So following Sunday’s NY Times article on bribes being paid for prescribing and my comments yesterday, the Industry Veteran let me in on some email exchanges going on round his electronic watercooler. You’ll note that he and his colleagues do not ascribe most of the blame to pharma:

This morning a friend who teaches marketing at a local university e-mailed to me an article from yesterday’s NYTimes. The subject line of his e-mail read, "Just how stupid is Big Pharma anyway?" I am forwarding to you my reply to him. I think my reply will again tweak the noses of your physician readers who consider themselves healthcare’s good guys because I believe physicians hold equal or more blame for the system of pharma-to-prescriber payoffs now coming to light.

The Veteran’s reply to his friend:

‘In this case I don’t think it’s a matter of stupidity as much as systemic incentives and culture. Whenever fiduciary gatekeepers (e.g., healthcare professionals) are inserted into a market system, there will always be an enormous temptation to influence their decision-making. It’s the same with company purchasing agents and government contract committees. From the NYTimes article, one might as easily admonish physicians as the pharma companies. If you were to speak with the marketing and sales people who develop these payoff programs, I’m sure they’d all say that the docs expect it and that if their company were to opt out the payoff system, their competitors would get all the business.I’d make the argument that over the past 40 years, the development of physicians’ unbridled avarice represents a bigger change than any supposed penchant for corruption on the part of Big Pharma. After years of attending scores of brand team meetings at all the Big Pharma companies, I’d go so far as to say that in most cases where baldfaced, baksheesh programs are developed, the driving force is usually one or more of the physicians in the room. As a curbstone assessment of their underlying psychology, I suspect that they typically seek to impress other team member with their machismo and their marketing acumen. Their payoff initiatives represent an attempt by arrogant ignoramuses to figuratively say, "What’s so tough about this marketing stuff? Hell, I’m not just a clinical nerd. I’ll show you marketing."’

A little later the Veteran copied some more correspondence into THCB

I wanted a reality check on the reply that I sent to my academic friend this morning. After sending it you (i.e THCB) I also forwarded it to an acquaintance who has worked for 20+ years in the industry. Unlike my dangerously subversive political views, his are hard core, Reagan-Bush right wing. He is, however, scrupulously honest and empirically open-minded. I pass along to you his comments in anticipation of the fusillade from the medical practitioners of negotiable virtue.

"I agree with your message back to _____: the $$ demands of MDs are just amazing. And having been in marketing most of my career (launched two products and Director of Marketing for a biotech company), I can tell you that most of the time pharma is in reactive mode. Those who are strong enough can resist the demands* of the purveyors of the Hippocratic Oath, but it is difficult for the very reason you mentioned: at some point, you know you’ll get left in the competitive dust. And one of the biggest jokes is biotech. Many, if not most of their top honchos are ex-academic researchers. In my experience the majority of them are not at all cognizant (nor do they care) about such trivialities as FDA guidelines or anything that they believe applies only to the dirty, big pharma companies. In their way of thinking, biotech is much too cerebral and pure to be lumped in with the pharma industry."

*Just look at how the cost per patient of legit clinical trials has zoomed the past 10-12 years; clinical investigators will take on any trial if the price is right.