The gsk experiment and the role of practitioners in promotion

At the end of 2013, GlaxoSmithKline (GSK) announced that it would end the practice of financially compensating healthcare professionals to speak on its behalf about its products or disease states to audiences who can prescribe or influence prescribing behavior. The company simultaneously announced it would no longer compensate its sales force based on individual sales targets, but instead on their own skills and overall business performance.

This is a bold move by a well-established industry player. And although the initiative is well intended – to ensure that patient interests come first – its impact on the industry should be carefully considered.

Pharmaceutical companies paying practitioners for speaking to their peers has been a norm for many years. And like any convention, has been implemented honorably by some and abused by others. Rightfully so, long gone are the days of excessive corporate-sponsored junkets. In fact the pendulum has swung so far that the pens and mugs often associated with a sales call are now an abandoned ritual.

The pharmaceutical industry is one of the most heavily regulated and with very good reason. The implications are far reaching. But it is important to remember the role practitioners play within the drug development process.

The truth is that there is a mutually beneficial partnership between industry and those practicing medicine. Both may not want to admit it, but they thrive on each other. Pharmaceutical companies would not be able to address unmet medical need and run clinical trials without practitioners. And without the financial capability and market motivation of pharmaceutical companies, practitioners would not have access to many of the most highly innovative treatments of our time. The common bond? Ultimately to help people live better lives. Another common bond? Financial motivation. This is not a bad thing unto itself, so long as there is transparency and an absence of conflict of interest.

Who more than healthcare professionals understand the medical challenges people face, the limitations of current therapies or the day-to-day realities of the healthcare system? Who more than healthcare professionals participating in clinical trials better understand the safety and efficacy of the treatments they tested. Their knowledge and experience are invaluable. In fact, as invaluable as the dedication and drive of the pharmaceutical companies to support the process. It’s a true joint venture and we all profit from the outcome (sometimes financially, sometimes through the opportunity for a longer, healthier life).

When an industry is as regulated as the medical industry is, those participating acclimate. Compliance is mandatory and a positive influence. People, however, recognize not only the importance of regulation, but also its many forms – the use of only substantiated claims, a fair and balanced presentation of information, the disclosure of financial compensation. When a physician speaks to a group of peers about a drug or disease state on behalf of a pharmaceutical company, those in the audience are fully aware of the context of the presentation. When this practice is performed compliantly, everything is carefully planned – from the approved slides to even compliance training for the speaker. Little is left to chance. There is a value of having practitioners interact with their peers in this format. And the speakers in these instances deserve to be compensated for their time.

Another dynamic to weigh is the size of the market. It may sound odd at first, but consider the development of a treatment for an orphan disease. The patient populations are significantly small and practitioner involvement can become that much more important in raising awareness and providing useful information. Often in the rare disease space, myths are unknowingly perpetuated until clinical study provides more accurate insights. Pharmaceutical companies and practitioners are making these discoveries together. Further, because less is well understood about rare diseases, they do not garner the regular attention of practitioners (and until recent years, even industry). The industry/practitioner partnership is vital in order for these disease states and their treatments to stay on the collective radar.

The GSK decision is well motivated and will undoubtedly serve as a catalyst for constructive action. The key will be how, on a level playing field, to involve and educate practitioners without industry or healthcare professionals sacrificing integrity.

To see the GSK announcement, please click here.

by Jonathan D. Katz