Neil Berliner, M.D.

Dr. Berliners new book, A Franchise of One: Strategies for Pharmaceutical Sales, is now available. Order online at www.xlibris.com. Dr. Berliner can be booked directly for representative training: nb@reptrainer.com

The trillion-dollar healthcare industry is the perfect breeding ground for turf battles. For decades, such battles have included MDs versus chiropractors, optometrists versus ophthalmologists, "traditional" medicine versus "alternative" medicine, and many, many others.

While eating lunch at my favorite restaurant the other day – the free sample displays at Costco – I got an idea for a column on pharmaceutical samples. Pharmaceutical representatives have been bringing samples of their products to physicians' offices for decades. But recently, the merits of this practice have become a topic of fierce debate.

There is a recent trend of Americans seeking out healthcare services in places other than where they live. More often than not, the bottom-line reason for this phenomenon is ... the bottom line. Patients frequently seek out services that offer good dollar value, or better service for the same cost. In other cases, the objective is to simply get what is believed to be better care somewhere else.

Some pharmaceutical companies serve patients who have extremely rare diseases. They provide innovative products for these often severely ill people who have few treatment options. Certain of these products, as defined below, are classified as orphan drugs.

How will declining physician incomes affect healthcare in this country? A recent article in The New York Times remarked that liberals want Washington to "force cuts in prescription-drug prices and insurance company profits," and that conservatives want "people to pay more of their own medical costs" in order to curb spiraling healthcare costs.

Many physicians I've known have had extremely interesting hobbies or second careers ... or hobbies that have evolved into second careers. Some of these people derive such a consistent degree of success and satisfaction from their avocations that they even decide to pursue them full-time.

Differences in cultural values between patients and treatment providers can result in dissatisfaction.

The culturally competent physician is aware of these issues and is more likely to explain to patients how various philosophies can be used in tandem to offer the best chance for effective treatment.

Pharmaceutical representatives need to be aware of many types of trends in order to optimally detail their physicians. One of the most important (and sometimes overlooked) of these trends is the increasing ethnic and cultural diversity of the United States over the past several decades, which continues at a growing rate.