The following was retrieved from www.pharmexec.com.
Mr Reidy was fired after his book was published by Eli Lilly.
While admittedly Jamie slacked his way though what was suppose to be a vocation, he did illustrate one point rather clearly- that pharmaceutical representatives are not needed at all:
Bad Rep? A Q&A with Jamie Reidy
By Ron Feemster
Jamie Reidy wrote the book on how to slack off as a pharma sales rep. Now, the sales manager's nightmare unveils more scams, sizes up the corporate selling culture—and reveals what finally made him care.
TO HEAR JAMIE REIDY TELL IT, HE'S ALWAYS BEEN THE SORT of slacker who succeeds. He did enough work to get decent grades in high school and at Notre Dame University, which he attended on an ROTC scholarship.
After graduation, First Lieutenant Reidy spent three years on easy duty, much of it in Japan, where he chafed at military discipline but stayed out of bunkers, except on the golf course.
When force reductions allowed him to leave the Army early, he jumped at the chance, even though he had no idea what his next job would be. Which is how he happened to be unemployed, living at his parents' New Jersey home, and answering the phone in boxer shorts when a Pfizer recruiter called.
Jamie Reidy
Reidy stumbled into a job at the world's largest pharmaceutical company, seduced more by the $40,000 starting salary than any desire to help patients. What he discovered there was an oddly
familiar military culture with rigorous training, rigid sales scripts, and an unyielding requirement to call on 40 doctors a week.
But he soon realized that no one checked up on him. He worked from home, and no one knew if he started his day at 10 a.m. or even went AWOL—as long as he made his quota and enough doctors signed for samples every week.
Within months, he had found a new way to spend weekdays at home in his boxers: He launched on the less-than-sterling career he chronicled in his tell-all book, Hard Sell: The Evolution of a Viagra Salesman. He started work late and often took off at three in the afternoon.
He persuaded doctors to sign undated sample receipts, which allowed him to fake sales calls. Once, he traveled to London, England, without taking vacation time, even pretending to be in an Indiana parking lot when he returned his boss's calls.
Excerpt from Hard Sell
Of course, that only worked because he was good at selling pharmaceuticals. To his own surprise, he was promoted to Pfizer's new urology division, where he eventually—based on sales recorded two months after he quit—became the number-one Viagra sales rep in the nation.
In October of 2000, Reidy began a second career in pharmaceutical sales, which he took much more seriously. He often worked a full day selling oncology drugs for Eli Lilly, where he and his sales partner also reached number one in the country.
The company promoted him to oncology sales trainer—his favorite job in pharma—one he likens to the roving batting instructors of minor-league baseball. Lilly fired him when Hard Sell was published in March of this year.
His next book, about the Lilly oncology years, will be called Hard Feelings. Reidy lives in Manhattan Beach, California. He is writing a screenplay, and closing a deal for the movie rights to Hard Sell.
First, let's talk about the slacking. Are there stories about skipping work at Pfizer that aren't in the book? Could this book have been 500 pages long?
There are other stories I left out. Some of them I just forgot about. Like, I was at an Army reunion in Arkansas and my friend said, "What the hell? How come you didn't tell the story about the flowers?"
I had completely forgotten about our first Army reunion in Little Rock, Arkansas. It was a Friday and I was playing hooky, but I sent flowers to an office to celebrate their grand opening. I called the florist in Modesto, California, and placed the order there. So of course it looked like I went in the flower shop and ordered.
You went to Arkansas from California, and to feign being at this grand opening you called the local flower shop and had them deliver flowers? How did that go over? Didn't the doctors see through that?
No, they just thought: "That's so cool. Jamie Reidy sent flowers." My bosses never knew. I mean, they knew that I sent flowers. Because they had a sales receipt.
What have your friends in the industry said about your book?
One of my friends from Lilly called me up and said, "Reidy, You hit it on the nose, man. This book is hilarious. It's like reading my journal." And then he called me a bunch of names and said, "You ruined it for us all." He meant that nobody can work only 20 hours a week anymore.
I also heard from a district manager at another company who mailed me ten copies of my book to sign for everybody on his team. He wanted to show them that he knew all the tricks now, and that they shouldn't try to get away with anything. But he also said he thought there were some sales gems in there that they could learn from.
So are reps going to have to work more than 20 hours a week? How much has the job changed?
I've heard from people at Pfizer that they're totally cracking down on everything now. They are being a lot more vigilant and checking things out, possibly looking for different receipts. And then there's another old manager trick, which I hear they've used a couple times since the book came out. The manager calls you at lunchtime on Tuesday and says, "Hey, where are you going to be at one o'clock? I want to meet up with you." That is the ultimate panic attack right there.
You seem to have gone your own way on selling, too, by rejecting some of the regimented scripts and detailing procedures that Pfizer used, developing your own relationships with doctors, and trying to think on your feet. As far as you know, how do other people feel about doing things the company way?
I think there are two reactions. I think the public reaction is always, "Come on, we're grown-ups. We're smart, educated people. We can do our own thing. Don't baby us."
And people really push back on the script outwardly. But I think for a lot of people, the script makes the job even easier because you know exactly what you're supposed to say. And so now you've got this job where you're already programmed and you just—the phrase is "show up and throw up." You just regurgitate the sales pitch and the data that you've been taught to share.
And how well does that serve the company?
As my first boss always said, "Enthusiasm sells." And I would add that conviction sells. So if Pfizer or any company has spent thousands and thousands of dollars to come up with the marketing plan and the sales pitch, and you then take that and enthusiastically share it and don't make it sound like it's some canned spiel, that works.
If you can sort of flavor it a little bit, I think it helps the company, because they know exactly what they want us to say. If they have their soldiers talking the company line and the company's research is correct, then that should further sales.
Even when there are three or four people calling on the same doctor, talking about the same product and giving the same basic speech?
Now we run into problems. That's where doctors have caught on over the years and said, "Hey, this is all canned." Say another rep and I both call on Dr. Smith, and this Dr. Smith doesn't really pay attention to me. He's sorting his mail as I'm giving him my pitch.
And then the other rep comes in two weeks later and the doctor's got more time and he's listening to the detail and he's like, this all sounds really familiar. And I come in two weeks later and he says, "Wait a minute. This is the same stuff that other guy just told me."
That's when we start to look like storm troopers. I'm not a resource for that doctor, anymore. I'm just like everybody else. I'm the UPS guy dropping samples off. I'm a well-dressed caterer with lunch for the nurses.
So where is the solution? You were on the front lines. What do you think would work best?
I think that they should reinstate our ability to take doctors golfing, and to Laker games, and to Celine Dion shows. But, of course, they had to do away with that to make it look like we weren't buying the doctors' love, which is what we were doing, and what I am advocating.
Are you serious?
In all seriousness, I think the companies need to cut back the sales force by half. When I started, there were about 35,000 reps in America. And now I read there are between 90,000 and 100,000. Doctors are just fed up.
We need fewer reps, because now the value of every rep gets diminished. Once the doctor figures out that John, Jamie, Jenny, and Sheila are all going to tell him the same thing, then none of us have any value anymore, even though I used to be a valued source to him.
Now we're all the same and it doesn't matter which rep he sees. It actually doesn't matter if he sees anybody, because they're all going to give him the same company-sponsored line.
If you talk to reps who have been around for 15 or 20 years, they all lament the loss of the old days when they were able to sit down with a doctor and discuss the merits of each drug in treating the 57-year-old Hispanic woman with diabetes and a history of heart disease in her family. Reps were much more of a resource back then. Now we're just extensions of multibillion-dollar companies.
Do senior reps feel like they have to play this diminished role to keep their jobs?
The old guys question the mindset that you have to get, say, ten signatures a day for samples. There's that pressure when your boss comes back to you and reminds you that you only had 38 signatures last week. It drives the old guys crazy. They say, "Look, I'm a sales guy. My job is to drive sales. I'm not a sample guy."
There was a great story at Lilly. We didn't even have samples in the oncology division, but Lilly started pushing us to make more sales calls. We had to make five a day, which doesn't seem like anything.
But in oncology you've got to share data all the time, so you wait around for hours if you need to see somebody. So probably the most seasoned rep in the Lilly oncology division picks his boss up in the morning at 8:30 for a ride-along. He goes to a big office to start his day and has good discussions with five doctors. Then he drives the boss back to his hotel.
And the boss says, "What are we doing? " The rep says, "Oh, I'm done. All you care about is that I see five doctors. I just saw my five doctors." He wasn't being a smart-aleck. He was saying, "You won't fire me for this. I want to dramatically demonstrate what's going on at this company."
So the boss calls headquarters and says, "We've got a problem. What am I going to tell the guy? He's right. That's all we're asking for."
What did the company do?
Let's say they shifted focus. They said, "Listen, that five is a goal. We would like you to strive for that, but by all means don't avoid your biggest customer just because it always takes three hours and you have to get your five calls a day." So it was actually an awesome wake-up call. The reps of the country rejoiced.
You worked as a roving sales trainer, so you got to see a lot of different reps interact with doctors. How did you come to see the job differently?
The really interesting observation for me as a trainer—the second guy in the waiting room—was how in-the-way drug reps are, and how much we stand out. Patients know exactly what we're doing. I guess I sort of blocked it out as a rep, all the dirty looks you get from patients. It was really an eye-opener for me. I just felt, wow, we don't belong here.
Imagine you're in the doctor's office with your mom who has breast cancer. The doctor's an hour late, and while you're waiting two well-dressed people walk in with bags of M&Ms and chat it up with the nurses. Then they go back and they're back there for a half hour. You know why the doctor is late. And that gets very upsetting for people, especially when you're dealing with something as sensitive as cancer. Man, I'd be crawling in my skin to get out of there.
Another thing struck me about your book. On the one hand, you were the slacker guy with an ironic distance from his job. But on the other hand, you got pretty excited about your products. Where did that come from? How much of it was trained into you?
I think it came from the brainwashing that happens in training. And I got it more so at Pfizer than I did at Lilly, because the Pfizer training staff was so impressive, and the people they kept bringing in to speak to us were so impressive. They keep rolling out the next drug, which is the best, and here is why. So you learn everything—or at least you think you learn everything—about your competing drugs.
I will still to this day argue why Zithromax was the best antibiotic in America. I can still give you the five reasons why it's better than Biaxin. And I will argue to my dying day that Zoloft was a better drug than Prozac and Paxil. And don't even get me started on Zyrtec and Claritin.
But the great thing is, if you talk to people from Lilly, they'll say that Prozac was a way better drug than Zoloft, and boom, boom, boom, here's why. And the Biaxin people say the same thing. So I think it's just like you always think your school team is better—whether it really is or not. You get that spirit going, combined with a little data to support your position, and you've got a pretty strong start.
That might explain why doctors take much of what companies say with a grain of salt. Doctors say they want studies that were not funded by the pharmaceutical industry. As drug reps, you're only getting the data the company gives you, right?
Correct. Here's an interesting thing I never knew—and if you want to talk about being na and drinking the Kool-Aid, go ahead—I never knew that studies are done, but we don't see the results. That was news to me, and I don't know if I'm the lone idiot who didn't realize that. But to find out that all these trials were done, and the results were not released, that was certainly an eye opener.
But there was more than blind belief involved, wasn't there? At some point after you were hired at Lilly, at least, you started wanting to do your job: your real job of selling doctors and solving patients' problems. What changed?
I'll tell you what changed. When you walk into an oncology office, and you're in the back looking at patients hooked up to chemotherapy IV tubes, and you're listening to people with lung cancer cough, and you see people with no hair, and they're all shriveled up. You say to yourself, you know what? If you really believe in your drug, it's a good thing to get out there and try to help these patients. It's a very powerful experience to stand in the back of an oncology office.
Would you go back if you could, assuming that another company would hire you tomorrow?
In order to stay true to myself, I have to give this writing thing my full attention. I can be so easily distracted. But if I went back, I would only work in oncology.
That's really where it's at. You deal with the ultimate situation and try to discuss life and death. Once you've worked with oncologists, and seen what they're dealing with and the level of data they get into, then you really are an expert, and it's a lot more compelling to go to work every day.
So what would it have taken to get you to do your job at Pfizer?
I don't really know. It would have had to be something compelling like that, because it wasn't money. Money doesn't drive me. People who sell antidepressants will say, "Hey listen, that patient could have killed himself. I might save somebody's life." Okay, that's two iterations away. Someone went on my drug and lived longer directly because of it. Now that's something.
A breast cancer patient in Hawaii hugged me. And she thanked me. You would have thought I invented Gemzar. That was something I'll never forget.
Do you miss being a drug rep?
I certainly miss helping patients, because in spite of all the jokes I make in the book and all the heat that the industry takes in the media, you do get to help patients. Whether the doctors switch from Paxil to Zoloft and the patient does a lot better, or the patient goes on your lung-cancer chemotherapy and makes it to her granddaughter's wedding, you can really affect somebody's life. I miss that.
I find that I really miss the day-to-day human interaction of walking into the offices that are mine. I used to feel kind of like the TV character, Norm, when he walks into the bar at Cheers and everybody says, "Norm!"
You also started your career as a writer while you worked as a sales rep at Lilly. How long did it take you to write the book?
It probably took me three years but—well, it won't be a surprise since you read the book—I was really lazy about it. I would put it down for two months at a time. So it's tough to say with all the starts and stops how long it really took me.
Do you miss that lifestyle? Having the rep job with a regular paycheck, and writing the book in your spare time?
I do. Being a pharmaceutical salesman is the greatest day job in the world. Every aspiring artist, musician, and writer should become a drug rep, because you make a lot of money and you don't have to work. You know, you can get away with working 20 hours a week.
Jamie Reidy Relaxes under the pier For most of his career in pharma, Reidy focused on documenting work he didn't do. Now he goes to the beach without faking a sales call.
Jamie Reidy
Excerpt from Hard Sell
Monday, June 29, 2009
Tuesday, June 9, 2009
Reciprocity
Salespeople's Renging Orientation, Self-esteem, and Selling BehaviorsShare
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Salespeople’s Renqing Orientation, Self-esteem, and Selling Behaviors: An Empirical Study in Taiwan
Ming-Hong Tsai,1 Shu-Cheng Steve Chi,2 and Hsiu-Hua Hu3
1University of California, 11140 Rose Ave. Apt 307, Los Angeles, CA USA
2Department of Business Administration, National Taiwan University, 1, Sec. 4, Roosevelt Road, Taipei, Taiwan
3Department of International Business, Ming Chuan University, 250, Sec. 5, Chung Shan N. Road, Taipei, Taiwan
Ming-Hong Tsai, Phone: +1-310-7794312, Email: mtsai@anderson.ucla.edu.
The purpose of this study was to investigate how salespeople’s renqing orientation and self-esteem jointly affect their selling behavior.
Design/Methodology/Approach
Data were obtained from a survey of salespeople from 17 pharmaceutical and consumer-goods companies in Taiwan (n = 216).
Findings
Salespeople’s renqing orientation (i.e., their propensity to adhere to the accepted norm of reciprocity) compensates the negative effect of self-esteem on their selling behaviors, such as adaptive selling and hard work.
Implications
Our study results underscore the critical role of the character trait of renqing orientation in a culture emphasizing a norm of reciprocity. Therefore, it would be useful to consider a strategy of recruiting salespeople with either a high self-esteem or a combination of high renqing orientation and low self-esteem.
Originality/Value
The existing literature of industrial/organizational psychology and marketing primarily relies on constructs that are derived from Western cultural contexts. However, the present paper extended these literatures by investigating the possible joint effects of self-esteem with a trait originated from the Chinese culture on salespeople’s selling behaviors.
Networks of informal relationships are one of the major characteristics of business and social activities in Asian regions such as Mainland China, Hong Kong, Korea, Japan, and Taiwan (Kienzle and Shadur 1997; Gerlach 1987). Consequently, organizational members often need to make use of their interpersonal relationships to improve job performance. Salespeople, in particular, consistently interact with customers, and their sales performance largely depends upon how successfully they translate interpersonal relationships into actual purchases.
The now well-known Chinese term guanxi describes interpersonal dynamics that draw on a web of connections with the purpose of securing particular favors in personal relations (Park and Luo 2001). The Chinese culture of Confucianism has institutionalized this “norm of reciprocity” into everyday lives. That is, personal guanxis describes an individual’s particular, reciprocal exchanges with another person (e.g., a relative, a friend, a customer, a business partner, a colleague, or a boss/subordinate, etc.).
