointly with Novartis to fertility specialists, gynecologists and obstetricians. In its letter in Canada, Novartis said it is "aware that Femara is being used to stimulate ovulation in women who are infertile, or unable to become pregnant, as a treatment to increase their chances of becoming pregnant." The drug "should not be used in women who may become pregnant, during pregnancy and/or while breast-feeding, because there is a potential risk of harm to the mother and the fetus, including risk of fetal malformations," the company said. Pregnant women who have received the drug should contact their doctor. The U.S. Food and Drug Administration has not taken any action, but a spokeswoman said the agency was reviewing the matter. Novartis plans to send a letter to U.S. fertility specialists by the end of the week, said Fox of Novartis. It is unknown how many women have been prescribed the drug as a fertility treatment. Doctors in many specialties sometimes prescribe drugs for uses not approved by health regulators, believing the drug can still serve to treat a condition. ON THE NET Novartis: http://www.novartis.com Food and Drug Administration: http://www.fda.gov > I'm not necessarily against the idea of drugs being open market. But > are you telling me letrozole, to take one example, should be sold OTC? Yes. It's impossible to make a fool-proof world, because fools are so ingenius. > Is it enough to make sure the couple sitting in front of you have been > read the relevant parts of the PDR in order to protect you from [quoted text clipped - 5 lines] > these acts. As to diseases, make a habit of two things-to help, or at > least to do no harm." Indeed, but that's a professional obligation. And it's certainly not one I'd want enforced legally (which means, in practice, at gunpoint). Physicians give advice. Ignore us if you like, but if we wanted to be traffic cops or judges, we'd have gone into law or law-enforcement. >(seat belts, brakes in another context) < Should cause you to bite your tongue. They are of course completely different things. Bad brakes are where you put others at risk. Seatbelts/harnesses (at least for adults) are where you put only yourself at risk (seatbelts for children is yet another thing). Seatbelt laws (at least for adults) are (as such) an abomination which leads inexorably to cholesterol and food Nazis, dental floss police, and the entire idea that the nanny goverment should be controlling your behavior from bedroom to bathroom. Once you let that camel get its nose in the tent, then you're in for it. The war on drugs is merely a logical outcome of it. The idea that government should, or even can, efficiently protect people "from themselves" (as opposed to protecting them from each other and from rare human preditors) is based on the extremely dubious idea that THE SAME people who are (on average) too lazy or too uninformed or too stupid to pick the behaviors which will directly benefit their OWN health (a matter in which they have utmost and direct interest), will YET somehow be (on average) nevertheless industrious and/or knowlegable and/or intelligent enough to pick politicians who can make these decisions FOR them. How's that, again? You're not smart enough to buckle up, but are smart enough to elect people who will tell you to, or else?? How many people are naturally more interested in local and national politics than their own bodies? So tell me again how it is, that we're going to get a complicated risk/reward decision chain to work, when we can't even get a simple one to work? My answer is that (by common sense and by experience) we can't. And it doesn't work to let politicians handle your market choices, either. And for exactly the same reason. SBH >> I'm not necessarily against the idea of drugs being open market. But >> are you telling me letrozole, to take one example, should be sold OTC? >Yes. It's impossible to make a fool-proof world, because fools are so >ingenius. I believe this is a quote from Einstein. As I am quoting from memory, I may have some errors here. Man tries to make things foolproof, but nature tries to create a better fool. Nature is winning. >> Is it enough to make sure the couple sitting in front of you have been >> read the relevant parts of the PDR in order to protect you from >> litigation? As a society I think we have a responsibility to protect >> the consumer as much as possible (seat belts, brakes in another >> context) and as a physician I think you have an obligation. >> "Declare the past, diagnose the present, foretell the future; practice >> these acts. As to diseases, make a habit of two things-to help, or at >> least to do no harm." >Indeed, but that's a professional obligation. And it's certainly not >one I'd want enforced legally (which means, in practice, at gunpoint). >Physicians give advice. Ignore us if you like, but if we wanted to be >traffic cops or judges, we'd have gone into law or law-enforcement. I am not sure of that for all physicians. Far too many believe that they are there to give orders, and do so. The one who makes the decision should be the one liable, but alas, the totalitarians who make the laws cannot see this. >>(seat belts, brakes in another context) < >Should cause you to bite your tongue. They are of course completely >different things. Bad brakes are where you put others at risk. [quoted text clipped - 6 lines] >in the tent, then you're in for it. The war on drugs is merely a >logical outcome of it. This is absolutely correct. They still have not fixed the airbag law. Even according