Proof That Aggressively Courting (And Paying) Doctors Changes Prescribing Patterns -- Sunday's New York Times

This story does not involve any New Merck (or legacy Schering-Plough) product. However, it does offer concrete proof of what we've all strongly suspected for decades: At least in Nevada, market share can be driven by courting doctors. [In Las Vegas: From 87% share, to less than 1% share in under three years -- for Boston Scientific, with an essentially mirror image on share trend, under 2% to over 95%, enjoyed by Biotronik. Astonishing!] Click to enlarge:



Aggressive courting of doctors, and in some cases, paying them via both hard dollars and softer ones -- trips and honoraria -- will shift prescribing patterns. Bank on it. Do go read it all, at The New York Times -- but by 2013, Biotronik will be required to disclose to whom, and exactly how much, it is paying -- in these clearly suspect arrangements:

. . . .The company’s hold at the hospital center is all the more striking because its implants were not used there before 2008, and its national share of the heart-device market barely exceeds 5 percent, according to industry estimates.

The devices’ sudden popularity was apparently not left to chance. In mid-2008, Biotronik hired several cardiologists who implant heart devices at the Las Vegas hospital as consultants, paying them fees that may have reached as high as $5,000 a month, company documents reviewed by The New York Times indicate. Those doctors then did the rest. Meanwhile, the hospital’s chief executive said she never asked during the hospital’s switch to Biotronik whether those physicians had a financial connection to the company.

A federal investigation is examining Biotronik’s marketing and sales practices, according to a company e-mail. While a lawyer for Biotronik confirmed the inquiry, he declined to elaborate. . . .

Biotronik also declined to disclose what it had paid to Dr. Resh and his partners. The switch by Dr. Resh and his colleagues to Biotronik soon paid big dividends for Biotronik and Western Medical, documents indicate. In August 2008, Biotronik sold $1 million worth of devices in Las Vegas, company documents show. That Biotronik document also described University Medical Center as “our #1 implanting hospital.”

To generate sales, Biotronik and Western Medical also courted physicians like general cardiologists and others who referred patients in need of heart devices to implant specialists like Dr. Resh and his colleagues at Nevada Heart and Vascular. And not long after Biotronik retained those physicians, a competing implant group in Las Vegas saw referrals from a local general medical practice dwindle, said the head of that implant group, Dr. David L. Navratil.

Today, it is impossible to say how, or if, the marketing practices of Biotronik or Western Medical have changed since early last year when the device maker received a federal subpoena. . . .

As I say -- do go read it all.