Theorists have suggested that it is the anticipation of repayment that motivates Chinese people to offer one another favors (e.g., Hwang 1987). For instance, a Chinese person seeking a business opportunity may activate his or her guanxi networks in the hope that an earlier favor paid to someone else will generate new opportunities.
Given that every Chinese person may exchange favors under an accepted cultural norm, both the giver and the recipient of favors expect the other party to continue these reciprocal exchanges in the future. As an illustration, during special occasions such as the Chinese New Year, weddings, birthdays, or festivals, Chinese people may feel duty-bound to give presents to individuals of priority within their guanxi network. This gift-giving is a large part of guanxi-building and maintenance (Hwang 1987). Put another way, maintaining networks of guanxis implies continual exchanges of favors (Chen 1995).
Renqing Orientation as a Personality Trait.
Nevertheless, not every Chinese person follows this cultural norm in the same manner. Some may have a higher tendency of giving gifts to those who have helped them in the past, for example, but others may not. Recent articles by Cheung et al. (1996, 2001) proposed and showed that Chinese people act differently when facing decisions about exchanges of favors.
Cheung et al. (1996, 2001) termed the degree to which a person abides to rules of reciprocity regarding favor exchanges as “renqing orientation”. They also developed a personality inventory—the Chinese Personality Assessment Inventory (CPAI)—to examine such individual differences among Chinese people (Cheung et al. 1996). Renqing was one of the three personality constructs chosen in consideration of Chinese culture (the other two were face and harmony). Their study findings evidenced the psychometric properties of CPAI and its reliability and validity.
To date, only few studies have utilized the renqing orientation construct and examined its effects on other variables. One study by Chan (2002) found that tutors’ renqing orientation positively affected students’ perceived teaching effectiveness, such as motivation, presentation, and attitude, at a distance-learning institution in Hong Kong. Zhang and Bond (1998) discovered a positive relationship between college students’ renqing orientation and their filial piety. In their findings, students with a high renqing orientation had a high tendency to provide for the material and mental well-being of their aged parents, in order to ensure the continuity of the family line, and to perform ceremonial duties of ancestral worship.
Linking Renqing Orientation to Selling Behaviors
The present study proposed a direct link between salespeople’s renqing orientation and their selling behaviors. We followed Weitz et al.’s (1986) classification of selling behaviors. They identified two general types of selling behaviors: adaptive selling and hard work (see also Levy and Sharma 1994; Sujan 1986; Weiner 1980; Sujan et al. 1994).
Adaptive Selling
The first type of selling behavior is “adaptive selling”, or “the altering of sales behaviors during a customer interaction, or across customer interactions, based on perceived information about the nature of the selling situation” (Levy and Sharma 1994, p. 39).
Research has shown that excellent sales representatives often alter their selling behaviors on the basis of situational considerations (Sujan et al. 1994; Leong et al. 1989). That is, these salespeople will try to understand the need of their customers, select the best sales strategies for these customers, and recommend products that satisfy these customers’ particular needs (Weitz 1978; Weitz et al. 1986; Lambert et al. 1990).
We proposed a direct relationship between salespeople’s renqing orientation and their degree of adaptive selling. Specifically, we suggested that salespeople with a high renqing orientation are especially sensitive to their customers’ needs. Thus, relative to salespeople with a low renqing orientation, it is likely that salespeople with a high renqing orientation will be more flexible in response to the needs of individual customers in expectation that these customers will reciprocate attentiveness with purchases.
Hard Work
Another type of selling behavior, “hard work” describes “the overall amount of effort that a salesperson devotes to his or her work” (Sujan et al. 1994, p. 40). Empirical evidence has shown that high-performing salespeople are usually those who work very hard at their jobs (Churchill et al. 1985; Sujan et al. 1994). Sujan et al. (1994) suggested that these successful salespeople tend to be persistent at selling, devote a great deal of effort to their work, and continue their selling effort even in the face of failure.
Again, we proposed that salespeople with a high renqing orientation will be sensitive to the giving and receiving of social favors based on the implicit social norm (Luo 1997). These salespeople are inclined to work hard to understand and satisfy the needs of their customers. That is, we proposed that individuals with a high renqing orientation tend to work hard to meet their customers’ needs. Therefore, relative to salespeople with a low renqing orientation, it is likely that salespeople with a high renqing orientation will devote more effort and be persistent in satisfying the needs of their customers, expecting these customers to reciprocate their efforts with purchases.
In sum, a high renqing orientation elevates a salesperson’s motivation to cultivate customer relationships, be more flexible in meeting customers’ needs, and work hard to make sales. These salespeople have a high expectation of receiving payoffs for their efforts. That is, they believe that if they invest time, effort, and resources in building and maintaining relationships with customers, their efforts will translate into purchases. Based on the preceding discussion, we proposed the following hypotheses:
Hypothesis 1 A positive relationship exists between a salesperson’s renqing orientation and his or her adaptive selling.
Hypothesis 2 A positive relationship exists between a salesperson’s renqing orientation and how hard he or she works at selling.
The Moderating Role of Self-esteem
In addition, we proposed that the positive effects of salespeople’s renqing orientation on their selling behaviors are likely to vary depending upon their levels of self-esteem. Scholars have defined self-esteem as the degree to which people perceive themselves to be capable, significant, and worthy (Coopersmith 1967; Marsh 1993; Wells and Marwell 1976).
Relative to people with low self-esteem, individuals with high self-esteem tend to access more positive thoughts about themselves after a failure and tend to maintain a positive focus (Taylor and Brown 1988). Additionally, when compared with those with low self-esteem, individuals with high self-esteem are better able to manage stressful situations and perceive the work environment as controllable.
Sager (1991), for example, discovered a negative relationship between the self-esteem of salespeople and their level of job-related stress. Similarly, Burton et al. (2005) found that individuals with higher self-esteem were more likely to respond to a perceived injustice aggressively.
This study sought to investigate the possible joint effects of self-esteem (a core concept in a person’s self-perception) with renqing orientation (a trait that is crucial within Chinese culture) on salespeople’s selling behaviors. The examination of such effects is critical because, on the one hand, it may enhance our understanding of the boundary condition of the effects of self-esteem on individual behaviors and, on the other hand, the dynamics of self-esteem with another trait that is more relevant to the embedded culture.
We suspected that, for salespeople with high self-esteem, the relationship between renqing orientation and selling behaviors would be relatively weak. On the contrary, for salespeople with low self-esteem, the relationship between renqing orientation and selling behaviors is relatively strong. We borrowed Brockner’s (1988) concept of “behavioral plasticity” to explain this proposition.
According to Brockner (1988), people respond differently to external factors, such as influence attempts from other people. Brockner suggested that individuals with low self-esteem tend to be more “behaviorally plastic”, or reactive, than those with high self-esteem. Research findings have supported this behavioral plasticity hypothesis in the realm of feedback effects, peer–group interaction, and workplace socialization (e.g., Ganster and Schaubroeck 1991b; Kahn and Byosiere 1992). In addition, individuals with low self-esteem are highly uncertain about their own work attitudes and behaviors (Brockner 1988), and they have a strong need for approval from others (e.g., superiors or customers).
As a result, they often rely on others’ actions and suggestions to perform their own job activities (Pierce et al. 1993). Samad (2007), for example, found that, for low self-esteem employees, having an open personality had an insignificant effect on psychological empowerment. That is, low self-esteem individuals would not be empowered even by a high degree of openness, but would prefer to rely on directions from above.
It is likely that salespeople with low self-esteem and high renqing orientation make use of their social connections to solve their problems rather than relying on their own abilities and skills. According to Hobfoll and Leiberman’s (1987) arguments, a person with plenty of social resources will be able to make effective use of these resources when the situation demands them. Consequently, low self-esteem salespeople will make a better psychological adjustment, if they utilize their social resources when facing misfortune (Baumeister 1998).
Accordingly, renqing orientation was likely to have a greater impact on the selling behaviors of those with low self-esteem and a smaller impact on the selling behaviors of those with high self-esteem. Salespeople with high self-esteem often are adaptive in stressful situations and engage in active coping and planning (Pierce et al. 1993). Therefore, their selling behaviors emerge from more than just a concern for the norm of reciprocal exchange.
On the contrary, among salespeople with low self-esteem, those with a high renqing orientation are more willing to engage in selling behaviors for the purpose of winning customers’ trust and purchases. They are motivated by the norm of reciprocity, rather than a sense of their own ability, and expect their favors to generate high sales performance. Therefore, we proposed the following:
Hypothesis 3 Self-esteem mitigates the positive relationship between the renqing orientation of salespeople and their adaptive selling.
Hypothesis 4 Self-esteem mitigates the positive relationship between the renqing orientation of salespeople and their hard work in selling.
The participants in this study were salespeople at 17 pharmaceutical and consumer-goods companies in Taiwan. Survey questionnaires were distributed to participants through the companies’ human resource offices. The participants were told that the purpose of the research was to better understand salespeople’s behaviors; they were assured that the study was anonymous and that only aggregated data would be reported.
Each participant completed the questionnaire and returned it in a sealed envelope to their company’s human resource manager, who then forwarded it to the researcher. Of the 400 questionnaires distributed, 216, or 54%, were returned. About two thirds of the participants (67.6%) were male. The average age of participants was 35, and they had an average of about 9 years of selling experience.
Measures
Renqing Orientation
We used Cheung et al.’s (1996) 11-item scale to assess salespeople’s renqing orientation. A sample item is: “When dealing with institutions, things can work out more smoothly through the connections of friends working inside”.
The reliability and validity of the renqing scale have been examined in several studies. Its internal consistency coefficients (Cronbach’s alphas) ranged from .55 to .74 (Cheung et al. 1996, 2003). Its test–retest correlation coefficients were statistically significant (Cheung et al. 1996). The convergent validity of the scale was examined by comparing the patterns of its correlation coefficients with the Minnesota multiphasic personality inventory (MMPI-2; Butcher 1996; Cheung and Zhang 2004).
The scale demonstrated reasonable patterns that were associated with the MMPI-2 scales. Specifically, renqing orientation was negatively related to “conversion hysteria” and was positively related to “schizophrenia” and “hypomania” in the MMPI-2 clinical scales. Cheung et al. (2003) further examined the clinical validity of the CPAI in two studies that included 167 male prisoners in Hong Kong and 339 psychiatric patients in mainland China. According to their logistic regression results, the renqing scale was a useful tool in distinguishing psychiatric patients from the normative sample in China and in distinguishing male prisoners from normal male respondents in Hong Kong.
Self-esteem
We used Rosenberg’s (1965) 10-item scale to assess salespeople’s self-esteem. A sample item is: “On the whole, I am satisfied with myself”. Higher scores indicate a higher degree of self-esteem.
Adaptive Selling
We used Spiro and Weitz’s (1990) 12-item measure of adaptive selling to assess salespeople’s adaptive selling. A sample item is: “I vary my sales style from situation to situation”.
Working Hard
We used Sujan et al.’s three-item measure (Sujan et al. 1994) to assess salespeople’s degree of hard work in job-related activities. A sample item is: “I work untiringly at selling a customer until I get an order”.
Among our measures, the Renqing orientation scale was developed in Mandarin Chinese, while the other scales were originally written in English, translated by the researchers into Chinese, then back-translated into English (Brislin et al. 1973) to assure their correct meanings. We used a six-point Likert scale (6 = strongly agree, 1 = strongly disagree) for all of the above scales, asking the respondents to indicate their degree of agreement.
In addition to these measures, we asked respondents to report their sex, age, education, and past selling experiences (in years) as control variables. Research has shown that these variables may be related to salespeople’s selling behaviors (e.g., Bernard 1981; Goolsby et al. 1992; Levy and Sharma 1994).
We tested the hypotheses using multiple regression analysis. We mean-centered the predictors (i.e., renqing orientation and self-esteem) before multiplying them in order to minimize multi-collinearity between the interaction term and its components, as recommended by Aiken and West (1992). In the regression models, we first entered the four control variables (sex, age, past selling experience, and education).
In our results, Hypotheses 1 and 2 were not supported (see Table 2). That is, renqing orientation did not have a significant positive relationship with adaptive selling and hard work (ps > .05).
Hypotheses 3 and 4 proposed that self-esteem mitigates the relationship of renqing orientation with adaptive selling and with hard work. As shown in Table 2, we found significant and negative coefficients of the renqing orientation × self-esteem interaction term on adaptive selling (β = −.16, p < .05) and on hard work (β = −.18, p < .01).
We examined these interaction effects by looking at the regression weights (simple slopes) of self-esteem at one standard deviation above and below the mean score of renqing orientation (see Figs. 1, 2). As predicted, the regression coefficients of renqing orientation with adaptive selling (β = .22, p < .05) and with hard work (β = .26, p < .001) were statistically significant when self-esteem was low, but not when it was high (p > .05).
These results suggest that a high level of self-esteem reduces the positive effect of renqing orientation on selling behaviors. By contrast, a low level of self-esteem facilitated the effects of renqing orientation on selling behaviors. In addition, we found that self-esteem had a positive relationship with adaptive selling (β = .34, p < .001) and hard work (β = .38, p < .001).
Lastly, we discovered two additional findings from the data. First, we found a positive correlation between education and renqing orientation (r = .24, p < .001), but we did not find significant correlation between education and selling behaviors (p > . 05). Second, we found a negative correlation between selling experience and renqing orientation (r = −.20, p < .01), while we found positive correlations between selling experience and selling behaviors (for adaptive selling, r = .27, p < .001; for hard work, r = .33, p < .001).
Study Limitations and Future Research Directions
References DiscussionTo our knowledge, no study has yet examined relationships among individuals’ renqing orientation, self-esteem, and task-related behaviors. Our findings demonstrated an interplay of self-esteem and renqing orientation for Chinese salespeople in business environments. However, our data did not find the expected positive relationship between renqing orientation and selling behaviors.
It is likely that the two types of selling behavior are mainly related to work motivation (e.g., obtaining orders from customers or altering selling strategies when necessary) rather than to long-term business relationships. For example, the salespeople, who were high in renqing orientation might agree to a delay in customer payment or promise small gifts with purchase in expectation of reciprocal returns for these favors; however, such behaviors might not increase salespersons’ motivation to obtain orders from customers or to adopt different strategies in different situations.
Our study results showed evidence that self-esteem had a mitigating role on the relationship between renqing orientation and selling behaviors. When compared with salespeople with low self-esteem, those with high self-esteem tended to engage in a lower degree of adaptive selling and hard work. Our results supported Brockner’s (1988) behavioral plasticity hypothesis, which states that individuals with low self-esteem have a higher tendency to accommodate customers’ needs than do individuals with high self-esteem (Brockner 1988; Ganster and Schaubroeck 1991a; Kahn and Byosiere 1992).
Two additional findings from the data must be noted. First, we found a positive correlation between education and renqing orientation, but no correlation between education and selling behaviors. It may be that the higher education of Chinese people helps to nurture their preferences for abiding by the social obligation of reciprocity. However, the higher education of salespeople may not be helpful with regard to their selling behaviors.
Second, we found a negative correlation between selling experience and renqing orientation, but positive correlations between selling experience and selling behaviors. These findings are interesting. Our data showed that senior salespeople tended to have a lower level of renqing orientation and higher degrees of selling behaviors.
One possible reason is that the salespeople, who have been promoted are those who have demonstrated effective selling behaviors (working smart and working hard), rather than those who have focused on abiding cultural norms. Another possible reason is that those who have a higher level of renqing orientation might have successfully utilized their social connections and, therefore, followed a broader career path beyond their initial sales jobs.
Our study makes two contributions to the business-psychology literature and management practice. First, the existing literature of industrial/organizational psychology and marketing primarily relies on constructs that are derived from Western cultural contexts. We extended these literatures by investigating the possible joint effects of self-esteem with a trait originated from the Chinese culture on salespeople’s selling behaviors.
Second, the increased globalization of business environment has heightened the importance of cross-cultural understanding. Consequently, our study has an important practical implication: helping international managers, who wish to do business in Chinese contexts to better understand, how cultural traits are relevant in sales situations.