to the official figures, my adult daughter should not use an airbag, and I should. The only solution here which makes sense is a switch. But what has been done? One can get a medical certificate, authorizing a mechanic to disconnect the airbag. But most mechanics will not, because they are afraid that if they do and someone else is injured or killed, presumably because the airbag is not working, they will get sued. The word "presumably" is deliberate here. I have not read the article, but it has been claimed that if a proper assessment is made of high speed deaths in which airbags are deployed, it will be found that on the whole these devices cause more deaths than they prevent. >The idea that government should, or even can, efficiently protect >people "from themselves" (as opposed to protecting them from each other [quoted text clipped - 10 lines] >that we're going to get a complicated risk/reward decision chain to >work, when we can't even get a simple one to work? Essentially this precise statement was made by Jefferson. Also, most of these people believe that the resources are there to provide "optimal" health care to everyone. >My answer is that (by common sense and by experience) we can't. And it >doesn't work to let politicians handle your market choices, either. And >for exactly the same reason. It is worse than that. It has been realized that the government cannot be allowed to make investment decisions, because this would effectively ruin the market. State universities have to have foundations which are allowed to do it, which are not controlled by the state, so that a large investor's portfolio adjustment does not start a panic, and the current large investors know this. A British commission has just recommended that British workers be allowed to invest some of the monies now going into their retirement funds. >SBH SignatureThis address is for information only. I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 > > Oh more rrationalizing. I'd like to see this business transaction > > returned to the business of medicine. [quoted text clipped - 33 lines] > > SBH Let's pretend you have less government than we do. Does bribery happen less in your system? I think, but can't prove, bribery relevant to healthcare happens less in our system. {Probably owing in part to all that not keeping up our end in the research department.} You're right, we can't leave it up to government. Medical associations have to take a stronger role; there has to be a role for consumers too. Perhaps we can include libertarians? But we can't leave it up to libertarians either. From your description here (what happened to that kinder gentler libertarian of another post?) it looks like in a libertarian world only people with money would get healthcare, and possibly health information too. A wise physician told me once it's not what you know, but who you know... People with money tend to know other people with money. Membership has benefits. When you have an underclass that doesn't 'know anyone', you need some governement protection. >> > Oh more rrationalizing. I'd like to see this business transaction >> > returned to the business of medicine. >> COMMENT >> We've had this conversation before. You're not going to get rid of >> advertising. And as for the advertising to people you pay to consult, [quoted text clipped - 3 lines] >> and outright bribes were used on the airline execs to buy a plane made >> by Boeing? Versus, say, Airbus? >> I suggest you save your ire for the real problem here, which is the war >> on drugs which succeeded in making doctors the gateway for most of the [quoted text clipped - 7 lines] >> other). Everything else you should be able to buy at the liquor-store. >> Don't blame me that you can't--- blame your nosey neighbors. >> In a libertarian world where adults are treated as adults, if you >> suspect doctor A is being bribed or enticed into recommending drug Y, [quoted text clipped - 6 lines] >> bribery. Such bibery always being one reason to keep government as >> small as possible. >> SBH >Let's pretend you have less government than we do. Does bribery happen >less in your system? >I think, but can't prove, bribery relevant to healthcare happens less >in our system. {Probably owing in part to all that not keeping up our >end in the research department.} >You're right, we can't leave it up to government. Medical associations >have to take a stronger role; there has to be a role for consumers too. [quoted text clipped - 3 lines] >libertarian world only people with money would get healthcare, and >possibly health information too. No, in a libertarian world, the amount of medical care you would get would be what you could pay for, OR get under some welfare procedure. If a physician gets paid for treating patients through the government, he can waive the charge for someone else, but he cannot charge less than the government pays for those it provides for. In a libertarian society, those doctors who wish to can form a union, but cannot enforce their union rules against anyone else. Also, libertarians are very strongly against fraud, and consider the present interpretations as extremely weak. One thing which would be considered fraudulent are such statements as, "It worked for me, and it will work for you." or even, "This has worked for all my patients, so it will solve your problem." As for health information, I cannot see any reason why it should be harder to get than under the present system. >A wise physician told me once it's not what you know, but who you >know... People