Pharmaceuticals is one of the most profitable industries in North America. But do the drugs industry's sales and marketing strategies go too far?

制药业是北美最盈利的行业之一。但药品行业的销售和营销策略是否过于激进？

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AA few months ago Kim Schaefer, sales representative of a major global pharmaceutical company, walked into a medical center in New York to bring information and free samples of her company's latest products. That day she was lucky - a doctor was available to see her. 'The last rep offered me a trip to Florida. What do you have?' the physician asked. He was only half joking.

[p:a]几个月前，一家全球大型制药公司的销售代表金·谢弗走进纽约的一家医疗中心，带来公司最新产品的信息和免费样品。那天她很幸运——有一位医生愿意接待她。“最后一位代表邀请我到佛罗里达州去一趟，你有什么产品？”医生问道。他其实只是半开玩笑而已。

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BWhat was on offer that day was a pair of tickets for a New York musical. But on any given day, what Schaefer can offer is typical for today's drugs rep - a car trunk full of promotional gifts and gadgets, a budget that could buy lunches and dinners for a small country, hundreds of free drug samples and the freedom to give a physician $200 to prescribe her new product to the next six patients who fit the drug's profile. And she also has a few $1,000 honoraria to offer in exchange for doctors' attendance at her company's next educational lecture.

[p:b]那天她能提供的，是一张纽约音乐剧的门票。但对如今的药品代表来说，每天所能获得的通常都差不多：一辆后备箱塞满促销礼品和小玩意的汽车、足以支付一个小镇午餐和晚餐的预算、数百份免费的药品样本，以及可以随意给医生200美元，让他们为符合该药适应症的下六名患者开处方的自由。此外，她还准备了若干1000美元的酬金，作为医生参加公司下一场教育讲座的交换条件。

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CSelling pharmaceuticals is a daily exercise in ethical judgement. Salespeople like Schaefer walk the line between the common practice of buying a prospect's time with a free meal, and bribing doctors to prescribe their drugs. They work in an industry highly criticized for its sales and marketing practices, but find themselves in the middle of the age-old chicken-or-egg question - businesses won't use strategies that don't work, so are doctors to blame for the escalating extravagance of pharmaceutical marketing? Or is it the industry's responsibility to decide the boundaries?

[p:c]销售药品是一项日常的伦理判断。像舍弗这样的销售人员，常常在一种常见的做法与另一种做法之间徘徊：前者是用免费餐食来争取潜在客户的关注，后者则是贿赂医生以促使他们开具药物处方。他们身处一个因销售和营销手段而备受批评的行业，却陷入了一个古老的问题——企业不会采用无效的策略，那么医生是否应为日益加剧的医药营销铺张浪费负责？还是说，该由行业自身来决定这些界限？

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DThe explosion in the sheer number of salespeople in the field - and the amount of funding used to promote their causes - forces close examination of the pressures, influences and relationships between drug reps and doctors. Salespeople provide much-needed information and education to physicians. In many cases the glossy brochures, article reprints and prescriptions they deliver are primary sources of drug education for healthcare givers. With the huge investment the industry has placed in face-to-face selling, salespeople have essentially become specialists in one drug or group of drugs - a tremendous advantage in getting the attention of busy doctors in need of quick information.

[p:d]销售代表数量的激增，以及用于推广其业务的资金投入巨大，迫使人们必须深入审视药品代表与医生之间的压力、影响和关系。销售代表为医生提供了急需的信息和教育。在许多情况下，他们提供的精美宣传册、文章转载和处方单，已成为医疗从业者获取药物知识的主要来源。由于行业对面对面销售投入了巨额资金，销售代表实际上已成为某一特定药物或药物类别的专家——这在需要快速获取信息的忙碌医生中具有巨大的吸引力。

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EBut the sales push rarely stops in the office. The flashy brochures and pamphlets left by the sales reps are often followed up with meals at expensive restaurants, meetings in warm and sunny places, and an inundation of promotional gadgets. Rarely do patients watch a doctor write with a pen that isn't emblazoned with a drug's name, or see a nurse use a tablet not bearing a pharmaceutical company's logo. Millions of dollars are spent by pharmaceutical companies on promotional products like coffee mugs, shirts, umbrellas, and golf balls. Money well spent? It's hard to tell. 'I've been the recipient of golf balls from one company and I use them, but it doesn't make me prescribe their medicine,' says one doctor. 'I tend to think I'm not influenced by what they give me.'

[p:e]但销售推广在办公室里却很少就此止步。销售人员留下的那些花哨的宣传册和小册子，往往伴随着昂贵餐厅的用餐、温暖阳光下的会议，以及大量促销小工具的赠送。患者很少看到医生用笔书写时，笔上没有药品名称，也极少见到护士使用没有制药公司标志的平板电脑。制药公司每年花费数百万美元用于购买咖啡杯、T恤、雨伞和高尔夫球等促销产品。这笔钱花得值吗？很难说。“我曾收到过一家公司的高尔夫球，我也用过，但这并不意味着我会开他们的药方，”一位医生表示，“我通常觉得他们送的东西不会影响我的判断。”

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FFree samples of new and expensive drugs might be the single most effective way of getting doctors and patients to become loyal to a product. Salespeople hand out hundreds of dollars' worth of samples each week- $7.2 billion worth of them in one year. Though few comprehensive studies have been conducted, one by the University of Washington investigated how drug sample availability affected what physicians prescribe. A total of 131 doctors self-reported their prescribing patterns - the conclusion was that the availability of samples led them to dispense and prescribe drugs that differed from their preferred drug choice.

[p:f]免费提供新药和高价药品的样品，可能是让医生和患者对某种产品产生忠诚度的最有效方式。销售人员每周发放价值数百美元的样品，一年内总额高达72亿美元。尽管尚未开展大规模研究，但华盛顿大学的一项调查曾探讨过药品样品的可获得性如何影响医生的处方行为。共有131名医生填写了自我报告的处方情况，结果显示，样品的可获得性促使他们开具与自己首选药物不同的药品。

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GThe bottom line is that pharmaceutical companies as a whole invest more in marketing than they do in research and development. And patients are the ones who pay - in the form of sky-rocketing prescription prices - for every pen that's handed out, every free theatre ticket, and every steak dinner eaten. In the end the fact remains that pharmaceutical companies have every right to make a profit and will continue to find new ways to increase sales. But as the medical world continues to grapple with what's acceptable and what's not, it is clear that companies must continue to be heavily scrutinized for their sales and marketing strategies.

[p:g]归根结底，制药公司整体上在营销方面的投入远超研发。而患者则为此买单——以飞涨的处方药价格形式，支付每一支发放的笔、每张免费的剧院门票以及每顿牛排晚餐。最终的事实是，制药公司完全有权利盈利，并将继续寻找新的方式来增加销量。然而，随着医疗界持续争论什么是可以接受的、什么是不可接受的，显然企业必须继续受到严格审查，以确保其销售和营销策略的合规性。