That is, it is useful to know that salespeople’s renqing orientation can compensate for the positive effects of self-esteem on selling behaviors. Our study results underscore the critical role of the character trait of renqing orientation in a culture emphasizing a norm of reciprocity. Therefore, it would be useful to consider a strategy of recruiting salespeople with either a high self-esteem or a combination of high renqing orientation and low self-esteem.
Study Limitations and Future Research Directions
References Study Limitations and Future Research DirectionsThis study has several limitations that need to be addressed. First, our sample was made up of salespeople from only pharmaceutical and consumer-goods companies, limiting the generalizability of our results; future research may want to include salespeople from other industries. Second, our study was done in Taiwan, which limits the generalizability of our study results to different cultural settings.
Future research may want to include salespeople in other countries or regions. Third, all our data were obtained from self-report survey questions. Thus, our findings may have the problem of common-method variance (i.e., variance attributable to the measurement method rather than to the constructs that the measures represent; Podsakoff et al. 2003).
A final limitation is that we did not measure the salespeople’s sales performance. Many studies have shown a strong correlation between sales performance and adaptive selling or hard work in selling (Leong et al. 1989; Sujan et al. 1994). Therefore, it would be fruitful for us to obtain a more objective measure of sales performance to explore a relationship among renqing orientation, self-esteem, and sales performance.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
Contributor InformationMing-Hong Tsai, Phone: +1-310-7794312, Email: mtsai@anderson.ucla.edu.
Shu-Cheng Steve Chi, Phone: +886-2-33661049, Fax: +886-2-23689305, Email: n136@management.ntu.edu.tw.
Hsiu-Hua Hu, Phone: +886-2-28824564, Email: shhu@mcu.edu.tw.
Top
Abstract
Introduction
Methods
Results
Discussion
Study Limitations and Future Research Directions
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Salespeople’s Renqing Orientation, Self-esteem, and Selling Behaviors: An Empirical Study in Taiwan
Ming-Hong Tsai,1 Shu-Cheng Steve Chi,2 and Hsiu-Hua Hu3
1University of California, 11140 Rose Ave. Apt 307, Los Angeles, CA USA
2Department of Business Administration, National Taiwan University, 1, Sec. 4, Roosevelt Road, Taipei, Taiwan
3Department of International Business, Ming Chuan University, 250, Sec. 5, Chung Shan N. Road, Taipei, Taiwan
Ming-Hong Tsai, Phone: +1-310-7794312, Email: mtsai@anderson.ucla.edu.
The purpose of this study was to investigate how salespeople’s renqing orientation and self-esteem jointly affect their selling behavior.
Design/Methodology/Approach
Data were obtained from a survey of salespeople from 17 pharmaceutical and consumer-goods companies in Taiwan (n = 216).
Findings
Salespeople’s renqing orientation (i.e., their propensity to adhere to the accepted norm of reciprocity) compensates the negative effect of self-esteem on their selling behaviors, such as adaptive selling and hard work.
Implications
Our study results underscore the critical role of the character trait of renqing orientation in a culture emphasizing a norm of reciprocity. Therefore, it would be useful to consider a strategy of recruiting salespeople with either a high self-esteem or a combination of high renqing orientation and low self-esteem.
Originality/Value
The existing literature of industrial/organizational psychology and marketing primarily relies on constructs that are derived from Western cultural contexts. However, the present paper extended these literatures by investigating the possible joint effects of self-esteem with a trait originated from the Chinese culture on salespeople’s selling behaviors.
Networks of informal relationships are one of the major characteristics of business and social activities in Asian regions such as Mainland China, Hong Kong, Korea, Japan, and Taiwan (Kienzle and Shadur 1997; Gerlach 1987). Consequently, organizational members often need to make use of their interpersonal relationships to improve job performance. Salespeople, in particular, consistently interact with customers, and their sales performance largely depends upon how successfully they translate interpersonal relationships into actual purchases.
The now well-known Chinese term guanxi describes interpersonal dynamics that draw on a web of connections with the purpose of securing particular favors in personal relations (Park and Luo 2001). The Chinese culture of Confucianism has institutionalized this “norm of reciprocity” into everyday lives. That is, personal guanxis describes an individual’s particular, reciprocal exchanges with another person (e.g., a relative, a friend, a customer, a business partner, a colleague, or a boss/subordinate, etc.).
Theorists have suggested that it is the anticipation of repayment that motivates Chinese people to offer one another favors (e.g., Hwang 1987). For instance, a Chinese person seeking a business opportunity may activate his or her guanxi networks in the hope that an earlier favor paid to someone else will generate new opportunities.
Given that every Chinese person may exchange favors under an accepted cultural norm, both the giver and the recipient of favors expect the other party to continue these reciprocal exchanges in the future. As an illustration, during special occasions such as the Chinese New Year, weddings, birthdays, or festivals, Chinese people may feel duty-bound to give presents to individuals of priority within their guanxi network. This gift-giving is a large part of guanxi-building and maintenance (Hwang 1987). Put another way, maintaining networks of guanxis implies continual exchanges of favors (Chen 1995).
Renqing Orientation as a Personality Trait.
Nevertheless, not every Chinese person follows this cultural norm in the same manner. Some may have a higher tendency of giving gifts to those who have helped them in the past, for example, but others may not. Recent articles by Cheung et al. (1996, 2001) proposed and showed that Chinese people act differently when facing decisions about exchanges of favors.
Cheung et al. (1996, 2001) termed the degree to which a person abides to rules of reciprocity regarding favor exchanges as “renqing orientation”. They also developed a personality inventory—the Chinese Personality Assessment Inventory (CPAI)—to examine such individual differences among Chinese people (Cheung et al. 1996). Renqing was one of the three personality constructs chosen in consideration of Chinese culture (the other two were face and harmony). Their study findings evidenced the psychometric properties of CPAI and its reliability and validity.
To date, only few studies have utilized the renqing orientation construct and examined its effects on other variables. One study by Chan (2002) found that tutors’ renqing orientation positively affected students’ perceived teaching effectiveness, such as motivation, presentation, and attitude, at a distance-learning institution in Hong Kong. Zhang and Bond (1998) discovered a positive relationship between college students’ renqing orientation and their filial piety. In their findings, students with a high renqing orientation had a high tendency to provide for the material and mental well-being of their aged parents, in order to ensure the continuity of the family line, and to perform ceremonial duties of ancestral worship.
Linking Renqing Orientation to Selling Behaviors
The present study proposed a direct link between salespeople’s renqing orientation and their selling behaviors. We followed Weitz et al.’s (1986) classification of selling behaviors. They identified two general types of selling behaviors: adaptive selling and hard work (see also Levy and Sharma 1994; Sujan 1986; Weiner 1980; Sujan et al. 1994).
Adaptive Selling
The first type of selling behavior is “adaptive selling”, or “the altering of sales behaviors during a customer interaction, or across customer interactions, based on perceived information about the nature of the selling situation” (Levy and Sharma 1994, p. 39).
Research has shown that excellent sales representatives often alter their selling behaviors on the basis of situational considerations (Sujan et al. 1994; Leong et al. 1989). That is, these salespeople will try to understand the need of their customers, select the best sales strategies for these customers, and recommend products that satisfy these customers’ particular needs (Weitz 1978; Weitz et al. 1986; Lambert et al. 1990).
We proposed a direct relationship between salespeople’s renqing orientation and their degree of adaptive selling. Specifically, we suggested that salespeople with a high renqing orientation are especially sensitive to their customers’ needs. Thus, relative to salespeople with a low renqing orientation, it is likely that salespeople with a high renqing orientation will be more flexible in response to the needs of individual customers in expectation that these customers will reciprocate attentiveness with purchases.
Hard Work
Another type of selling behavior, “hard work” describes “the overall amount of effort that a salesperson devotes to his or her work” (Sujan et al. 1994, p. 40). Empirical evidence has shown that high-performing salespeople are usually those who work very hard at their jobs (Churchill et al. 1985; Sujan et al. 1994). Sujan et al. (1994) suggested that these successful salespeople tend to be persistent at selling, devote a great deal of effort to their work, and continue their selling effort even in the face of failure.
Again, we proposed that salespeople with a high renqing orientation will be sensitive to the giving and receiving of social favors based on the implicit social norm (Luo 1997). These salespeople are inclined to work hard to understand and satisfy the needs of their customers. That is, we proposed that individuals with a high renqing orientation tend to work hard to meet their customers’ needs. Therefore, relative to salespeople with a low renqing orientation, it is likely that salespeople with a high renqing orientation will devote more effort and be persistent in satisfying the needs of their customers, expecting these customers to reciprocate their efforts with purchases.
In sum, a high renqing orientation elevates a salesperson’s motivation to cultivate customer relationships, be more flexible in meeting customers’ needs, and work hard to make sales. These salespeople have a high expectation of receiving payoffs for their efforts. That is, they believe that if they invest time, effort, and resources in building and maintaining relationships with customers, their efforts will translate into purchases. Based on the preceding discussion, we proposed the following hypotheses:
Hypothesis 1 A positive relationship exists between a salesperson’s renqing orientation and his or her adaptive selling.
Hypothesis 2 A positive relationship exists between a salesperson’s renqing orientation and how hard he or she works at selling.
The Moderating Role of Self-esteem
In addition, we proposed that the positive effects of salespeople’s renqing orientation on their selling behaviors are likely to vary depending upon their levels of self-esteem. Scholars have defined self-esteem as the degree to which people perceive themselves to be capable, significant, and worthy (Coopersmith 1967; Marsh 1993; Wells and Marwell 1976).
Relative to people with low self-esteem, individuals with high self-esteem tend to access more positive thoughts about themselves after a failure and tend to maintain a positive focus (Taylor and Brown 1988). Additionally, when compared with those with low self-esteem, individuals with high self-esteem are better able to manage stressful situations and perceive the work environment as controllable.
Sager (1991), for example, discovered a negative relationship between the self-esteem of salespeople and their level of job-related stress. Similarly, Burton et al. (2005) found that individuals with higher self-esteem were more likely to respond to a perceived injustice aggressively.
This study sought to investigate the possible joint effects of self-esteem (a core concept in a person’s self-perception) with renqing orientation (a trait that is crucial within Chinese culture) on salespeople’s selling behaviors. The examination of such effects is critical because, on the one hand, it may enhance our understanding of the boundary condition of the effects of self-esteem on individual behaviors and, on the other hand, the dynamics of self-esteem with another trait that is more relevant to the embedded culture.
We suspected that, for salespeople with high self-esteem, the relationship between renqing orientation and selling behaviors would be relatively weak. On the contrary, for salespeople with low self-esteem, the relationship between renqing orientation and selling behaviors is relatively strong. We borrowed Brockner’s (1988) concept of “behavioral plasticity” to explain this proposition.
According to Brockner (1988), people respond differently to external factors, such as influence attempts from other people. Brockner suggested that individuals with low self-esteem tend to be more “behaviorally plastic”, or reactive, than those with high self-esteem. Research findings have supported this behavioral plasticity hypothesis in the realm of feedback effects, peer–group interaction, and workplace socialization (e.g., Ganster and Schaubroeck 1991b; Kahn and Byosiere 1992). In addition, individuals with low self-esteem are highly uncertain about their own work attitudes and behaviors (Brockner 1988), and they have a strong need for approval from others (e.g., superiors or customers).
As a result, they often rely on others’ actions and suggestions to perform their own job activities (Pierce et al. 1993). Samad (2007), for example, found that, for low self-esteem employees, having an open personality had an insignificant effect on psychological empowerment. That is, low self-esteem individuals would not be empowered even by a high degree of openness, but would prefer to rely on directions from above.
It is likely that salespeople with low self-esteem and high renqing orientation make use of their social connections to solve their problems rather than relying on their own abilities and skills. According to Hobfoll and Leiberman’s (1987) arguments, a person with plenty of social resources will be able to make effective use of these resources when the situation demands them. Consequently, low self-esteem salespeople will make a better psychological adjustment, if they utilize their social resources when facing misfortune (Baumeister 1998).
Accordingly, renqing orientation was likely to have a greater impact on the selling behaviors of those with low self-esteem and a smaller impact on the selling behaviors of those with high self-esteem. Salespeople with high self-esteem often are adaptive in stressful situations and engage in active coping and planning (Pierce et al. 1993). Therefore, their selling behaviors emerge from more than just a concern for the norm of reciprocal exchange.
On the contrary, among salespeople with low self-esteem, those with a high renqing orientation are more willing to engage in selling behaviors for the purpose of winning customers’ trust and purchases. They are motivated by the norm of reciprocity, rather than a sense of their own ability, and expect their favors to generate high sales performance. Therefore, we proposed the following:
Hypothesis 3 Self-esteem mitigates the positive relationship between the renqing orientation of salespeople and their adaptive selling.
Hypothesis 4 Self-esteem mitigates the positive relationship between the renqing orientation of salespeople and their hard work in selling.
The participants in this study were salespeople at 17 pharmaceutical and consumer-goods companies in Taiwan. Survey questionnaires were distributed to participants through the companies’ human resource offices. The participants were told that the purpose of the research was to better understand salespeople’s behaviors; they were assured that the study was anonymous and that only aggregated data would be reported.
Each participant completed the questionnaire and returned it in a sealed envelope to their company’s human resource manager, who then forwarded it to the researcher. Of the 400 questionnaires distributed, 216, or 54%, were returned. About two thirds of the participants (67.6%) were male. The average age of participants was 35, and they had an average of about 9 years of selling experience.
Measures
Renqing Orientation
We used Cheung et al.’s (1996) 11-item scale to assess salespeople’s renqing orientation. A sample item is: “When dealing with institutions, things can work out more smoothly through the connections of friends working inside”.
The reliability and validity of the renqing scale have been examined in several studies. Its internal consistency coefficients (Cronbach’s alphas) ranged from .55 to .74 (Cheung et al. 1996, 2003). Its test–retest correlation coefficients were statistically significant (Cheung et al. 1996). The convergent validity of the scale was examined by comparing the patterns of its correlation coefficients with the Minnesota multiphasic personality inventory (MMPI-2; Butcher 1996; Cheung and Zhang 2004).
The scale demonstrated reasonable patterns that were associated with the MMPI-2 scales. Specifically, renqing orientation was negatively related to “conversion hysteria” and was positively related to “schizophrenia” and “hypomania” in the MMPI-2 clinical scales. Cheung et al. (2003) further examined the clinical validity of the CPAI in two studies that included 167 male prisoners in Hong Kong and 339 psychiatric patients in mainland China. According to their logistic regression results, the renqing scale was a useful tool in distinguishing psychiatric patients from the normative sample in China and in distinguishing male prisoners from normal male respondents in Hong Kong.
Self-esteem
We used Rosenberg’s (1965) 10-item scale to assess salespeople’s self-esteem. A sample item is: “On the whole, I am satisfied with myself”. Higher scores indicate a higher degree of self-esteem.
Adaptive Selling
We used Spiro and Weitz’s (1990) 12-item measure of adaptive selling to assess salespeople’s adaptive selling. A sample item is: “I vary my sales style from situation to situation”.
Working Hard
We used Sujan et al.’s three-item measure (Sujan et al. 1994) to assess salespeople’s degree of hard work in job-related activities. A sample item is: “I work untiringly at selling a customer until I get an order”.
Among our measures, the Renqing orientation scale was developed in Mandarin Chinese, while the other scales were originally written in English, translated by the researchers into Chinese, then back-translated into English (Brislin et al. 1973) to assure their correct meanings. We used a six-point Likert scale (6 = strongly agree, 1 = strongly disagree) for all of the above scales, asking the respondents to indicate their degree of agreement.
In addition to these measures, we asked respondents to report their sex, age, education, and past selling experiences (in years) as control variables. Research has shown that these variables may be related to salespeople’s selling behaviors (e.g., Bernard 1981; Goolsby et al. 1992; Levy and Sharma 1994).
We tested the hypotheses using multiple regression analysis. We mean-centered the predictors (i.e., renqing orientation and self-esteem) before multiplying them in order to minimize multi-collinearity between the interaction term and its components, as recommended by Aiken and West (1992). In the regression models, we first entered the four control variables (sex, age, past selling experience, and education).