with money tend to know other people with money. >Membership has benefits. >When you have an underclass that doesn't 'know anyone', you need some >governement protection. You will not get it that way. The government will only limit you, like it has done in education, seeing that nobody with brains can get a good education, because of "protecting the underclass". "No child left behind" means "no child gets ahead", so the genius is limited to being exposed to what the idiot can handle. And at this point, academic schools for the bright are almost non-existent. Having money, or knowing people who have money, can mean little as well as long as the government locks things up. At this point, the government HAS weakened research by funding it, originally making the money easy to get, but now not funding much that is not in its "priority list". We had at least 100 independent major sources of research funds before WWII; now we have ONE. SignatureThis address is for information only. I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 > >> > Oh more rrationalizing. I'd like to see this business transaction > >> > returned to the business of medicine. [quoted text clipped - 55 lines] > charge for someone else, but he cannot charge less than the > government pays for those it provides for. It's sounds like nothing I want any part of. Welfare. Here, the government pays for everyone. There's no stigma, then. My phyician will charge the same for each visit or procedure whether it's me or Conrad Black she see's and sends out for cholesterol testing. > In a libertarian society, those doctors who wish to can form > a union, but cannot enforce their union rules against anyone > else. Also, libertarians are very strongly against fraud, > and consider the present interpretations as extremely weak. I don't know how you can make a blanket statement like that. Surely they are each individuals with some individual variation of what they think (or I have I mis-read Ayn Rand?) > One thing which would be considered fraudulent are such > statements as, "It worked for me, and it will work for you." > or even, "This has worked for all my patients, so it will > solve your problem." That would be great if true. But unfortunately, I think an element of ethics must enter, and that again is an individual thing, and isn't necessarily implicit just because someone is a libertarian. > As for health information, I cannot see any reason why it should > be harder to get than under the present system. Because as Steve said, the person seeking information about his condition is going to go to other physicians. In your system, and a libertarian system, that costs. For the welfare patient that would be limited, or non-existent. > >A wise physician told me once it's not what you know, but who you > >know... People with money tend to know other people with money. [quoted text clipped - 10 lines] > idiot can handle. And at this point, academic schools for the > bright are almost non-existent. The genius is never limited in the way you suggest. If there is limitation it is only through poverty and access. > Having money, or knowing people who have money, can mean little > as well as long as the government locks things up. At this [quoted text clipped - 9 lines] > Herman Rubin, Department of Statistics, Purdue University > hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 >> >> > Oh more rrationalizing. I'd like to see this business transaction >> >> > returned to the business of medicine. >> >> COMMENT .................... >> >> In a libertarian world where adults are treated as adults, if you >> >> suspect doctor A is being bribed or enticed into recommending drug Y, [quoted text clipped - 6 lines] >> >> bribery. Such bibery always being one reason to keep government as >> >> small as possible. >> >> SBH >> >Let's pretend you have less government than we do. Does bribery happen >> >less in your system? >> >I think, but can't prove, bribery relevant to healthcare happens less >> >in our system. {Probably owing in part to all that not keeping up our >> >end in the research department.} >> >You're right, we can't leave it up to government. Medical associations >> >have to take a stronger role; there has to be a role for consumers too. [quoted text clipped - 3 lines] >> >libertarian world only people with money would get healthcare, and >> >possibly health information too. >> No, in a libertarian world, the amount of medical care you >> would get would be what you could pay for, OR get under >> some welfare procedure. If a physician gets paid for >> treating patients through the government, he can waive the >> charge for someone else, but he cannot charge less than the >> government pays for those it provides for. >It's sounds like nothing I want any part of. Welfare. Here, the >government pays for everyone. There's no stigma, then. My phyician will >charge the same for each visit or procedure whether it's me or Conrad >Black she see's and sends out for cholesterol testing. You are falling into the fallacy of the commons. If the government pays for everything, it will have to decide what care you get, or go broke. So the government could say that you cannot get the treatment you want, and which will do a lot of good for you. Nor can the government even make an intelligent decision, as the benefits are for the individual, while the losses are partly to the individual and partly to the government. If anything, the ones who can afford medical treatment will get less, and not what they want. The government does not take into