"I think everyone is aware of the ABPI codes, but even if we did take notice of them, there were always ways of getting round them. We used to set up mock conferences, college reunions, or pay for doctors to go to the States for a conference, but really it was just a holiday. I always hit my targets, but it made me feel grubby and cynical about GPs. But a lot of GPs will either not see reps at all, or will take them with a pinch of salt. These were always the ones I preferred.

"The GP I see now as a patient doesn't see reps at all. I made sure of that before I joined the surgery. As someone who used to be a rep, I find that reassuring

First, I left the industry over 12 years ago so what I’m about to say may not be relevant – although a piece of research I did recently suggests that what I learnt hasn’t changed much Second, that none of the companies I worked for exist any longer so it would be difficult to prove what I’m about to say and may not be applicable to any current company – on the other hand as most companies don’t necessarily publish everything they do its very hard to say that it doesn’t!!!!)

I learnt that the key to the Pharmaceutical Industry’s success is control over information

"Control one" - in doing clinical trials you need to choose your investigator carefully, you need an opinion leader and then you need to tie them up in a contract so tight that they cant publish (or say) anything about the results of the trial good or bad without your agreement first.

"Control two" - you don’t ask a research question you don’t want to know the answer to (usually the one you don’t ask is “is your product as good as or better than the current gold standard?”)

"Control three" – when teaching reps about new clinical trials you draw out quotes to highlight the good parts and show them how to skip over the criticisms/flaws of the trial (like its relevance to the wider population)

"Control four" – you don’t publish anything in full that doesn’t show benefit or you only publish abstracts which aren’t peer reviewed (yes I know its obvious now but 12 years ago it wasn’t).

I also learnt that strategic marketing can make all the difference – a good plan of action is essential – by pin pointing strategically the opinion leaders in secondary care (usually Consultants) you can have an impact on the prescribing of up to 150 GP’s (or more if it is a teaching hospital) and if you offer a product at a ridiculously low cost to Hospitals but charge a premium in primary care you can make a huge difference to your profits.

The key point for companies is increase the market share – your competitors gain but so will you … ”penetration of new drugs is greater than gap perceived.” MacGavock et al BMJ Aug 93 and also …“success depends more on creative marketing than innovative research” Ill-advised rep from a pharma company

I also learnt having been involved in a couple of drug withdrawals that - today’s wonder drug is tomorrow’s problem.

Last but not least I learnt cynicism – no matter how much “idealism” there maybe in individuals in the pharma industry and no matter how companies tell you their researchers are altruistic and on a mission to “save lives” – “companies” are there to make a profit and individuals research/projects will only be taken up if it is likely to be profitable. (Note the lack of investment in research for topical or rare diseases prevalent in third world nations and the desire of companies to medicalise certain conditions that they can treat symptomatically but not cure – after all there is no comparison in the profit gained in curing conditions compared to the profit in long-term treatment of symptoms)

Price tricks – such as changing packs from 28 days to 30 days, the development of modified release preps and purified optical isomers as patent extenders

Product switches with accompanying access to practices confidential information and more importantly doctors prescribing preferences – remember the key point for companies is to increase the market share – ”penetration of new drugs is greater than gap perceived”

The acceptance of “freebies” and what the true cost might be – there was one particular case that stands out in my mind, a practice (fundholding) had made significant changes to generic prescribing except for one product. When asked why (just out of interest) they happily declared the particular company that produced the branded product had been very supportive providing training for the practice. When we pointed out that this gesture had cost them £26,000 over and above the cost of the generic equivalent in the previous 12 months which could have funded a number of other their services, the switch was quite dramatic – the company were supportive but not that supportive!

Personally I am committed to the principles of NFL and where possible don’t see reps or attend “sponsored” events. The difficulty working in the NHS at the moment is there is so little money for developing new ideas and providing education that we are becoming dependent on finding “other” money to finance these things. The key I believe, given completely turning our back on Pharma money or events/initiatives involving Pharma companies is not always possible in this new cash strapped world in which we live, is to ensure any dealings with the Pharma Industry are transparent and open – using the old legal adage slightly amended – being independent as well as being seen to be independent and that money is only accepted for non-promotional events.