In our results, Hypotheses 1 and 2 were not supported (see Table 2). That is, renqing orientation did not have a significant positive relationship with adaptive selling and hard work (ps > .05).
Hypotheses 3 and 4 proposed that self-esteem mitigates the relationship of renqing orientation with adaptive selling and with hard work. As shown in Table 2, we found significant and negative coefficients of the renqing orientation × self-esteem interaction term on adaptive selling (β = −.16, p < .05) and on hard work (β = −.18, p < .01).
We examined these interaction effects by looking at the regression weights (simple slopes) of self-esteem at one standard deviation above and below the mean score of renqing orientation (see Figs. 1, 2). As predicted, the regression coefficients of renqing orientation with adaptive selling (β = .22, p < .05) and with hard work (β = .26, p < .001) were statistically significant when self-esteem was low, but not when it was high (p > .05).
These results suggest that a high level of self-esteem reduces the positive effect of renqing orientation on selling behaviors. By contrast, a low level of self-esteem facilitated the effects of renqing orientation on selling behaviors. In addition, we found that self-esteem had a positive relationship with adaptive selling (β = .34, p < .001) and hard work (β = .38, p < .001).
Lastly, we discovered two additional findings from the data. First, we found a positive correlation between education and renqing orientation (r = .24, p < .001), but we did not find significant correlation between education and selling behaviors (p > . 05). Second, we found a negative correlation between selling experience and renqing orientation (r = −.20, p < .01), while we found positive correlations between selling experience and selling behaviors (for adaptive selling, r = .27, p < .001; for hard work, r = .33, p < .001).
Study Limitations and Future Research Directions
References DiscussionTo our knowledge, no study has yet examined relationships among individuals’ renqing orientation, self-esteem, and task-related behaviors. Our findings demonstrated an interplay of self-esteem and renqing orientation for Chinese salespeople in business environments. However, our data did not find the expected positive relationship between renqing orientation and selling behaviors.
It is likely that the two types of selling behavior are mainly related to work motivation (e.g., obtaining orders from customers or altering selling strategies when necessary) rather than to long-term business relationships. For example, the salespeople, who were high in renqing orientation might agree to a delay in customer payment or promise small gifts with purchase in expectation of reciprocal returns for these favors; however, such behaviors might not increase salespersons’ motivation to obtain orders from customers or to adopt different strategies in different situations.
Our study results showed evidence that self-esteem had a mitigating role on the relationship between renqing orientation and selling behaviors. When compared with salespeople with low self-esteem, those with high self-esteem tended to engage in a lower degree of adaptive selling and hard work. Our results supported Brockner’s (1988) behavioral plasticity hypothesis, which states that individuals with low self-esteem have a higher tendency to accommodate customers’ needs than do individuals with high self-esteem (Brockner 1988; Ganster and Schaubroeck 1991a; Kahn and Byosiere 1992).
Two additional findings from the data must be noted. First, we found a positive correlation between education and renqing orientation, but no correlation between education and selling behaviors. It may be that the higher education of Chinese people helps to nurture their preferences for abiding by the social obligation of reciprocity. However, the higher education of salespeople may not be helpful with regard to their selling behaviors.
Second, we found a negative correlation between selling experience and renqing orientation, but positive correlations between selling experience and selling behaviors. These findings are interesting. Our data showed that senior salespeople tended to have a lower level of renqing orientation and higher degrees of selling behaviors.
One possible reason is that the salespeople, who have been promoted are those who have demonstrated effective selling behaviors (working smart and working hard), rather than those who have focused on abiding cultural norms. Another possible reason is that those who have a higher level of renqing orientation might have successfully utilized their social connections and, therefore, followed a broader career path beyond their initial sales jobs.
Our study makes two contributions to the business-psychology literature and management practice. First, the existing literature of industrial/organizational psychology and marketing primarily relies on constructs that are derived from Western cultural contexts. We extended these literatures by investigating the possible joint effects of self-esteem with a trait originated from the Chinese culture on salespeople’s selling behaviors.
Second, the increased globalization of business environment has heightened the importance of cross-cultural understanding. Consequently, our study has an important practical implication: helping international managers, who wish to do business in Chinese contexts to better understand, how cultural traits are relevant in sales situations.
That is, it is useful to know that salespeople’s renqing orientation can compensate for the positive effects of self-esteem on selling behaviors. Our study results underscore the critical role of the character trait of renqing orientation in a culture emphasizing a norm of reciprocity. Therefore, it would be useful to consider a strategy of recruiting salespeople with either a high self-esteem or a combination of high renqing orientation and low self-esteem.
Study Limitations and Future Research Directions
References Study Limitations and Future Research DirectionsThis study has several limitations that need to be addressed. First, our sample was made up of salespeople from only pharmaceutical and consumer-goods companies, limiting the generalizability of our results; future research may want to include salespeople from other industries. Second, our study was done in Taiwan, which limits the generalizability of our study results to different cultural settings.
Future research may want to include salespeople in other countries or regions. Third, all our data were obtained from self-report survey questions. Thus, our findings may have the problem of common-method variance (i.e., variance attributable to the measurement method rather than to the constructs that the measures represent; Podsakoff et al. 2003).
A final limitation is that we did not measure the salespeople’s sales performance. Many studies have shown a strong correlation between sales performance and adaptive selling or hard work in selling (Leong et al. 1989; Sujan et al. 1994). Therefore, it would be fruitful for us to obtain a more objective measure of sales performance to explore a relationship among renqing orientation, self-esteem, and sales performance.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
Contributor InformationMing-Hong Tsai, Phone: +1-310-7794312, Email: mtsai@anderson.ucla.edu.
Shu-Cheng Steve Chi, Phone: +886-2-33661049, Fax: +886-2-23689305, Email: n136@management.ntu.edu.tw.
Hsiu-Hua Hu, Phone: +886-2-28824564, Email: shhu@mcu.edu.tw.
Top
Abstract
Introduction
Methods
Results
Discussion
Study Limitations and Future Research Directions
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Bastardized
If I were to rate the corruptive tactics performed by big pharmaceutical companies during my intimate experience with them , the frequent and intentional strategy of implementing fabricated and unreliable results of clinical trials performed by others possibly tops the list of corruptive tactics by the pharmaceutical industry that sponsors such trials.
By this atrophy of the scientific method absent of authenticity that has been known to occur, harm and damage is possibly done to the health of the public.
The marketing protocol for pharmaceutical clinical trials includes designing the clinical trial protocol and having the ability to oversee this trial. Also, they select targeted investigators and the clinical trial sites. The sponsor runs investigator meetings, as well as select and control contract research organizations (CROs). The sponsor also performs data assessment, as well as completes the clinical trial so it can be published in a journal chosen by the sponsor.
Most would agree that the science of research should be sound and as aseptic as possible- completely free of deliberate and reckless interference. However, it appears, money and increased profits can be a catalyst for disregard for human health with the clinical trial process that is largely unregulated.
This is particularly a factor on post-marketing studies of various pharmaceutical companies, as some pharmaceutical corporations seem to be deliberately conducting nothing less than seeding trials- with about a 50 percent tax credit for these trial sponsors. Trials that are in fact pointless and void of scientific benefit.
Decades ago, clinical trials were conducted at academic settings that focused on the acquisition of knowledge and the completely objective discoveries of drugs and devices to benefit mankind. Then, in 1980, the Bayh-Dole Act, Public Law 96-517,was created, which allowed for such places with their researchers can profit off of their discoveries that were performed for pharmaceutical companies and others in the past.
Furthermore, such academic institutions were coerced to license patented inventions to those pharmaceutical companies that will then commercialize these discoveries paid for in large part by the taxpayers who funded this research to a degree.
This resulted in the creation of for-profit research trial sites without any academic affiliation that are called Contract Research Organizations. CROS utilize primarily community patient care clinics whose staff are absent of any research training compared with the former researchers that existed decades ago.
Because of this structure, the clinical trial investigators of these pharmaceutical sponsored trials are likely novice compared with academic researchers.
This, of course, happens with intent by the sponsor who can and does control all aspects of the clinical trial protocol at the site locations of a clinical trial that the pharmaceutical company structures and even gives the trial the title they want for their marketing purposes.
These quite numerous CROS are in fact for- profit, with some CROs making billions of dollars a year, and this market continues to grow.
The trials conducted at such places again are sponsored by pharmaceutical companies that control and manipulate all aspects of the trial being conducted involving their particular drug chosen to be studied.
Etiology for their deception regarding this manipulation is because the pharmaceutical company that sponsors such a trial is basically creating a marketing tool for this drug of theirs to be studied in this manner. This coercion is done by various methods of deception in subtle and tacit methods.
As a result, research in this protocol of the sponsor ensures favorable results of the sponsor’s medication that is involved in the clinical trial they clearly own.
These activities are again believed to be absent of true or applied regulation to any degree, and therefore have the autonomy to create whatever they want to benefit the pharmaceutical sponsor.
There likely is a collusive relationship between the sites, the CRO, and the sponsor, as this whole system is planned beforehand by the pharmaceutical sponsor of their clinical trial to again be utilized to increase the market share of the drug studied that they promote.
Guest authorship has been known to be aggressively recruited by sponsors by paying a known opinion leader to sign off on the completed clinical trial. The author’s duty includes making noted cognitive contributions to a published clinical trial, as well as revising and drafting the clinical trial.
Furthermore, the pharmaceutical sponsor recruits investigators to be used for this function of what ultimately is a fabricated clinical trial protocol. The trial manuscript and protocol design is prepared by those employed by the drug company sponsor upon specific direction of this sponsor on how this should be prepared.
The medical program coordinator of a particular sponsored trial is an actual employee of the sponsoring drug company and also may act as the publisher, manuscript version reviewer, and the clinical trial director who works with the drug company’s hired CRO editors whose objectives are to benefit the sponsor.
Typical and ultimate cost of the final manuscript of the trial to the sponsor created by the hired CRO and the recruited ghostwriters exceeds 1000 dollars per page, some have said.
Merck engages in this behavior, which shocked many, as they were always viewed as an ethical pharmaceutical company that always placed patients over profits.
Apparently, this is no longer the case. There are other well known and large pharmaceutical corporations that consider this plan of action standard operating procedures to ensure growth of their drugs.
Further disturbing is that once the creation of the trials is completed, the research paper is often composed with specific directions by the sponsor to writers known again as ghostwriters. These people are usually not identified and acknowledged by the sponsor, and may not be trained in clinical research overall, as they are simply freelance writers.
One does not need research training or certification in order to perform this function. Rarely do clinical trial ghostwriters question their instructions about their assignment, which is clearly deceptive and undocumented by the pharmaceutical sponsor. Also, these hired mystery writers are known to make about 100 grand a year performing this deception full time.
This activity removes accountability and authenticity of the fabricated clinical trial even further. The corruptive act is finally completed by the sponsor hiring again a known thought leader as an author to have their name be placed on the trial, while this hired author likely had absolutely no involvement with the trial, or even reviewing the trial is not asked or required by the hired author, others have said.
To have the trial published, the sponsor has been known to pay an obscure journal, and the sponsor bribes the journal in a few ways, such as the sponsor purchasing from a selected journal thousands of reprints of their study from the journal, for example.
Again, how often this process is performed is unknown, yet frequent enough to create hundreds of such false writers mentioned earlier and progressively growing research sites to receive the support the pharmaceutical industry.
So benefits of pharmaceuticals that are studied in such a malicious way potentially can harm patients and their treatment options along with clear safety risks as a result of this process.
The purchased reprints of the fabricated clinical trial are then bought by the sponsor of the study from the medical journal they hired to publish this trial. The reprints are eventually distributed to the sponsor’s sales force to share the content with prescribers, with the sales force completely unaware about this manipulation that has happened with such a trial that benefits the drug they promote for their employer.
As a bonus, the sponsor may agree to pay the chosen medical journal to advertise their products to be placed in this journal as well.
Such misconduct discussed so far impedes research and the scientific method with frightening ethical and harmful concerns, as stated previously. If so, our health care treatment options with drugs that are claimed to have benefits that are absent have now become unreliable in large part due to such corruptive situations. Not to mention the absence of objectivity that has been intentionally eliminated with trials produced in this way.
More now than ever, meds are removed from the market or are given black box warnings due to the damaging effects of drugs approved by the FDA. We as citizens need to dig deep and ask why this is happening.
Transparency and disclosure needs to happen with the pharmaceutical industry for reasons such as this as well as many others, in order to correct what we have historically relied upon for conclusive proof, which is the scientific method.
More importantly, research should be conducted in a way that the sponsor cannot in any way interfere in such ways described in this article, which would require independent clinical trial sites with no involvement from the maker of the drug studied in a clinical trial.
And clearly, regulation has to be enforced not selectively, but in a complete fashion regarding such matters. Public awareness would be a catalyst for this to occur, after initially experiencing a state of total disbelief that such operations actually are conducted by such people, of course. We can no longer be dependent on others for our optimal health.
Commercial sponsors of clinical studies have the potential to manipulate the structure, implementation, and assessment of the clinical trial results to further their monetary interests.
This, of course, is detrimental for patients because clinical trial results supposed to be based on the best information from clinical trials possibly may be restructured by others, and is done so with deliberate intent and reckless disregard. Pharmaceutical Marketing uses science this way as a host to infect it, and bastardize the scientific method.
Knowledge is power, and is also possibly a lifesaver.
“Ethics and Science need to shake hands.” ……. Richard Cabot
Dan Abshear
Author’s note: What has been written was based upon information and belief.
Published on: www.brainblogger.com
By this atrophy of the scientific method absent of authenticity that has been known to occur, harm and damage is possibly done to the health of the public.
The marketing protocol for pharmaceutical clinical trials includes designing the clinical trial protocol and having the ability to oversee this trial. Also, they select targeted investigators and the clinical trial sites. The sponsor runs investigator meetings, as well as select and control contract research organizations (CROs). The sponsor also performs data assessment, as well as completes the clinical trial so it can be published in a journal chosen by the sponsor.
Most would agree that the science of research should be sound and as aseptic as possible- completely free of deliberate and reckless interference. However, it appears, money and increased profits can be a catalyst for disregard for human health with the clinical trial process that is largely unregulated.
This is particularly a factor on post-marketing studies of various pharmaceutical companies, as some pharmaceutical corporations seem to be deliberately conducting nothing less than seeding trials- with about a 50 percent tax credit for these trial sponsors. Trials that are in fact pointless and void of scientific benefit.
Decades ago, clinical trials were conducted at academic settings that focused on the acquisition of knowledge and the completely objective discoveries of drugs and devices to benefit mankind. Then, in 1980, the Bayh-Dole Act, Public Law 96-517,was created, which allowed for such places with their researchers can profit off of their discoveries that were performed for pharmaceutical companies and others in the past.
Furthermore, such academic institutions were coerced to license patented inventions to those pharmaceutical companies that will then commercialize these discoveries paid for in large part by the taxpayers who funded this research to a degree.
This resulted in the creation of for-profit research trial sites without any academic affiliation that are called Contract Research Organizations. CROS utilize primarily community patient care clinics whose staff are absent of any research training compared with the former researchers that existed decades ago.
Because of this structure, the clinical trial investigators of these pharmaceutical sponsored trials are likely novice compared with academic researchers.
This, of course, happens with intent by the sponsor who can and does control all aspects of the clinical trial protocol at the site locations of a clinical trial that the pharmaceutical company structures and even gives the trial the title they want for their marketing purposes.
These quite numerous CROS are in fact for- profit, with some CROs making billions of dollars a year, and this market continues to grow.
The trials conducted at such places again are sponsored by pharmaceutical companies that control and manipulate all aspects of the trial being conducted involving their particular drug chosen to be studied.
Etiology for their deception regarding this manipulation is because the pharmaceutical company that sponsors such a trial is basically creating a marketing tool for this drug of theirs to be studied in this manner. This coercion is done by various methods of deception in subtle and tacit methods.
As a result, research in this protocol of the sponsor ensures favorable results of the sponsor’s medication that is involved in the clinical trial they clearly own.
These activities are again believed to be absent of true or applied regulation to any degree, and therefore have the autonomy to create whatever they want to benefit the pharmaceutical sponsor.
There likely is a collusive relationship between the sites, the CRO, and the sponsor, as this whole system is planned beforehand by the pharmaceutical sponsor of their clinical trial to again be utilized to increase the market share of the drug studied that they promote.