account the value of the time you spend in going to physicians, etc. The government cannot take into account the value of a given treatment to a given individual, because it depends strongly on the individual's value system. The resulting problem can be shown not to have a rational solution. >> In a libertarian society, those doctors who wish to can form >> a union, but cannot enforce their union rules against anyone >> else. Also, libertarians are very strongly against fraud, >> and consider the present interpretations as extremely weak. >I don't know how you can make a blanket statement like that. Surely >they are each individuals with some individual variation of what they >think (or I have I mis-read Ayn Rand?) I do not understand your question. Of course they are individuals, but any misrepresentation is fraud. >> One thing which would be considered fraudulent are such >> statements as, "It worked for me, and it will work for you." >> or even, "This has worked for all my patients, so it will >> solve your problem." >That would be great if true. But unfortunately, I think an element of >ethics must enter, and that again is an individual thing, and isn't >necessarily implicit just because someone is a libertarian. I see no problem of ethics. Anyone who cannot see what is wrong with those statements is in no position to make a reasoned judgment. People are different, and neither the government nor the medical profession adequately take this into account. If someone takes an action because of such a statement, and it does not work, a libertarian society would award damages. >> As for health information, I cannot see any reason why it should >> be harder to get than under the present system. >Because as Steve said, the person seeking information about his >condition is going to go to other physicians. In your system, and a >libertarian system, that costs. For the welfare patient that would be >limited, or non-existent. Not as much as you think. Again, the individual with money is likely to place high value on his time, and be reluctant to seek the help. Also, it might not be always necessary to visit other physicians, provided that physicians were required to advise, not order or even recommend. While it cannot be fully implemented now, sound advice has to give a reasonable estimate of the probabilities of the various outcomes under the various actions, including the importance of unknown prior opinions, which are partly the patient's. >> >A wise physician told me once it's not what you know, but who you >> >know... People with money tend to know other people with money. >> >Membership has benefits. >> >When you have an underclass that doesn't 'know anyone', you need some >> >governement protection. >> You will not get it that way. The government will only limit >> you, like it has done in education, seeing that nobody with [quoted text clipped - 3 lines] >> idiot can handle. And at this point, academic schools for the >> bright are almost non-existent. >The genius is never limited in the way you suggest. If there is >limitation it is only through poverty and access. You have no idea what you are talking about. The access can be there, but if nobody knows about it, it is useless. I had no idea of what mathematics is (arithmetic is very definitely not mathematics) until I was more than 12 years old, and in the next year, I had essentially completed more than 5 years, and I still had not SEEN the foundations at all. The foundations can be taught early, and should be. But if one does not know how to find them, they are not found. A small amount of the foundations were presented to students then; even less now. Would Mozart have started composing at 6 without a father to guide him? The schoolteachers do not know the foundations as well as they did a half century ago, and they did not know much then. Nor will they let the subject matter scholars into the act. >> Having money, or knowing people who have money, can mean little >> as well as long as the government locks things up. At this [quoted text clipped - 3 lines] >> independent major sources of research funds before WWII; now >> we have ONE. SignatureThis address is for information only. I do not claim that these views are those of the Statistics Department or of Purdue University. Herman Rubin, Department of Statistics, Purdue University hrubin@stat.purdue.edu Phone: (765)494-6054 FAX: (765)494-0558 >If anything, the ones who can afford medical treatment will >get less, and not what they want. The government does not >take into account the value of the time you spend in going >to physicians, etc. There is an interesting line of studies I saw a couple of years ago of perceived barriers to access to care in Medicare populations (those already with insurance). Money came in third generally. The biggest barrier in the studies I saw was time. The second was usually transportation (which, if you think about it, is yet another proxy for time. -- Dr. Cameron: Men should grow up. Dr. Gregory House: Yeah. And dogs should stop licking themselves. It's not gonna happen. > >If anything, the ones who can afford medical treatment will > >get less, and not what they want. The government does not [quoted text clipped - 7 lines] > usually transportation (which, if you think about it, is yet another > proxy for time. Maybe Canada can take over all of transportation and provide everybody with cars and in that way take the stigma away from welfare. They can force car manufacturers into price controls and all car mechanics under reduced wage scales. The