Novartis has several divisions with thousands of reps in the U.S. and I was in The X Division. The rules set for by the FDA are same for our division as it is for every other division, as well as they are the for the entire industry.
As discussed briefly earlier, According to the FDA, for a speaker program to be considered legal it must have these criteria met:
1. The event must take place at a venue that is conducive to learning like a private room at a restaurant or banquet hall. No ball parks, fishing trips, etc…
2. You must have 3 healthcare professionals in attendance.
3. A slide show must be presented and the slide deck must be approved by the FDA, also certain portions of the lecture must include unbiased disease state education as well as a few other factors like not being allowed to show off label clinical study data.
Now there are other smaller, less intrusive requirements like how much you can spend per person on the dinner. The amount the speaker gets paid can vary greatly depending on who is speaking, to whom and how many. At Novartis we were told not to exceed a hundred bucks a person for dinner or risk raising a red flag to the FDA or OIG come expense time. So if dinner was 1500 bucks, you better have 15 names on that receipt. The honorium the speaker gets paid is anywhere from 500 bucks for the night, or as I have seen, 50,000 bucks for a conference with hundreds of attendees.
The amount, Novartis will have you think, is based on the speaker’s stature and their influence on the others in their medical community. This is a complete and utter fallacy! I REAPEAT, " COMPLETELY FALSE!!"
In reality, the selection for speakers was solely based on his or her ability to write Drug X. The more scripts the doctor wrote, the more they would get paid. We paid with flat out checks, we paid with endless dinners and lunches, we paid with all expense paid vacations for the doctor and their spouse to Europe. There was literally no set limit to how much you can pay any physician in the U.S. under this program, the sky is the limit and Big Pharma knows it, and so do the doctors that participate in these programs.
Again, on the surface the Novartis Speaker Bureau program sounds legit and perfectly acceptable, but just like the iceberg that tore open the Titanic, the real danger is in what lies beneath the surface. See, Novartis NEVER did, and STILL DOESN’T just target K.O.L.’s to become paid shills for the company, nope, not even close. They target any warm body with a pulse and a M.E. License, and even some who don’t, as I will explain. They will target any physician, doctor’s assistant, Nurse, and P.A. who according to the data, write scripts for that disease state your drug targets, which in my case was Drug X. The more drugs you wrote for the class, the more we tried to recruit you to speak on behalf of the company. It didn’t matter if you were an actual K.O.L. or a brand new Physician’s assistant straight out of night school, if you can write Drug X we recruited you as a speaker. At one time we had over 5000 Registered Speakers for Drug X doctors across America. With only 500 sales reps promoting the drug, that meant there were literally 10 doctors promoting Drug X for every one sales rep employed by Novartis. 10 to 1!
The reality is that there are maybe 50 doctors, MAYBE!, in any field of medicine that would be considered actual real life K.O.L.’s by their respective peers, not 5000! The idea that Novartis would even have the audacity to try and claim that it only targets K.O.L.’s would be quite laughable if it weren’t true. That’s exactly what they claim they are doing with their Speaker Bureau Program.
Much the way lobbyists pay our congressmen and women to pass laws that favor their respective industries they represent, Novartis pays U.S. doctors to write Novartis drugs, quid pro quo. Now Novartis wouldn’t spend billions of dollars on this program if it didn’t pay off in spades. Novartis did internal studies and shared the results with the sales reps.
The statistics showed that after a doctor had been sent on a lavish trip somewhere exotic, for an all expenses paid weekend for them and their spouse to be trained on how to speak on behalf of Novartis regarding Drug X, or any Novartis drug for that matter, their prescriptions for the drug went up anywhere from 30-50%. So naturally with these types of figures we were told make EVERYONE a speaker, and that’s exactly what we did. Hell, I had speakers that could barely speak English, giving talks every month for years and years, same talks, same physicians, same attendees! Didn’t matter, “Show me the scripts!” It was really a contest come evaluation time, how many doctors could you get registered as speakers, a contest I often won.
For some physicians that may mean a few more scripts a week, for others, especially the bigger doctors, it meant dozens of extra scripts every week. It doesn’t take a rocket scientist to do the math, it’s extremely profitable, so that’s why it is done, Period! That is exactly why as reps we were constantly under pressure to recruit more speakers, to conduct more programs, it was absolutely relentless. The company was constantly evaluating your ability to recruit speakers so much so it became a daily grind, and one that starts to become extremely stressful. After all there is only so many of these programs you can do before doctors say I been there, done that, no thanks, I won’t be attending. So inevitably management and reps decided that in order to preserve their own jobs, they start down the path of “questionable tactics” in order to not be the last one on the program list come evaluation time. Nobody wanted to hear from their district manager, “why weren’t you able to spend your speaker budget for the year?”, NOBODY! People that didn’t spend their budget were slackers, they were just lazy, so they got targeted on reviews for not being a team player and the biggest Christmas gift you got to open that year was a P.I.P. The dreaded Performance Improvement Plan. This is no joke, I witnessed this year in and year out, great reps chased out because they wouldn’t tow the company Kickback Line.
The real problem as I stated earlier, doctors are bombarded with invites to speaker programs every day from all the pharma companies out there and they simply don’t have the want, need, or desire to attend these events, and the more the reps press, the more they say no to everybody in order to not show favoritism. So as the pressure was ever increasing and the market of available attendees ever shrinking you get the following, you fudge the paperwork, and you and your manager, and even his manager is happy, a win, win, win. The only loser is the patient, whose cost of all this is built into the price of the drug they need, a drug that may be keeping them alive.
Here is how we went about cheating the system as directed by Novartis Management:
More to come........
