Now a huge collection of drug company internal documents—revealed as part of a lawsuit—offers a wealth of detail. In 1996, Dr. David Franklin, an employee of the drug company Parke-Davis, filed the lawsuit under federal whistleblower statutes alleging that the company was illegally promoting a drug called Neurontin for so called "off-label' uses. Under federal law, once the FDA approves a drug, a doctor can prescribe it for anything. But the law specifically prohibits the drug company from promoting the drug for any unapproved uses. In 2004, the company, by then a division of Pfizer admitted guilt and agreed to pay $430 million in criminal and civil liability related to promoting the drug for off-label use.
Spokespeople for Pfizer say that any wrong doing occurred before Pfizer acquired the company. But Pfizer fought hard to keep all the papers related to the suit under seal. A judge denied the request and they are now part of the Drug Industry Document Archive at the University of California, San Francisco.
What is most interesting is not the illegal actions they reveal, but the details of activities that are perfectly legal. And according to people familiar with the industry, the methods detailed in these company memos are routine.
One tactic identifies certain doctors as "thought leaders, "—those whose opinions influence the prescribing pattern of other doctors. Those whose views converge with the company goals are then showered with rewards, research and educational grants. In the Parke-Davis case 14 such big shots got between $10,250 and $158,250 between 1993 and 1997.
"Medical education drives this market", wrote the author of one Parke-Davis business plan in the files. Many state licensing boards require physicians to attend sessions in what is called continuing medical education (CME) to keep current in their field.
At one time, medical schools ran most CME courses. Now, an industry of medical education and communications committees (MECCs) run most of the courses. These companies with innocent sounding names like Medical Education Systems set up courses, sometimes in conjunction with medical meetings, at other times often in fancy restaurants and resorts. The drug companies foot the bill, with the program usually noting it was financed by an "unrestricted educational grant" from the company.
Using MECCs, Parke-Davis set up conference calls so that doctors could talk to one another about the drugs. The moderators of the calls, often thought leaders or their younger assistants, received $250 to $500 a call. Drug company reps were on the line, instructed to stay in a "listen only" mode, but monitoring to be sure the pitch met their expectations.
Clearly, 'many of the physicians in these schemes are not innocent bystanders. Whether it is ghost writing, making telephone calls to colleagues or leading a CME session, many of the doctors got paid well. Others received a free meal or transportation to a resort to listen to an "educational session".
Physicians often claim they are not influenced by payments from the pharmaceutical industry. But with the methods so thoroughly detailed in these papers, drug companies clearly believe they are getting their money's worth.
The drug companies are willing to pay leading doctors to
A. manipulate medical education sessions.
B. improve the individual health-care service.
C. have personal contact with physicians.
D. help promote the drugs they produce.
Part A
Directions: Read the following four texts. Answer the questions below each text by choosing A, B, C or D. (40 points)
For years Internet merchants have poured millions of dollars into new technologies to make their sites easier to use. So why aren't online customers happier?
Customer satisfaction levels have remained almost flat through the last several years. The problem, according to Larry Freed, chief executive of a consulting and research firm called ForeSee Results, is not so much that consumers have ignored the many improvements made in recent years. Rather, he said, they still expect more from Internet shopping than it has delivered.
"If we walk into a local store, we don't expect that experience to be better than it was a couple years ago", Mr. Freed said. "But we expect sites to be better. The bar goes up every year". In ForeSee's latest survey, released last month, just five e-commerce sites registered scores higher than 80 out of 100, and no site scored higher than 85. It was much the same story a year ago, when just five scored higher than 80, with no site surpassing 85. "Scores have inched up over time for the best e-commerce companies, but the overall numbers haven't moved drastically", Mr. Freed said. "At the same time though, if you don't do anything you see your scores drop steadily".
That dynamic has been a challenge for online merchants and investors, who a decade ago envisioned Internet stores as relatively inexpensive (and therefore extremely profitable) operations. Now some observers predict a future where online retailers will essentially adopt something like the QVC model, with sales staff pitching the site's merchandise with polished video presentations, produced in a high-tech television studio.
QVC.com is evolving in that direction. The Web site, which sold more than $1 billion in merchandise' in 2006, has for the last five years let visitors watch a live feed of the network's broadcast. But in recent months, QVC.com has also given visitors the chance to watch archives of entire shows, and in the coming months visitors will be able to find more video segments from recent shows, featuring individual products that remain in stock. Bob Myers, senior vice president of QVC.com, said the Web site's video salesmanship is especially effective when combined with detailed product information, customer reviews and multiple photographs.
About eight months ago, for instance, a customer said that she could not determine the size of a handbag from the photographs on the site because she could not tell the height of the model who was holding it. Within two weeks the site tested and introduced a new system, showing the bags with women of three different heights. The results were immediate: women who saw the new photographs bought the bags at least 10 percent more frequently than those who had not.
Still, Mr. Myers said, video is a critically important element to sales. "E-commerce started with television commerce", he said. "The sites who engage and entertain customers will be winning here in the near future". Such a prospect is not necessarily daunting to other e-commerce executives. Gordon Magee, head of Internet marketing for Drs. Foster & Smith, based in a Rhinelander, Wis. said a transition to video "will be seamless for us". The company, Mr. Magee said, has in recent weeks discussed putting some of its product on video "so customers could see a 360-degree view they don't have to manipulate themselves.
Larry Freed attributed low customer satisfaction to the fact that
A. consumers often failed to see the efforts made by Internet shops.
B. customers' expectations exceed what the Internet shops are offering.
C. consumer cognitive levels do not rise as easily as sellers believe.
D. customers expect Internet merchants to invest even more heavily.