price of oil would be regulated and gas prices would be under government control. There would be less gasoline stations which would require people waiting for hours for gas and all cars would be of the same generic box car type. You would have to make a one year appointment to have the oil changed. They would do studies on how it is better to have bicycles instead of cars in keeping the price control down. They would then brag about how the GNP spent on transportation went down with everybody riding bicycles. > > I've met several very ordinary-looking drug reps. I wouldn't say ugly. > > ;-) [quoted text clipped - 12 lines] > > SBH I am with you Steve as I have seen some really stunning beauties that left me mindless about what they were saying. I live for days like that. > (snip) > [quoted text clipped - 9 lines] > I've met several very ordinary-looking drug reps. I wouldn't say > ugly. ;-) When my son had his first intrathecal baclofen pump implant in 1996 the company sent a representative who attracted every neurosurgical resident, intern, etc. to learn about the new procedure. > > (snip) > > [quoted text clipped - 13 lines] > company sent a representative who attracted every neurosurgical > resident, intern, etc. to learn about the new procedure. Hope son is well and so is your extended family ! Ugly Bill SignatureGarden Shade Zone 5 S Jersey USA in a Japanese Jungle Manner.39.6376 -75.0208 This article is posted under fair use rules in accordance with Title 17 U.S.C. Section 107, and is strictly for the educational and informative purposes. This material is distributed without profit. >>>(snip) >>> [quoted text clipped - 15 lines] > > Hope son is well and so is your extended family ! Son is doing great. The implant was the best solution we could find to immobilizing spasticity. > Ugly Bill I knew you would deliver the goods sooner or later. > I knew you would deliver the goods sooner or later. Its not the actual sex that sells But the potential or promise of something to obtain? Possess flitting. Lit incense Image of a male organ could be female two breaths Union What drives us ? Division Bill SignatureGarden Shade Zone 5 S Jersey USA in a Japanese Jungle Manner.39.6376 -75.0208 This article is posted under fair use rules in accordance with Title 17 U.S.C. Section 107, and is strictly for the educational and informative purposes. This material is distributed without profit. >"There's a saying that you'll never meet an ugly drug rep," said Dr. >Thomas Carli of the University of Michigan. He led efforts to limit [quoted text clipped - 4 lines] >to realize that "the days of this sexual marketing are really quite >limited." Pretty much the case as Big Pharma made substantive changes to their field sales forces through the '90s and the first half of this decade. I'm old enough to remember when the reps were almost invariably pharmacists or nurses (the sorts of people who could speak with authority about pharmaceuticals and patient care, and automatically the beneficiaries of the Pavlovian conditioning sustained by the practicing physician throughout his years of medical school and residency training). Hell, three of the guys in my medical school class were former sales reps, their undergraduate degrees in pharmacology and allied health sciences, with excellent MCAT scores and profound knowledge of clinical medicine well established before they ever walked into the gross anatomy lab in first year. Back then, the selection of pharma reps was on the basis of intelligence and persuasive knowledge, not glossy good looks or the ability to practice smarmy suck-up-ery. I'd welcome the changes discussed above. Even if the top manage- ment of the big pharma companies continue to be pointy-haired thieving cement-heads, it'd be nice to interface more frequently with reps who understand that the best possible marketing is evidence- based and reliable clinical medicine. ---------------------- ...[E]very individual necessarily labours to render the annual revenue of the society as great as he can. He generally, indeed, neither intends to promote the public interest, nor knows how much he is promoting it. By preferring the support of domestic to that of foreign industry, he intends only his own security; and by directing that industry in such a manner as its produce may be of the greatest value, he intends only his own gain, and he is in this, as in many other cases, led by an invisible hand to promote an end which was no part of his intention. Nor is it always the worse for the society that it was no part of it. By pursuing his own interest he frequently promotes that of the society more effectually than when he really intends to promote it. I have never known much good done by those who affected to trade for the public good. -- Adam Smith, *The Wealth of Nations* (1776) > >"There's a saying that you'll never meet an ugly drug rep," said Dr. > >Thomas Carli of the University of Michigan. He led efforts to limit [quoted text clipped - 27 lines] > reps who understand that the best possible marketing is evidence- > based and reliable clinical medicine. The latter would obviate the need for marketing :-)) Would be more than happy to "glow" and chat about this and other things like cardiology, diabetes and nutrition that interest those following this thread here during the next on-line chat (12/08/05): http://tinyurl.com/cpayh For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/bgfqt In Christ's love always, Andrew http://tinyurl.com/b6xwk |
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