Whenever Dr. Victor M. Rivera diagnoses a patient with multiple sclerosis, one of the first things he does is arrange a home visit by a registered nurse such as Alecia Parks. Certified in MS treatment, Parks spends up to two hours teaching a new patient how to give self-injections and explaining the possible side effects of Rebif, a drug co-marketed by Serono Inc. (SRA) and Pfizer Inc. (PFE). She'll then call periodically to make sure patients are still giving themselves shots three times a week as prescribed. Rivera, medical director of the Maxine Mesinger MS Clinic in Houston, says more patients stay on the drug thanks to the personal attention.
While Rivera refers patients to Parks, she does not work for his clinic or a public-health agency. Her employer? Serono and Pfizer. Through an outfit called MS LifeLines, the drugmakers field full-time nurses in the nation's 30 largest metro markets to help patients start and stick with their product, which has a wholesale price of $19,200 a year, by giving them free medical advice.
For a host of reasons, not least their own self-interest, Big Pharma is staffing up on nurses. Three other companies with MS medications have on their payrolls nurse educators like Parks, who work exclusively with patients receiving drugs sold by the nurse's employer. To help out diabetes patients, Eli Lilly & Co. (LLY) marshals 600 part-time nurses across the country to conduct group classes with patients in doctors' offices, while rival Sanofi-Aventis Pharmaceuticals Inc. (SNY) just hired 70 full-time certified diabetes educators for in-office instruction. Since 2005, Hoffman-La Roche Inc. has employed a dozen experienced nurses to teach HIV patients how to use its injectable drug Fuzeon. "The feedback has been phenomenal," says Lynne Shorney, an educator who joined with Sanofi-Aventis in Dallas in November. "This is a great way to have one-on-ones with patients."
In recent years, critics of the drug industry have raked it over the coals for marketing its products too aggressively. And federal regulators have rapped companies on the knuckles for practices ranging from flying doctors to posh resorts for conferences to cutting five-figure checks to doctors for consulting services. Academics who study this sector are especially critical of sales pitches that drug companies make directly to consumers. That includes promoting drugs for complaints that can often be treated without prescription medicines.
Even as these moves have come under a microscope, however, drugmakers must discover new ways to boost sales. Simply adding more sales reps won't fly. They are already so numerous that physicians are now holding sales visits down to an average of 90 seconds.
In such a context, the nursing programs are attractive to the drugmakers because they help hold patients to the recommended drug regimen. Patients with progressive illnesses such as MS and diabetes are supposed to stay on medicines for their whole lives, but many quit because they feel no symptoms, or because the therapy adds to their discomfort. Jaideep Bajaj, a Princeton (N.J.) managing director at medical marketing consultant ZS Associates, estimates that this sort of patient noncompliance may deprive the drug industry of $30 billion in sales each year. The nurses, in short, serve companies and patients alike. "In principle, this sounds like a win-win situation," says George J. Annas, a professor of health law and bioethics at Boston University's School of Public Health.
TOO MUCH INFLUENCE?
Admittedly, the nurses talk up their employers' products, both to the patients and to medical personnel in doctors' offices. And while they are encouraging worthwhile treatments today, some watchdogs worry about overmedicating patients if these programs are expanded to include many different drugs. Watchdogs also wonder if hospitals can keep up with drugmakers on salary and benefits. In a current help-wanted ad, one drug company is offering $72,000 a year, plus benefits that include stock options and a car allowance, for nurses trained in treating kidney disease. That is 50% more than registered nurses make on average.
Will the efforts of nurse educators create a new wedge of influence for drug marketers? Not necessarily. They can't make diagnoses or write prescriptions. And they say their links to drugmakers are clear from the get-go. Patients are mostly grateful for the extra attention. Even those with life-threatening diseases often cannot get individual instruction from their doctor or other medical professionals. Insurance companies offer some programs, but patients must often pick up part of the tab. "It's one of the ironies of our health-care system that the only people who seem to care about compliance are not the health insurers or the providers but the drug companies that want to sell their drugs," says Matthew Holt, a health-care consultant in San Francisco.
Time-pressed doctors also appreciate the drug industry's help. Since they can call in the nurses at no expense, physicians do not have to hire or train their own nurses to instruct and check up on patients with chronic diseases. "All things being equal -- the same efficacy, the same costs -- I would go with the pharmaceutical company offering this service," says Dr. Walter "Duane" Hinshaw, who runs a family clinic in Garland, Tex.
Serono, a Swiss biotech company based in Geneva, and Pfizer started with a pilot program in 2004, two years after Rebif was approved by the Food & Drug Administration. The partners have since built up a staff of 35 licensed nurses screened by a subsidiary of Quintiles Transnational Corp., a Research Triangle Park (N.C.) pharmaceutical-industry contractor that also assembled Sanofi-Aventis' nurse-educator team. James E. Hoyes, Serono's executive vice-president of neurology, says he hasn't heard any complaints from patients about receiving instruction from nurses on a corporate payroll. Indeed, he says patients generally report that the nurses give them more time and better care than their own doctors do.
Jason Novak, 29, of Houston, who was diagnosed with MS when he was 14, has been getting help from Parks since Rivera put him on Rebif two years ago. Novak says he has always known that Parks works for MS LifeLines, which is owned by Serono and Pfizer. Does that matter? Not at all, he says. "Everyone is an employee of someone."
By Michael Arndt