Guest authorship has been known to be aggressively recruited by sponsors by paying a known opinion leader to sign off on the completed clinical trial. The author’s duty includes making noted cognitive contributions to a published clinical trial, as well as revising and drafting the clinical trial.
Furthermore, the pharmaceutical sponsor recruits investigators to be used for this function of what ultimately is a fabricated clinical trial protocol. The trial manuscript and protocol design is prepared by those employed by the drug company sponsor upon specific direction of this sponsor on how this should be prepared.
The medical program coordinator of a particular sponsored trial is an actual employee of the sponsoring drug company and also may act as the publisher, manuscript version reviewer, and the clinical trial director who works with the drug company’s hired CRO editors whose objectives are to benefit the sponsor.
Typical and ultimate cost of the final manuscript of the trial to the sponsor created by the hired CRO and the recruited ghostwriters exceeds 1000 dollars per page, some have said.
Merck engages in this behavior, which shocked many, as they were always viewed as an ethical pharmaceutical company that always placed patients over profits.
Apparently, this is no longer the case. There are other well known and large pharmaceutical corporations that consider this plan of action standard operating procedures to ensure growth of their drugs.
Further disturbing is that once the creation of the trials is completed, the research paper is often composed with specific directions by the sponsor to writers known again as ghostwriters. These people are usually not identified and acknowledged by the sponsor, and may not be trained in clinical research overall, as they are simply freelance writers.
One does not need research training or certification in order to perform this function. Rarely do clinical trial ghostwriters question their instructions about their assignment, which is clearly deceptive and undocumented by the pharmaceutical sponsor. Also, these hired mystery writers are known to make about 100 grand a year performing this deception full time.
This activity removes accountability and authenticity of the fabricated clinical trial even further. The corruptive act is finally completed by the sponsor hiring again a known thought leader as an author to have their name be placed on the trial, while this hired author likely had absolutely no involvement with the trial, or even reviewing the trial is not asked or required by the hired author, others have said.
To have the trial published, the sponsor has been known to pay an obscure journal, and the sponsor bribes the journal in a few ways, such as the sponsor purchasing from a selected journal thousands of reprints of their study from the journal, for example.
Again, how often this process is performed is unknown, yet frequent enough to create hundreds of such false writers mentioned earlier and progressively growing research sites to receive the support the pharmaceutical industry.
So benefits of pharmaceuticals that are studied in such a malicious way potentially can harm patients and their treatment options along with clear safety risks as a result of this process.
The purchased reprints of the fabricated clinical trial are then bought by the sponsor of the study from the medical journal they hired to publish this trial. The reprints are eventually distributed to the sponsor’s sales force to share the content with prescribers, with the sales force completely unaware about this manipulation that has happened with such a trial that benefits the drug they promote for their employer.
As a bonus, the sponsor may agree to pay the chosen medical journal to advertise their products to be placed in this journal as well.
Such misconduct discussed so far impedes research and the scientific method with frightening ethical and harmful concerns, as stated previously. If so, our health care treatment options with drugs that are claimed to have benefits that are absent have now become unreliable in large part due to such corruptive situations. Not to mention the absence of objectivity that has been intentionally eliminated with trials produced in this way.
More now than ever, meds are removed from the market or are given black box warnings due to the damaging effects of drugs approved by the FDA. We as citizens need to dig deep and ask why this is happening.
Transparency and disclosure needs to happen with the pharmaceutical industry for reasons such as this as well as many others, in order to correct what we have historically relied upon for conclusive proof, which is the scientific method.
More importantly, research should be conducted in a way that the sponsor cannot in any way interfere in such ways described in this article, which would require independent clinical trial sites with no involvement from the maker of the drug studied in a clinical trial.
And clearly, regulation has to be enforced not selectively, but in a complete fashion regarding such matters. Public awareness would be a catalyst for this to occur, after initially experiencing a state of total disbelief that such operations actually are conducted by such people, of course. We can no longer be dependent on others for our optimal health.
Commercial sponsors of clinical studies have the potential to manipulate the structure, implementation, and assessment of the clinical trial results to further their monetary interests.
This, of course, is detrimental for patients because clinical trial results supposed to be based on the best information from clinical trials possibly may be restructured by others, and is done so with deliberate intent and reckless disregard. Pharmaceutical Marketing uses science this way as a host to infect it, and bastardize the scientific method.
Knowledge is power, and is also possibly a lifesaver.
“Ethics and Science need to shake hands.” ……. Richard Cabot
Dan Abshear
Author’s note: What has been written was based upon information and belief.
Published on: www.brainblogger.com
Monday, June 8, 2009
Exposure
Exposure Is A Good Thing…..
Australian class action against Merck in the federal court began 3-30-2009 in Melbourne. Merck is fighting this class action- risking the copious amounts of dirty laundry of theirs being exposed to the world. Their confidence and ego as an entity are clearly inflated.
Plaintiffs are led by Graeme and Peterson law firm. The judge is Chris Jessup.
Trial is expected to take a critical look at the autonomy, behavior, and marketing tactics of Merck. Reports and articles from this trial since it has started follows:
3-31: Merck employee David Loker had both his parents die while on Vioxx. David considers Merck’s defense regarding Vioxx rightfully a bit too much to swallow. Merck is being accused of ignoring clinical tests, which they did if the tests did not favor Vioxx. Just because something is ignored or is not discussed certainly does not mean it does not exist.
Vioxx linked to CV events was acknowledged in 1998. Merck employee and laboratory head Ed Scholnick was troubled and worried about research results recently linking Vioxx to CV events in the year 2000. Yet no action was taken by this man high up the corporate ladder of Merck, and action should have been taken to save the lives of others.
4-1: Merck made a hit list of doctors who had to be neutralized and discredited due to criticizing Vioxx, and recommended a course of action, which included intimidation tactics as damage control. The doctors were primarily researchers and academics, as Merck was seeking KOLs. Key Opinion Leaders are coerced by Merck to present Vioxx with intentional bias, as Merck is paying them for this role with their company.
Merck’s culture is illustrated that seriously impinges on academic freedom. Mr. Peterson is accused by Merck of not taking Vioxx months before his myocardial infarction, based on filling of a prescription of Vioxx. Not taken into account is the samples of Vioxx Mr. Peterson likely took in the months before his MI.
4-2: Dr. Paul Anderson was unaware of the cardiovascular risk associated with Vioxx, and would not have prescribed this drug had he known this association existed. This overtly exposes Merck’s unbalanced representation of the qualities of Vioxx.
4-9: Merck hires guest authors, such as scientists, doctors, and academics, for research constructed by Merck, as well as Merck constructing entire journals that are deceptive to others intentionally. All data presented to others from such bastardization of the scientific method is likely harmful to both health care providers and the patients who may take Vioxx as a result.
4-15: Dr. John Dickman states that over the course of 3 years, the multiple visits by Vioxx sales representatives never disclosed the risks of Vioxx and cardiovascular events. This is not unusual, as pharmaceutical representatives are only concerned with increasing the number of prescriptions of products they promote to doctors. Balancing their conversations with doctors regarding their promoted products provides no benefit to the representative, and would be against their monetary goal.
4-16: Aggressive sales strategies shared with the court implemented by Merck and the marketing of Vioxx. Sales representatives with Merck were directed to utilize objection handling cards if anything negative about Vioxx was brought up by a prescriber. This, apparently, was felt necessary by Merck so that the sales representative would not engage or research any negative qualities associated with Vioxx.
Merck implemented a highly sophisticated and well-resourced marketing campaign that was able to minimize the awareness of safety risks that exist with Vioxx. This included telling Vioxx sales representatives that cardiovascular risks being associated with Vioxx is outright lies generated by competitors of Vioxx. This seemed to comfort the Vioxx sales representatives, and sedate any concerns they may have had about this very serious issue.
4-17: Merck implements quid pro quo with bribing targeted doctors so they will prescribe more Vioxx. This in itself is illegal in the United States at times, as it violates the federal Anti-Kickback statute.
Merck gives its sales representatives a ‘budget spend’, and requires them to exhaust the budget within a certain time frame. So obviously Merck representative are anxious to bribe doctors for this reason alone.
They determine such doctors by the prescribing data they have on each doctor due to the AMA selling prescribing data to the pharmaceutical industry in the United states that makes the American Medical Association about 50 million dollars a year.
4-18: Merck intends to bring a Vioxx human commercial to Australia to increase market share of Vioxx at this location, which actually is Merck attempting to acquire a new host for their damaging virus. Also, again it is stated the obvious- that Merck insists on minimizing potential adverse publicity while maintaining credibility of both Merck and Vioxx. With this trial, Merck is maximizing adverse publicity and disintegrating the credibility of the organization.
4-20: Merck creates an Arthritis Advisory board with the intent to mask this board as a front group to gain support for Vioxx both in Australia in Asia. This, they believed, would have more credibility than Merck attempting to accomplish this goal alone as a company.
One objective of this board, who was paid 2000 dollars each member at every meeting by Merck, was to publically state that Vioxx was superior to similar drugs, as well as offering positive advice about Vioxx to regulatory agencies. The board’s members at times were used by Merck without their knowledge to facilitate the profitable efforts of Merck regarding Vioxx.
While stating that this board was to educate others, it clearly was created to promote Vioxx. Front groups similar in nature to this one are often created by big pharmaceutical companies to expand the diagnostic boundaries of a specific disease state to increase the growth of their promoted product. What they call brand conditioning really is disease mongering.
4-22: Merck scientist and senior VP of Merck’s research laboratories Alise Reicin expressed concern about the CV issues associated with Vioxx in the year 1997. Dr. Briggs Morrison, a colleague of this scientist, was aware through this email of the Vioxx concerns 2 years before the drug got FDA approval in the United States.
4.24: Merck attempts to encourage their Vioxx sales representatives with ridiculous songs. This is nothing short of cult-like behavior. Merck wants their sales representatives to be passionate about a tangible object- Vioxx. Merck wants them to be void of objectivity, as this will to be to the benefit of Merck. The whole subculture of Merck seems to think that their vocations are some sort of TV show or movie. Fictional. Not illustrating the importance of what they should know and do.
4-24: Merck has hired a crisis management team and media relations firm to supplement their own litigation communications team for this trial to save face. This team and firm are largely failing, it seems. At this point, Merck is not going to be able to offer interpretations of what is being presented in this trial about a month old at this point.
4-28: Documents illustrate that Merck Vioxx sales representatives are extrinsically motivated primarily by money, and this is what Merck wants their primary motivation to be working for them. Helping the rich get richer can be deadly for others.
Merck representatives, as with other pharmaceutical representatives in the United States, rarely have a medical background or knowledge. Merck knows this, so their training mainly consists of how to manipulate prescribers and bribe them to grow the market share of products these representatives will promote for them. It is unlikely that these representatives understand cox II inhibition, the inflammatory process, the disease state of osteoarthritis, or the fact that if something is a drug, it has side effects. If a drug does not have side effects, it is not a drug.
4-29: Additional remuneration via dinners and nice hotels paid for by Merck for selected and target doctors potentially or actually core to the growth of Vioxx. It’s likely that Merck would not engage in such activities with doctors that are catalysts for their monetary growth if such activities were not effective.
5-5: Merck makes the claim that clinical studies involving Vioxx are contradictory often, and therefore Vioxx cannot be labeled a cardiovascular risk for patients. Yet Merck proved beyond material extent that the evidence from these clinical trials clearly showed that Vioxx did in fact increase the risk of heart attacks for those who take the drug. Yet if Vioxx is making over 2 billion dollars a year for Merck, such concerns are of little importance to the company.
5-6: Merck hired a heart expert in the United States to go to the Australian trial to praise Vioxx and its benefits and safety. Dr. Douglas Vaughan. Vioxx was promoted the safety of Vioxx through its sales representatives on every dialogue with a prescriber, as well as superior efficacy that did not exist compared with other cox II inhibitors and NSAIDS.
5-7: Elsevier in collusion with Merck’s deceptive marketing ploy by faking an independent medical journal for the benefit of Merck’s Vioxx, and others. Elsevier’s admission in this cronyism only happened when it was forced to do so due to various factors that were going to become transparent. Elsevier’s business model largely is directed at facilitating the marketing efforts for companies like Merck. Normally this business model of theirs is quietly implemented. This case is rare here.
5-7: Merck accused of making scientifically unsound claims generated from corrupted and invalid studies created by Merck, as claimed by Vioxx critic and Rheumatologist, Les Cleland. It appears the accusations are indeed with merit, as the evidence is overwhelming.
5-12: Merck convinces regulators, such as the FDA, to soften the warnings they insist on putting on the Vioxx label now three years after the drug has been on the market. The FDA considers such companies as Merck ‘clients’, due in large part to what is known as the PDUFA (Prescription Drug Users Fee Act). Created to speed drug approvals and have drug companies pay the FDA to do so, this act now accounts for over 50 percent of the FDA’s entire budget. The FDA is supposed to strictly regulate, and not serve those entities that may harm others.
5-14: Merck attempts to stall safety and pricing probes about Vioxx. The reasons are obvious.
5-23: The money spent by Merck for promotional tactics is illustrated. Merck, as with other large pharmaceutical companies, spends more money on marketing than they do on research. The plans involving these tactics are approved by various marketing leadership of Merck. Their strategies involving their tactics created with deliberate intent and reckless disregard were implemented with complete autonomy.
6-8: Merck planned to set up patient loyalty programs to assure greater compliance regarding such patients taking Vioxx. This was developed by Merck simply so patients would take Vioxx for a longer period of time. Think of it as a superior version of direct to consumer advertising.
Merck, I believe, is relying on the apathy of others as information continues to be shared from this trial. Thank you Milanda Rout at “The Australian” for your dedication in sharing with the world what is happening with this trial:
Hi,
I just wanted to say a belated thank you for your lovely comments about my coverage of the Vioxx trial – much appreciated!
I also note with interest that you were once a Merck sales representative – I would love to have a chat with you (off the record if you prefer it) about your experiences at Merck with Vioxx if that would suit you. I am interested in doing a more in-depth piece about the issues that the trial raised after the court process has finished.
Thanks again,
Milanda Rout
Milanda Rout
The Australian
Level 2, West IBM Centre,
60 City Rd, Southbank, Victoria.
Ph: 0414 835 787
Fax: (03) 9292 2803
-----Original Message-----
From: Robyn Clothier [mailto:robyn@healthyskepticism.org]
Sent: Monday, 25 May 2009 10:12 AM
To: Rout, Milanda
Subject: FW: Check out vioxx - The Australian Search
Milanda,
I thought you might be interested in these comments from one of our members – a former pharmaceutical representative in the US.
May I add my congratulations on your excellent work, which we have been following closely.
Robyn Clothier
Administrative Assistant
Healthy Skepticism Inc
34 Methodist St
Willunga SA 5172
Australia
Ph/Fax: +61 8 8557 1040
www.healthyskepticism.org
From: Diohdan@aol.com [mailto:Diohdan@aol.com]
Sent: Wednesday, 20 May 2009 1:05 PM
To: robyn@healthyskepticism.org
Subject: Check out vioxx - The Australian Search
Click here: vioxx - The Australian Search
The Australian has done a wonderful job exposing what were tacit tactics utilized by Merck to promote Vioxx. This would not have happened in the U.S., I'm sad to say, this kind of exposure.
I launched Vioxx as a representative with Merck back in 1999.
Aside from looming patent experations from two of Merck’s ACE Inhibitor hypertension drugs, Vasotec and Prinival, as well as their first statin drug, Mevacor, this drug was very important to Merck for two other more concerning reasons: One is that Lipitor, which was approved in 1997, rapidly acquired the lion's share of the statin market (Merck has the lion's share of this class of medications with Zocor before this happened). Merck was not prepared for this rapid uptake of Lipitor, and this vexed Merck greatly.
Secondly, Vioxx got approved 6 months after Celebrex, and this concerned Merck. Historically, the drug that is first in class that gains approval first will capture the lion's share of the market, and maintain the lead over the competitors- in this case, the Cox II class of medications.
Celebrex getting approval before Vioxx concerned Merck as well. So the plans implement read almost daily in The Australian are plans that were implemented in the United States as well. Merck was desperate, and clearly was willing to cross ethical lines to assure Vioxx would be the success that Merck needed it to be due to competition.
