Pharma foot-soldiers in the line of fire

Just weeks ago, 27-year-old medical representative Ashish Awasthi allegedly took his life by jumping in front of a train. A suicide letter in his pocket blames the pressure to meet sales targets as the reason for his extreme step.

Awasthi’s death is being investigated. But in his death, the young sales promotion employee has put the spotlight on these foot-soldiers of the pharmaceutical industry and the changing environment they operate in.

Probe a little and sporadic reports emerge of MR suicides from other parts of the country. And whether they are linked to the companies they worked in, or not, they do reveal a disturbing pattern that all is not quite well with this workforce.

An internal study by the Federation of Medical and Sales Representatives Association of India (FMRAI) over 13 years recorded over 200 premature deaths, including suicides, heart attacks and cerebral stroke. And the worrisome part is that the deaths are largely in the 20-30 years age group and occur in the last week of the month.

The last week is when people rush to meet targets… somehow bridge the shortfall, says PN Subramanian, Secretary, FMRAI . The situation has changed over the years and technology has only resulted in increasing the pressure on MRs at all times, he says.

Monthly reviews have become weekly ones and daily performances are tracked. But what these “targets” don’t capture is that the MR’s job is not in isolation. It is operational in nature — an MR merely markets a product, implementing a strategy developed “unilaterally” by the company. Whether it works depends on the company’s managerial inputs, market conditions, purchasing capacity and the MR’s own inputs, he explains.

While doctors are governed by the MCI (Medical Council of India) rules that outline an ethics code, drug companies are not held accountable for the unhealthy promotional practices they compel their MRs to undertake, he alleges. It is almost standard operating procedure for drug companies to “invest” in doctors and expect a “return on investment” of six to eight times, depending on the company, he says. Earlier it was about getting visibility at the doctor’s chamber, now it’s about cornering long-term prescriptions, he adds.

From pedigreed dogs bought from puppy mills to junkets to exotic places like Tashkent, drug companies find ways to fund such activities and the MRs are expected to help carry them out; all this slips between the regulatory cracks, allege industry representatives.

The UCPMP (Uniform Code for Pharmaceutical Marketing Practices) is still a voluntary code, says Subramanian, not binding on drug companies. It was to become mandatory from July 1, but the Government’s notification continues to hang fire.

Pharma industry representatives, across domestic and foreign companies, say they endorse a marketing code that punishes extreme gifting and promotional junkets. But sponsoring a Continuing Medical Education session for doctors, for instance, still needs clarity, they say.

Industry-hands complain that some MRs do not put their best foot forward to promote products, at a time when the pharmaceutical industry faces stiff pressure from competition and Government regulations. The MR community largely does well, its just a few who cannot handle the nature of the job, adds another industry-hand.

Knowledge engagement Consultant and founder of Interlink RB Smarta, once an MR, explains that the profession has changed from being a “knowledge worker” to being just a “transaction related person”. Companies need to redefine their engagement with MRs, manage their expectations, energy and excellence, he says.

Assessing an MR by setting “targets” is a violation of Labour laws, say FMRAI representatives, as MRs are expected to promote the company’s products not achieve targets. Smarta adds, if companies make MRs feel part of the company and its strategies, the prescriptions will increase as the MR engages with doctors on a knowledgeable level and not just a “reminder call”.

Companies are looking to delink targets from incentives, others explore counselling to manage pressure and fluctuating performance perks.

Such interventions could pick up stress signals of an MR who could be working in a remote location.

Pointing to the European Union where these professionals take tests every three years, or Russia where they are qualified doctors, Smarta says, such knowledge initiatives bolster the image of an MR and will help put the pride back in the professions.

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