What we read about this trial that continues is accurate, even though merck is saying in defense that most of we read is 'mis-statements', or embellishents. What we read is true, and the ethically if not legally corrupt plans of actions implemented by Merck were with deliberate intent and reckless disregard as they continued to strive to gain additional market share with an unsafe drug of theirs.
Dan Abshear
Australian class action against Merck in the federal court began 3-30-2009 in Melbourne. Merck is fighting this class action- risking the copious amounts of dirty laundry of theirs being exposed to the world. Their confidence and ego as an entity are clearly inflated.
Plaintiffs are led by Graeme and Peterson law firm. The judge is Chris Jessup.
Trial is expected to take a critical look at the autonomy, behavior, and marketing tactics of Merck. Reports and articles from this trial since it has started follows:
3-31: Merck employee David Loker had both his parents die while on Vioxx. David considers Merck’s defense regarding Vioxx rightfully a bit too much to swallow. Merck is being accused of ignoring clinical tests, which they did if the tests did not favor Vioxx. Just because something is ignored or is not discussed certainly does not mean it does not exist.
Vioxx linked to CV events was acknowledged in 1998. Merck employee and laboratory head Ed Scholnick was troubled and worried about research results recently linking Vioxx to CV events in the year 2000. Yet no action was taken by this man high up the corporate ladder of Merck, and action should have been taken to save the lives of others.
4-1: Merck made a hit list of doctors who had to be neutralized and discredited due to criticizing Vioxx, and recommended a course of action, which included intimidation tactics as damage control. The doctors were primarily researchers and academics, as Merck was seeking KOLs. Key Opinion Leaders are coerced by Merck to present Vioxx with intentional bias, as Merck is paying them for this role with their company.
Merck’s culture is illustrated that seriously impinges on academic freedom. Mr. Peterson is accused by Merck of not taking Vioxx months before his myocardial infarction, based on filling of a prescription of Vioxx. Not taken into account is the samples of Vioxx Mr. Peterson likely took in the months before his MI.
4-2: Dr. Paul Anderson was unaware of the cardiovascular risk associated with Vioxx, and would not have prescribed this drug had he known this association existed. This overtly exposes Merck’s unbalanced representation of the qualities of Vioxx.
4-9: Merck hires guest authors, such as scientists, doctors, and academics, for research constructed by Merck, as well as Merck constructing entire journals that are deceptive to others intentionally. All data presented to others from such bastardization of the scientific method is likely harmful to both health care providers and the patients who may take Vioxx as a result.
4-15: Dr. John Dickman states that over the course of 3 years, the multiple visits by Vioxx sales representatives never disclosed the risks of Vioxx and cardiovascular events. This is not unusual, as pharmaceutical representatives are only concerned with increasing the number of prescriptions of products they promote to doctors. Balancing their conversations with doctors regarding their promoted products provides no benefit to the representative, and would be against their monetary goal.
4-16: Aggressive sales strategies shared with the court implemented by Merck and the marketing of Vioxx. Sales representatives with Merck were directed to utilize objection handling cards if anything negative about Vioxx was brought up by a prescriber. This, apparently, was felt necessary by Merck so that the sales representative would not engage or research any negative qualities associated with Vioxx.
Merck implemented a highly sophisticated and well-resourced marketing campaign that was able to minimize the awareness of safety risks that exist with Vioxx. This included telling Vioxx sales representatives that cardiovascular risks being associated with Vioxx is outright lies generated by competitors of Vioxx. This seemed to comfort the Vioxx sales representatives, and sedate any concerns they may have had about this very serious issue.
4-17: Merck implements quid pro quo with bribing targeted doctors so they will prescribe more Vioxx. This in itself is illegal in the United States at times, as it violates the federal Anti-Kickback statute.
Merck gives its sales representatives a ‘budget spend’, and requires them to exhaust the budget within a certain time frame. So obviously Merck representative are anxious to bribe doctors for this reason alone.
They determine such doctors by the prescribing data they have on each doctor due to the AMA selling prescribing data to the pharmaceutical industry in the United states that makes the American Medical Association about 50 million dollars a year.
4-18: Merck intends to bring a Vioxx human commercial to Australia to increase market share of Vioxx at this location, which actually is Merck attempting to acquire a new host for their damaging virus. Also, again it is stated the obvious- that Merck insists on minimizing potential adverse publicity while maintaining credibility of both Merck and Vioxx. With this trial, Merck is maximizing adverse publicity and disintegrating the credibility of the organization.
4-20: Merck creates an Arthritis Advisory board with the intent to mask this board as a front group to gain support for Vioxx both in Australia in Asia. This, they believed, would have more credibility than Merck attempting to accomplish this goal alone as a company.
One objective of this board, who was paid 2000 dollars each member at every meeting by Merck, was to publically state that Vioxx was superior to similar drugs, as well as offering positive advice about Vioxx to regulatory agencies. The board’s members at times were used by Merck without their knowledge to facilitate the profitable efforts of Merck regarding Vioxx.
While stating that this board was to educate others, it clearly was created to promote Vioxx. Front groups similar in nature to this one are often created by big pharmaceutical companies to expand the diagnostic boundaries of a specific disease state to increase the growth of their promoted product. What they call brand conditioning really is disease mongering.
4-22: Merck scientist and senior VP of Merck’s research laboratories Alise Reicin expressed concern about the CV issues associated with Vioxx in the year 1997. Dr. Briggs Morrison, a colleague of this scientist, was aware through this email of the Vioxx concerns 2 years before the drug got FDA approval in the United States.
4.24: Merck attempts to encourage their Vioxx sales representatives with ridiculous songs. This is nothing short of cult-like behavior. Merck wants their sales representatives to be passionate about a tangible object- Vioxx. Merck wants them to be void of objectivity, as this will to be to the benefit of Merck. The whole subculture of Merck seems to think that their vocations are some sort of TV show or movie. Fictional. Not illustrating the importance of what they should know and do.
4-24: Merck has hired a crisis management team and media relations firm to supplement their own litigation communications team for this trial to save face. This team and firm are largely failing, it seems. At this point, Merck is not going to be able to offer interpretations of what is being presented in this trial about a month old at this point.
4-28: Documents illustrate that Merck Vioxx sales representatives are extrinsically motivated primarily by money, and this is what Merck wants their primary motivation to be working for them. Helping the rich get richer can be deadly for others.
Merck representatives, as with other pharmaceutical representatives in the United States, rarely have a medical background or knowledge. Merck knows this, so their training mainly consists of how to manipulate prescribers and bribe them to grow the market share of products these representatives will promote for them. It is unlikely that these representatives understand cox II inhibition, the inflammatory process, the disease state of osteoarthritis, or the fact that if something is a drug, it has side effects. If a drug does not have side effects, it is not a drug.
4-29: Additional remuneration via dinners and nice hotels paid for by Merck for selected and target doctors potentially or actually core to the growth of Vioxx. It’s likely that Merck would not engage in such activities with doctors that are catalysts for their monetary growth if such activities were not effective.
5-5: Merck makes the claim that clinical studies involving Vioxx are contradictory often, and therefore Vioxx cannot be labeled a cardiovascular risk for patients. Yet Merck proved beyond material extent that the evidence from these clinical trials clearly showed that Vioxx did in fact increase the risk of heart attacks for those who take the drug. Yet if Vioxx is making over 2 billion dollars a year for Merck, such concerns are of little importance to the company.
5-6: Merck hired a heart expert in the United States to go to the Australian trial to praise Vioxx and its benefits and safety. Dr. Douglas Vaughan. Vioxx was promoted the safety of Vioxx through its sales representatives on every dialogue with a prescriber, as well as superior efficacy that did not exist compared with other cox II inhibitors and NSAIDS.
5-7: Elsevier in collusion with Merck’s deceptive marketing ploy by faking an independent medical journal for the benefit of Merck’s Vioxx, and others. Elsevier’s admission in this cronyism only happened when it was forced to do so due to various factors that were going to become transparent. Elsevier’s business model largely is directed at facilitating the marketing efforts for companies like Merck. Normally this business model of theirs is quietly implemented. This case is rare here.
5-7: Merck accused of making scientifically unsound claims generated from corrupted and invalid studies created by Merck, as claimed by Vioxx critic and Rheumatologist, Les Cleland. It appears the accusations are indeed with merit, as the evidence is overwhelming.
5-12: Merck convinces regulators, such as the FDA, to soften the warnings they insist on putting on the Vioxx label now three years after the drug has been on the market. The FDA considers such companies as Merck ‘clients’, due in large part to what is known as the PDUFA (Prescription Drug Users Fee Act). Created to speed drug approvals and have drug companies pay the FDA to do so, this act now accounts for over 50 percent of the FDA’s entire budget. The FDA is supposed to strictly regulate, and not serve those entities that may harm others.
5-14: Merck attempts to stall safety and pricing probes about Vioxx. The reasons are obvious.
5-23: The money spent by Merck for promotional tactics is illustrated. Merck, as with other large pharmaceutical companies, spends more money on marketing than they do on research. The plans involving these tactics are approved by various marketing leadership of Merck. Their strategies involving their tactics created with deliberate intent and reckless disregard were implemented with complete autonomy.
6-8: Merck planned to set up patient loyalty programs to assure greater compliance regarding such patients taking Vioxx. This was developed by Merck simply so patients would take Vioxx for a longer period of time. Think of it as a superior version of direct to consumer advertising.
Merck, I believe, is relying on the apathy of others as information continues to be shared from this trial. Thank you Milanda Rout at “The Australian” for your dedication in sharing with the world what is happening with this trial:
Hi,
I just wanted to say a belated thank you for your lovely comments about my coverage of the Vioxx trial – much appreciated!
I also note with interest that you were once a Merck sales representative – I would love to have a chat with you (off the record if you prefer it) about your experiences at Merck with Vioxx if that would suit you. I am interested in doing a more in-depth piece about the issues that the trial raised after the court process has finished.
Thanks again,
Milanda Rout
Milanda Rout
The Australian
Level 2, West IBM Centre,
60 City Rd, Southbank, Victoria.
Ph: 0414 835 787
Fax: (03) 9292 2803
-----Original Message-----
From: Robyn Clothier [mailto:robyn@healthyskepticism.org]
Sent: Monday, 25 May 2009 10:12 AM
To: Rout, Milanda
Subject: FW: Check out vioxx - The Australian Search
Milanda,
I thought you might be interested in these comments from one of our members – a former pharmaceutical representative in the US.
May I add my congratulations on your excellent work, which we have been following closely.
Robyn Clothier
Administrative Assistant
Healthy Skepticism Inc
34 Methodist St
Willunga SA 5172
Australia
Ph/Fax: +61 8 8557 1040
www.healthyskepticism.org
From: Diohdan@aol.com [mailto:Diohdan@aol.com]
Sent: Wednesday, 20 May 2009 1:05 PM
To: robyn@healthyskepticism.org
Subject: Check out vioxx - The Australian Search
Click here: vioxx - The Australian Search
The Australian has done a wonderful job exposing what were tacit tactics utilized by Merck to promote Vioxx. This would not have happened in the U.S., I'm sad to say, this kind of exposure.
I launched Vioxx as a representative with Merck back in 1999.
Aside from looming patent experations from two of Merck’s ACE Inhibitor hypertension drugs, Vasotec and Prinival, as well as their first statin drug, Mevacor, this drug was very important to Merck for two other more concerning reasons: One is that Lipitor, which was approved in 1997, rapidly acquired the lion's share of the statin market (Merck has the lion's share of this class of medications with Zocor before this happened). Merck was not prepared for this rapid uptake of Lipitor, and this vexed Merck greatly.
Secondly, Vioxx got approved 6 months after Celebrex, and this concerned Merck. Historically, the drug that is first in class that gains approval first will capture the lion's share of the market, and maintain the lead over the competitors- in this case, the Cox II class of medications.
Celebrex getting approval before Vioxx concerned Merck as well. So the plans implement read almost daily in The Australian are plans that were implemented in the United States as well. Merck was desperate, and clearly was willing to cross ethical lines to assure Vioxx would be the success that Merck needed it to be due to competition.
What we read about this trial that continues is accurate, even though merck is saying in defense that most of we read is 'mis-statements', or embellishents. What we read is true, and the ethically if not legally corrupt plans of actions implemented by Merck were with deliberate intent and reckless disregard as they continued to strive to gain additional market share with an unsafe drug of theirs.
Dan Abshear
Sunday, June 7, 2009
Disregarding
Conflicts of interests are not judged subjectively. They either exist, or they do not. It's a situation in which the regard for one duty leads to disregard of another, potentially or actually.
Essentially, in medicine, this is gifting, or the intent of gifting, and will likely affect the reliability of the receiver while providing benefit to the gifter. Gifting is also known as bribing.
As such, the receiver is now conflicted, compromised, and their best judgment is now clouded. Clinical research with pharmaceutical companies are examples of conflicts of interests.
Falsifying clinical research that is entirely premeditated by such criminals, as well as not sharing if not destroying negative data that may reflect their product is in fact a panacea screams conflicts of interests.
Why does this progressively occur, this bastardization of the scientific method?
Guidelines, if they exist, are intentionally ignored, as the manipulators have bought an atmosphere of profitable autonomy.
The revolving door between say congress and the DOJ with huge law firms that represent criminals and wrongdoers shouts tacitly “we are the poster children for conflicts of interest”, by allowing such autonomy to exist.
There has been a marriage made in hell. As a result, the health of others is not restored or harmed.
And no one stops this atrophy from happening- this toxic and anaphylactic death that is happening to our medical innovation, or lack of it existing at all.
Dan Abshear
Essentially, in medicine, this is gifting, or the intent of gifting, and will likely affect the reliability of the receiver while providing benefit to the gifter. Gifting is also known as bribing.
As such, the receiver is now conflicted, compromised, and their best judgment is now clouded. Clinical research with pharmaceutical companies are examples of conflicts of interests.
Falsifying clinical research that is entirely premeditated by such criminals, as well as not sharing if not destroying negative data that may reflect their product is in fact a panacea screams conflicts of interests.
Why does this progressively occur, this bastardization of the scientific method?
Guidelines, if they exist, are intentionally ignored, as the manipulators have bought an atmosphere of profitable autonomy.
The revolving door between say congress and the DOJ with huge law firms that represent criminals and wrongdoers shouts tacitly “we are the poster children for conflicts of interest”, by allowing such autonomy to exist.
There has been a marriage made in hell. As a result, the health of others is not restored or harmed.
And no one stops this atrophy from happening- this toxic and anaphylactic death that is happening to our medical innovation, or lack of it existing at all.
Dan Abshear
Wednesday, June 3, 2009
Vioxx
Mr. Tom Nesi, a 30 year pharmaceutical industry veteran, recently published a book called, “Poison Pills- The Untold Story of the Vioxx Drug Scandal.” I believe this to be a great book- very informative and interesting.
And I wanted to echo what he likely wrote in this book regarding Vioxx, since I was involved with the promotion of Vioxx when I was a sales representative with Merck some time ago:
Merck brought Vioxx to the market in the Spring of 1999 in the United States, which was six months after the first COX II class drug got approval in the United States, which was G.D. Searle’s Celebrex.
Many remember the shock when Vioxx was pulled from the market in the Fall of 2004. Many called this event unbelievable, if not surreal. The drug was so widely used and had been on the market for about 5 years.
And Merck was…well….MERCK. How could this happen? Over 80 million people had taken the drug worldwide at the time the drug was removed from the market. Sales were approaching 3 billion dollars a year. Why is this happening? To save the cardiovascular function of others who may take Vioxx?
Beginning I believe in 1998, Merck and G.D. Searle, a division of Monsanto, were in a race of sorts to bring to market the first COX-2 inhibitor. It would be a pain and inflammation drug that they speculated would be safe- especially safer on the stomach of the user than any other medication available.
Efficacy would not be compromised. Relief for these patients would occur. The word from both companies heard often was, ‘blockbuster’, when referring to their pending COX-2 inhibitors. This class would be in fact a pain and inflammation panacea, according to these two companies.
Turns out G.D. Searle came out with Celebrex, their COX-2 inhibitor first, towards the end of 1998. Merck was disappointed, but moved on confidently- knowing most likely that their COX-2, Vioxx, would surely get approved soon after Celebrex hit the market.
It had to acquire the lion’s share of the COX II francise. Lipitor was about to be launched, and Parke Davis was convinced it would be the number one statin drug- and would quickly overtake the lead of Merck's Zocor. Merck was very concerned about this viable threat to this franchise they owned with statins. Merck came out with the first statin, Mevacor, in the 1980s.
So, Vioxx was approved in the Spring of 1999. In fact, I launched the drug as a sales rep with Merck at that time along with most other sales representatives employed by Merck. The meeting which thousands of sales reps. attended was at one of San Francisco’s nicer hotels in late May of 1999. David Anstice gave some synthetic cheers, and the obedient soldiers followed. The elation of the sales force was nothing less than what can only be described as complete and disturbing mania. .
Everyone in the various sales teams had some part in the launch of Vioxx. Merck was depending on its success. And a successful launch it was- one of the best drug launches ever for a drug company.
What I did not know at the time I launched this drug is that Vioxx was suspected as having cardiovascular risks associated with this drug as early as 1996- and was confirmed to have this risk in 1998. Also, key opinion leaders (KOLs) increased in number, and their utilization, to further promote Vioxx aggressively and progressively both before and after approval of Vioxx. These speakers who favored Merck’s Vioxx were located within a state, region, or the entire United States.
They were selected by a targeting method utilized that factors in the volume of prescriptions a doctor writes, and how many of these prescriptions favor the products of Merck.
These KOLs were analyzed constantly to make sure they were doing what they were being paid to do- which is sell Vioxx to their peers- their fellow health care providers. Their prescribing analysis is due to the American Medical Association selling prescribing data on individual doctors to pharmaceutical companies- with a third party company as a carrier of this data to them. This earns the AMA about 50 million dollars every year.
I left Merck at the end of 1999- soon after the launch, for another employment opportunity. And I was sad to leave such a well-respected company, yet I felt that the hype of their sales and marketing force was a bit pathological and with an air of desperation within the culture of Merck, it seemed. So at the end of 1999, I wished to explore a new challenge with another company and hope for the best.
In the years after I left, the Merck sales reps. Were forced to acknowledge and address potential obstacles presented to them by prescribers regarding Vioxx, and would play games such as ‘dodgeball’ or some other silly neumonic concept derived from Merck’s marketing department. This was done so Merck could be comforted that their sales force would not engage in a conversation beneficial for the patients of the prescribers, but rather financially beneficial for Merck.
Additional games played by Merck to their sales reps often include comedy skits related to their promoted products, and the hiring of doctors to attend company meetings to hear the sales pitches of Merck reps.- and grade their performance afterwards.
Such ridiculous games enabled Merck sales reps. to hopefully internalize the concept that the cardiovascular risk associated with Vioxx was not a real risk that prescribers need to know. Merck does not want their reps. to think, of course.
Vioxx continued to grow, and it also continued to be studied to reassure others of the safety and efficacy of the drug, as well as possible other uses for the drug besides pain and inflammation.
The much anticipated VIGOR trial results were released in 2001, which compared Vioxx to Naproxen, an older non-steroidal anti-inflammatory drug. During the trial, there was a 4 fold increase in heart attacks with the Vioxx patients vs. Naproxen, which was concerning.
Since Merck controlled and secured all data from this trial for themselves to sculpt to their favor for Vioxx, they had the ability to selectively share data that was incomplete for publication. This is what occurred with the New England Journal of Medicine, who published what they believed was the entire data that was included and acquired from the VIGOR trial.
However, Merck, with deliberate intent, did not report negative data to the NEJM, such as MIs with subjects in the trial taking Vioxx. Merck deleted such data from the VIGOR manuscript before submitting the trial for publication, it has been reported.
Merck said this was due to the natural cardio-protective effects of Naproxen that had been known already. Others attributed the concerning risk of heart attacks and stroke to Vioxx and its undisclosed pro-thrombotic effect which was responsible for the increase in heart attacks and strokes. The debate continues to this day. Many believe Naproxen does not provide any significant cardioprotective effect for one who takes this drug.
Merck has a history of creating with deliberate intent seeding trials. These are trials that are disguised as science-seeking peer-reviewed journals. In actuality, such clinical trials are merely marketing outlets to fulfill marketing objectives.
Created by the marketing divisions of typically large pharmaceutical companies, this division not only handles all data acquired from their jigsaw trial, but also does not disclose the purpose of the trial to the trial participants.
Merck’s ADVANTAGE trial, which began soon after Vioxx got approved was the first documentary evidence that proved the existence of seeding trials, and was published in the Archives of Internal Medicine after its completion.
An editorial from the staff of the journal followed- illustrating that this trial is, in fact, a seeding trial. Merck responded to this editorial expressing shock and disbelief- stating that had only the authors and editors of the clinical trial contacted Merck about the fallacies illustrated in the trial and editorial, then all would see the true benefit and intentions with the ADVANTAGE trial. Yet, according to Merck, these gifted annotators chose not to contact them. Therefore, the study is flawed due to those not as competent as Merck.
Yet the FDA issued a notice to Merck in the Spring of 2002 that a warning would be on the labeling for Vioxx about the increased risk for cardiovascular events for those who take this drug. Also, soon after the results of VIGOR were released, it was discovered that Merck manipulated the data from the VIGOR trial and engaged in scientific misconduct with their deliberate statistical gymnastics they performed with the data from this trial.
When the truth about the complete data was analyzed by others, it was determined that Vioxx caused actually a 5 fold increase in cardiovascular events instead of four. Merck would later claim that this issue with the VIGOR trial was simply an oversight.
Over 100 thousand heart attacks, about 35 percent of them fatal, attributed to those who took Vioxx, and it was an ‘oversight’. Studies now show that one can have a cardiovascular event as soon as two weeks after taking Vioxx, and the risk continues for cardiovascular events up to a year after vioxx is no longer taken by a patient.
In addition, as others analyzed all data about Vioxx they could locate, others determined that Vioxx should have been removed from the Market a year after it was launched for use by patients who were prescribed Vioxx by their health care providers.
Merck, however, moved on with the growth of Vioxx, and appeared to ignore this overt and dangerous risk that likely was associated with their drug.
The APPROVe trial was initiated soon after the VIGOR trial to study the use of Vioxx in treating colon polyps. The trial was terminated early due to increase in adverse thrombitic cardiovascular events, heart attacks and strokes in particular, with those patients taking Vioxx.
In particular, those patients who took Vioxx long term experienced increased cardiovascular events, yet some experienced such events after only 2 months, it has been reported, and this was noted in the VIGOR trial. Vioxx was removed from the market shortly after this trial was halted. Merck minimized if not intentionally eliminated the risks of Vioxx as an etiology for cardiovascular events by skewing research.
Sponsors of their clinical trials have a clear financial interest in their products being studied, as well as a fiduciary duty to shareholders to provide a return on their investment. These particular variables ultimately disqualify the sponsor from other much more important duties, such as assuring clinical trials involving the sponsor’s products are aseptic and void of bias.
Yet since this method frequently occurs, the trust is violated of the human subjects who volunteer for these clinical trials to advance science, medicine, and public health.
The sales reps of Merck were encouraged to strive to increase their income only in all that they did for their employer that they were coerced to do by this source of income for them and the products they now promote that do not include Vioxx as of the Fall of 2004.
Dr. David Graham, Associate Director in the FDA’s Office of Drug Safety, witnessed the FDA trying to discredit him after Dr. Graham told a U.S. Senate Hearing that the FDA had failed to protect the public over Vioxx. Dr. Graham said that the FDA is simply not capable of protecting America against another Vioxx. Dr. Graham went on to mention a few other drugs on the market of concern as well.
Presently, there are warnings with all COX-2 inhibitors that they should not be taken by those patients who have cardiovascular disease, or are at risk for this disease, as it is believed that the cardiovascular events noted with Vioxx are a class effect with all COX-2 inhibitors.
Today, believe it or not, after re-analyzing all the data with Vioxx from all the studies performed on the drug, the FDA has concluded that Vioxx could be returned to the market, as it has been determined that, with certain patients, the benefits outweigh the risks. Other countries feel the same way, and consider COX-2 inhibitors as a class no different than NSAIDS as far as their safety for others is concerned.
Right now, there is a very interesting class action lawsuit occurring in Australia. Since the end of March of this year, often one can read about what tactics implemented by Merck when promoting Vioxx, and the whole world can acquire this very secret information. It is an unusually unexpected window into the aggressive tactics used by international drug companies to market their drugs. This window has been widely opened by Ms. Milanda Rout:
Hi,
I just wanted to say a belated thank you for your lovely comments about my coverage of the Vioxx trial – much appreciated!
I also note with interest that you were once a Merck sales representative – I would love to have a chat with you (off the record if you prefer it) about your experiences at Merck with Vioxx if that would suit you. I am interested in doing a more in-depth piece about the issues that the trial raised after the court process has finished.
Thanks again,
Milanda Rout
Milanda Rout
The Australian
Level 2, West IBM Centre,
60 City Rd, Southbank, Victoria.
Ph: 0414 835 787
Fax: (03) 9292 2803
-----Original Message-----
From: Robyn Clothier [mailto:robyn@healthyskepticism.org]
Sent: Monday, 25 May 2009 10:12 AM
To: Rout, Milanda
Subject: FW: Check out vioxx - The Australian Search
Milanda,
I thought you might be interested in these comments from one of our members – a former pharmaceutical representative in the US.
May I add my congratulations on your excellent work, which we have been following closely.
Robyn Clothier
Administrative Assistant
Healthy Skepticism Inc
34 Methodist St
Willunga SA 5172
Australia
Ph/Fax: +61 8 8557 1040
www.healthyskepticism.org
From: Diohdan@aol.com [mailto:Diohdan@aol.com]
Sent: Wednesday, 20 May 2009 1:05 PM
To: robyn@healthyskepticism.org
Subject: Check out vioxx - The Australian Search
Click here: vioxx - The Australian Search
The Australian has done a wonderful job exposing what were tacit tactics utilized by Merck to promote Vioxx. This would not have happened in the U.S., I'm sad to say, this kind of exposure.
I launched Vioxx as a representative with Merck back in 1999. This drug was very important to Merck for two reasons: One is that Lipitor, which was approved in 1997, rapidly acquired the lion's share of the statin market (Merck has the lion's share of this class of medications with Zocor before this happened). Merck was not prepared for this rapid uptake of Lipitor, and this vexed Merck greatly.
Secondly, Vioxx got approved 6 months after Celebrex, and this concerned Merck. Historically, the drug that is first in class that gains approval first will capture the lion's share of the market, and maintain the lead over the competitors- in this case, the Cox II class of medications.
Celebrex getting approval before Vioxx concerned Merck as well. So the plans implement read almost daily in The Australian are plans that were implemented in the United States as well. Merck was desperate, and clearly was willing to cross ethical lines to assure Vioxx would be the success that Merck needed it to be due to competition.
What we read about this trial that continues is accurate, even though Merck is saying in their defense that most of we read is 'mis-statements', or embellishments. What is now shared with the world are statements that are false, misleading, or lack context.
Merck insists that it has been vigilant in regulating and sharing all cardiovascular issues associated with Vioxx. They say they have acted responsibly and appropriately as it developed and commercialized Vioxx- acting in the best interest of patients always.
What we read is true, and the ethically if not legally corrupt plans of actions implemented by Merck were with deliberate intent and reckless disregard as they continued to strive to gain additional market share with an unsafe drug of theirs.
Dan Abshear
And I wanted to echo what he likely wrote in this book regarding Vioxx, since I was involved with the promotion of Vioxx when I was a sales representative with Merck some time ago:
Merck brought Vioxx to the market in the Spring of 1999 in the United States, which was six months after the first COX II class drug got approval in the United States, which was G.D. Searle’s Celebrex.
Many remember the shock when Vioxx was pulled from the market in the Fall of 2004. Many called this event unbelievable, if not surreal. The drug was so widely used and had been on the market for about 5 years.
And Merck was…well….MERCK. How could this happen? Over 80 million people had taken the drug worldwide at the time the drug was removed from the market. Sales were approaching 3 billion dollars a year. Why is this happening? To save the cardiovascular function of others who may take Vioxx?
Beginning I believe in 1998, Merck and G.D. Searle, a division of Monsanto, were in a race of sorts to bring to market the first COX-2 inhibitor. It would be a pain and inflammation drug that they speculated would be safe- especially safer on the stomach of the user than any other medication available.
Efficacy would not be compromised. Relief for these patients would occur. The word from both companies heard often was, ‘blockbuster’, when referring to their pending COX-2 inhibitors. This class would be in fact a pain and inflammation panacea, according to these two companies.
Turns out G.D. Searle came out with Celebrex, their COX-2 inhibitor first, towards the end of 1998. Merck was disappointed, but moved on confidently- knowing most likely that their COX-2, Vioxx, would surely get approved soon after Celebrex hit the market.
It had to acquire the lion’s share of the COX II francise. Lipitor was about to be launched, and Parke Davis was convinced it would be the number one statin drug- and would quickly overtake the lead of Merck's Zocor. Merck was very concerned about this viable threat to this franchise they owned with statins. Merck came out with the first statin, Mevacor, in the 1980s.
So, Vioxx was approved in the Spring of 1999. In fact, I launched the drug as a sales rep with Merck at that time along with most other sales representatives employed by Merck. The meeting which thousands of sales reps. attended was at one of San Francisco’s nicer hotels in late May of 1999. David Anstice gave some synthetic cheers, and the obedient soldiers followed. The elation of the sales force was nothing less than what can only be described as complete and disturbing mania. .
Everyone in the various sales teams had some part in the launch of Vioxx. Merck was depending on its success. And a successful launch it was- one of the best drug launches ever for a drug company.
What I did not know at the time I launched this drug is that Vioxx was suspected as having cardiovascular risks associated with this drug as early as 1996- and was confirmed to have this risk in 1998. Also, key opinion leaders (KOLs) increased in number, and their utilization, to further promote Vioxx aggressively and progressively both before and after approval of Vioxx. These speakers who favored Merck’s Vioxx were located within a state, region, or the entire United States.
They were selected by a targeting method utilized that factors in the volume of prescriptions a doctor writes, and how many of these prescriptions favor the products of Merck.
These KOLs were analyzed constantly to make sure they were doing what they were being paid to do- which is sell Vioxx to their peers- their fellow health care providers. Their prescribing analysis is due to the American Medical Association selling prescribing data on individual doctors to pharmaceutical companies- with a third party company as a carrier of this data to them. This earns the AMA about 50 million dollars every year.
I left Merck at the end of 1999- soon after the launch, for another employment opportunity. And I was sad to leave such a well-respected company, yet I felt that the hype of their sales and marketing force was a bit pathological and with an air of desperation within the culture of Merck, it seemed. So at the end of 1999, I wished to explore a new challenge with another company and hope for the best.
In the years after I left, the Merck sales reps. Were forced to acknowledge and address potential obstacles presented to them by prescribers regarding Vioxx, and would play games such as ‘dodgeball’ or some other silly neumonic concept derived from Merck’s marketing department. This was done so Merck could be comforted that their sales force would not engage in a conversation beneficial for the patients of the prescribers, but rather financially beneficial for Merck.
Additional games played by Merck to their sales reps often include comedy skits related to their promoted products, and the hiring of doctors to attend company meetings to hear the sales pitches of Merck reps.- and grade their performance afterwards.
Such ridiculous games enabled Merck sales reps. to hopefully internalize the concept that the cardiovascular risk associated with Vioxx was not a real risk that prescribers need to know. Merck does not want their reps. to think, of course.
Vioxx continued to grow, and it also continued to be studied to reassure others of the safety and efficacy of the drug, as well as possible other uses for the drug besides pain and inflammation.
The much anticipated VIGOR trial results were released in 2001, which compared Vioxx to Naproxen, an older non-steroidal anti-inflammatory drug. During the trial, there was a 4 fold increase in heart attacks with the Vioxx patients vs. Naproxen, which was concerning.
Since Merck controlled and secured all data from this trial for themselves to sculpt to their favor for Vioxx, they had the ability to selectively share data that was incomplete for publication. This is what occurred with the New England Journal of Medicine, who published what they believed was the entire data that was included and acquired from the VIGOR trial.
However, Merck, with deliberate intent, did not report negative data to the NEJM, such as MIs with subjects in the trial taking Vioxx. Merck deleted such data from the VIGOR manuscript before submitting the trial for publication, it has been reported.
Merck said this was due to the natural cardio-protective effects of Naproxen that had been known already. Others attributed the concerning risk of heart attacks and stroke to Vioxx and its undisclosed pro-thrombotic effect which was responsible for the increase in heart attacks and strokes. The debate continues to this day. Many believe Naproxen does not provide any significant cardioprotective effect for one who takes this drug.
Merck has a history of creating with deliberate intent seeding trials. These are trials that are disguised as science-seeking peer-reviewed journals. In actuality, such clinical trials are merely marketing outlets to fulfill marketing objectives.
Created by the marketing divisions of typically large pharmaceutical companies, this division not only handles all data acquired from their jigsaw trial, but also does not disclose the purpose of the trial to the trial participants.
Merck’s ADVANTAGE trial, which began soon after Vioxx got approved was the first documentary evidence that proved the existence of seeding trials, and was published in the Archives of Internal Medicine after its completion.
An editorial from the staff of the journal followed- illustrating that this trial is, in fact, a seeding trial. Merck responded to this editorial expressing shock and disbelief- stating that had only the authors and editors of the clinical trial contacted Merck about the fallacies illustrated in the trial and editorial, then all would see the true benefit and intentions with the ADVANTAGE trial. Yet, according to Merck, these gifted annotators chose not to contact them. Therefore, the study is flawed due to those not as competent as Merck.
Yet the FDA issued a notice to Merck in the Spring of 2002 that a warning would be on the labeling for Vioxx about the increased risk for cardiovascular events for those who take this drug. Also, soon after the results of VIGOR were released, it was discovered that Merck manipulated the data from the VIGOR trial and engaged in scientific misconduct with their deliberate statistical gymnastics they performed with the data from this trial.
When the truth about the complete data was analyzed by others, it was determined that Vioxx caused actually a 5 fold increase in cardiovascular events instead of four. Merck would later claim that this issue with the VIGOR trial was simply an oversight.
Over 100 thousand heart attacks, about 35 percent of them fatal, attributed to those who took Vioxx, and it was an ‘oversight’. Studies now show that one can have a cardiovascular event as soon as two weeks after taking Vioxx, and the risk continues for cardiovascular events up to a year after vioxx is no longer taken by a patient.
In addition, as others analyzed all data about Vioxx they could locate, others determined that Vioxx should have been removed from the Market a year after it was launched for use by patients who were prescribed Vioxx by their health care providers.
Merck, however, moved on with the growth of Vioxx, and appeared to ignore this overt and dangerous risk that likely was associated with their drug.
The APPROVe trial was initiated soon after the VIGOR trial to study the use of Vioxx in treating colon polyps. The trial was terminated early due to increase in adverse thrombitic cardiovascular events, heart attacks and strokes in particular, with those patients taking Vioxx.
In particular, those patients who took Vioxx long term experienced increased cardiovascular events, yet some experienced such events after only 2 months, it has been reported, and this was noted in the VIGOR trial. Vioxx was removed from the market shortly after this trial was halted. Merck minimized if not intentionally eliminated the risks of Vioxx as an etiology for cardiovascular events by skewing research.
Sponsors of their clinical trials have a clear financial interest in their products being studied, as well as a fiduciary duty to shareholders to provide a return on their investment. These particular variables ultimately disqualify the sponsor from other much more important duties, such as assuring clinical trials involving the sponsor’s products are aseptic and void of bias.
Yet since this method frequently occurs, the trust is violated of the human subjects who volunteer for these clinical trials to advance science, medicine, and public health.
The sales reps of Merck were encouraged to strive to increase their income only in all that they did for their employer that they were coerced to do by this source of income for them and the products they now promote that do not include Vioxx as of the Fall of 2004.
Dr. David Graham, Associate Director in the FDA’s Office of Drug Safety, witnessed the FDA trying to discredit him after Dr. Graham told a U.S. Senate Hearing that the FDA had failed to protect the public over Vioxx. Dr. Graham said that the FDA is simply not capable of protecting America against another Vioxx. Dr. Graham went on to mention a few other drugs on the market of concern as well.
Presently, there are warnings with all COX-2 inhibitors that they should not be taken by those patients who have cardiovascular disease, or are at risk for this disease, as it is believed that the cardiovascular events noted with Vioxx are a class effect with all COX-2 inhibitors.
Today, believe it or not, after re-analyzing all the data with Vioxx from all the studies performed on the drug, the FDA has concluded that Vioxx could be returned to the market, as it has been determined that, with certain patients, the benefits outweigh the risks. Other countries feel the same way, and consider COX-2 inhibitors as a class no different than NSAIDS as far as their safety for others is concerned.
Right now, there is a very interesting class action lawsuit occurring in Australia. Since the end of March of this year, often one can read about what tactics implemented by Merck when promoting Vioxx, and the whole world can acquire this very secret information. It is an unusually unexpected window into the aggressive tactics used by international drug companies to market their drugs. This window has been widely opened by Ms. Milanda Rout:
Hi,
I just wanted to say a belated thank you for your lovely comments about my coverage of the Vioxx trial – much appreciated!
I also note with interest that you were once a Merck sales representative – I would love to have a chat with you (off the record if you prefer it) about your experiences at Merck with Vioxx if that would suit you. I am interested in doing a more in-depth piece about the issues that the trial raised after the court process has finished.
Thanks again,
Milanda Rout
Milanda Rout
The Australian
Level 2, West IBM Centre,
60 City Rd, Southbank, Victoria.
Ph: 0414 835 787
Fax: (03) 9292 2803
-----Original Message-----
From: Robyn Clothier [mailto:robyn@healthyskepticism.org]
Sent: Monday, 25 May 2009 10:12 AM
To: Rout, Milanda
Subject: FW: Check out vioxx - The Australian Search
Milanda,
I thought you might be interested in these comments from one of our members – a former pharmaceutical representative in the US.
May I add my congratulations on your excellent work, which we have been following closely.
Robyn Clothier
Administrative Assistant
Healthy Skepticism Inc
34 Methodist St
Willunga SA 5172
Australia
Ph/Fax: +61 8 8557 1040
www.healthyskepticism.org
From: Diohdan@aol.com [mailto:Diohdan@aol.com]
Sent: Wednesday, 20 May 2009 1:05 PM
To: robyn@healthyskepticism.org
Subject: Check out vioxx - The Australian Search
Click here: vioxx - The Australian Search
The Australian has done a wonderful job exposing what were tacit tactics utilized by Merck to promote Vioxx. This would not have happened in the U.S., I'm sad to say, this kind of exposure.
I launched Vioxx as a representative with Merck back in 1999. This drug was very important to Merck for two reasons: One is that Lipitor, which was approved in 1997, rapidly acquired the lion's share of the statin market (Merck has the lion's share of this class of medications with Zocor before this happened). Merck was not prepared for this rapid uptake of Lipitor, and this vexed Merck greatly.
Secondly, Vioxx got approved 6 months after Celebrex, and this concerned Merck. Historically, the drug that is first in class that gains approval first will capture the lion's share of the market, and maintain the lead over the competitors- in this case, the Cox II class of medications.
Celebrex getting approval before Vioxx concerned Merck as well. So the plans implement read almost daily in The Australian are plans that were implemented in the United States as well. Merck was desperate, and clearly was willing to cross ethical lines to assure Vioxx would be the success that Merck needed it to be due to competition.
What we read about this trial that continues is accurate, even though Merck is saying in their defense that most of we read is 'mis-statements', or embellishments. What is now shared with the world are statements that are false, misleading, or lack context.
Merck insists that it has been vigilant in regulating and sharing all cardiovascular issues associated with Vioxx. They say they have acted responsibly and appropriately as it developed and commercialized Vioxx- acting in the best interest of patients always.
What we read is true, and the ethically if not legally corrupt plans of actions implemented by Merck were with deliberate intent and reckless disregard as they continued to strive to gain additional market share with an unsafe drug of theirs.
Dan Abshear
Tuesday, June 2, 2009
Caregiver
"Everyone should check out Dan Abshear's post under the discussion board on patient/caregivers rights. . . and I mean everyone, i.e., patients, advocates, providers, reps, etc. It's one of the most concise pieces on the topic I've ever read, born of experience." --- Dr. Mark
As one who did patient care for over a decade before becoming a medical salesman, I'd like to offer these recommendations to those patient caregivers who are perhaps new to their profession:
1. Do not let those in the pharmaceutical or medical device industries, for example, interfere with or take priority over patient care.
2. Do not let the industry befriend your staff to gain access to doctors that work with them who are restoring the health of their patients.
3. Do have nurses only accept drug samples from drug reps. No literature of any kind from them. Likely, any clinical information the drug rep may have regarding the drug samples he or she may leave you is inaccurate.
4. Do let those you work with know they have a right to refuse interaction with the medical industries in their practice.
5. Do not answer questions from drug reps about what doctors prefer prescribing for their patients as it relates to their promoted products, or anything else about the health care providers at your location, for that matter.
6. Do not accept any promotional material unless it is truly beneficial for their patients, without branding on the material offered to members who work at your clinic or medical institution.
7. Do let the nurses know that drug reps. are overall not in their clinical setting to facilitate patient care, but to rather increase the volume of what they many be promoting, as this is the etiology for their interaction with you.
8. Do let others who you work wth that, if asked by medical representatives to have a disease screening day of some sort at your facility, or has invitations for such a screening for you or others to attend, consider refusing this request. Often, the screenings are conducted by front groups to expand the diagnostic boundaries of a particular disease state.
9. Do make others you may work with aware, or reiterate to them, that generic drugs are preferred over branded drugs for many reasons, including cost and experience with the medication while providing the safety and efficacy your patients need. Such drugs are listed in what is called an Orange Book.
10. Do let the nurse know that drug reps have in their possession the prescribing or buying habits of health care providers, and will tailor their interaction with them and the prescribers based on this data.
11. Do let others you may work with know that the drug reps are, overall, decent and friendly people who are just doing what they are instructed to do by their employer, and they should be aware of what they may be doing could be detrimental to the health of their patients, if such situations develop.
12. Do let those you may work with know that medical representatives who may be in your patient treatment area can question doctors about what they may choose to prescribe a patient. Yet such representatives should be aware that their time at your patient treatment area is limited.
13. Do let others you may work with know that there are doctors who receive inducements, incentives, rebates, and remuneration from particular drug reps. These gifts that are actually bribes are largely based on the prescriber's affinity for the drug. rep's promoted products or the volume of prescriptions a doctor writes compared with other health care providers. The potential consequences of accepting such bribes which the industry calls many things, including 'gifts', could have on the health of patients and the choices of treatment for them. Such bribing may cloud the judgment of the health care providers who receive such gifts..
14. Let others you may work with know that pharmaceuticals are not the answer to all symptoms or medical conditions. This is of particular importance when it comes to the issue of utilizing psychotropic drugs and antibiotics, as drugs are very over-utilized in the United States.
15. Let others who may work with you know that they should make patient care paramount when seeing patients, and should not let the industry coerce them into thinking otherwise. In other words, their idealism and passion straight out of school should be maintained, however difficult this may be at times. As a patient caregiver, you may get overwhelmed at times.
16. Let others you may work with know that, in the U.S., medical reps. have little training, education, or clinical knowledge relevant to what they may be promoting, however may have charming personalities and appear to possess quality genetic stock. What they may share with you about their promoted drugs is likely embellished or fabricated, if not fully understood by the medical representative.
17. Let others you may work with know that whatever is done for or with patients should be entirely for their benefit, and not for the benefit of a drug company or a health care provider, if such a situation develops or are noticed.
18. Speaking from the perception of the situation in the U.S., there is a shortage of nurses, and the demands on them are cumbersome and exhausting. Remind the nurses that this should not affect the treatment and care they give their patients, as difficult as this may be for the nurses. The pharma industry only amplifies this situation in various ways at certain times and locations. To say again, do not allow others to interfere with patient care.
19. Let others you may work with know that their vocations are noble and needed, and what they do for others most choose not to consider, such as drug reps., for example.
20. "Nursing would be a dream job if there were no doctors." --- Imo Philips
Dan Abshear
As one who did patient care for over a decade before becoming a medical salesman, I'd like to offer these recommendations to those patient caregivers who are perhaps new to their profession:
1. Do not let those in the pharmaceutical or medical device industries, for example, interfere with or take priority over patient care.
2. Do not let the industry befriend your staff to gain access to doctors that work with them who are restoring the health of their patients.
3. Do have nurses only accept drug samples from drug reps. No literature of any kind from them. Likely, any clinical information the drug rep may have regarding the drug samples he or she may leave you is inaccurate.
4. Do let those you work with know they have a right to refuse interaction with the medical industries in their practice.
5. Do not answer questions from drug reps about what doctors prefer prescribing for their patients as it relates to their promoted products, or anything else about the health care providers at your location, for that matter.
6. Do not accept any promotional material unless it is truly beneficial for their patients, without branding on the material offered to members who work at your clinic or medical institution.
7. Do let the nurses know that drug reps. are overall not in their clinical setting to facilitate patient care, but to rather increase the volume of what they many be promoting, as this is the etiology for their interaction with you.
8. Do let others who you work wth that, if asked by medical representatives to have a disease screening day of some sort at your facility, or has invitations for such a screening for you or others to attend, consider refusing this request. Often, the screenings are conducted by front groups to expand the diagnostic boundaries of a particular disease state.
9. Do make others you may work with aware, or reiterate to them, that generic drugs are preferred over branded drugs for many reasons, including cost and experience with the medication while providing the safety and efficacy your patients need. Such drugs are listed in what is called an Orange Book.
10. Do let the nurse know that drug reps have in their possession the prescribing or buying habits of health care providers, and will tailor their interaction with them and the prescribers based on this data.
11. Do let others you may work with know that the drug reps are, overall, decent and friendly people who are just doing what they are instructed to do by their employer, and they should be aware of what they may be doing could be detrimental to the health of their patients, if such situations develop.
12. Do let those you may work with know that medical representatives who may be in your patient treatment area can question doctors about what they may choose to prescribe a patient. Yet such representatives should be aware that their time at your patient treatment area is limited.
13. Do let others you may work with know that there are doctors who receive inducements, incentives, rebates, and remuneration from particular drug reps. These gifts that are actually bribes are largely based on the prescriber's affinity for the drug. rep's promoted products or the volume of prescriptions a doctor writes compared with other health care providers. The potential consequences of accepting such bribes which the industry calls many things, including 'gifts', could have on the health of patients and the choices of treatment for them. Such bribing may cloud the judgment of the health care providers who receive such gifts..
14. Let others you may work with know that pharmaceuticals are not the answer to all symptoms or medical conditions. This is of particular importance when it comes to the issue of utilizing psychotropic drugs and antibiotics, as drugs are very over-utilized in the United States.
15. Let others who may work with you know that they should make patient care paramount when seeing patients, and should not let the industry coerce them into thinking otherwise. In other words, their idealism and passion straight out of school should be maintained, however difficult this may be at times. As a patient caregiver, you may get overwhelmed at times.
16. Let others you may work with know that, in the U.S., medical reps. have little training, education, or clinical knowledge relevant to what they may be promoting, however may have charming personalities and appear to possess quality genetic stock. What they may share with you about their promoted drugs is likely embellished or fabricated, if not fully understood by the medical representative.
17. Let others you may work with know that whatever is done for or with patients should be entirely for their benefit, and not for the benefit of a drug company or a health care provider, if such a situation develops or are noticed.
18. Speaking from the perception of the situation in the U.S., there is a shortage of nurses, and the demands on them are cumbersome and exhausting. Remind the nurses that this should not affect the treatment and care they give their patients, as difficult as this may be for the nurses. The pharma industry only amplifies this situation in various ways at certain times and locations. To say again, do not allow others to interfere with patient care.
19. Let others you may work with know that their vocations are noble and needed, and what they do for others most choose not to consider, such as drug reps., for example.
20. "Nursing would be a dream job if there were no doctors." --- Imo Philips
Dan Abshear
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