Even reservation intermediaries have appeared due to regulations on hospital visits by MRs.

Pharmaceutical companies once had fierce competition to sell their products to doctors, but the number has been on the decline since peaking in 2014 (65,752 people).

　According to the MR Certification Center, the number of MRs as of the end of March 2018 was 62,433. This represents a decrease of approximately 3,300 people over the past four years.

　Excessive entertainment was banned within the pharmaceutical industry in 2012, but in 2014 the Diovan incident, a conflict of interest incident involving an employee of Novartis Japan Corporation as a statistical analyst, was discovered. Last year, the Japan Pharmaceutical Manufacturers Association (Nisseikyo), which has 72 pharmaceutical companies as members, revised its ``Guidelines for Transparency in the Relationship between Corporate Activities and Medical Institutions,'' which was formulated in 2011. Furthermore, in April of this year, the Ministry of Health, Labor and Welfare enacted the ``Guidelines for Activities Providing Sales Information for Prescription Drugs'' and began regulating inappropriate information provision activities by pharmaceutical companies.

　Not only is there growing criticism against MRs, but it is also becoming harder to create new drugs, so pharmaceutical companies are hiring fewer MRs and encouraging voluntary retirement.

　What is the current state of MR? I spoke to a current MR. Let's say it's Mr. A. Mr. A is in his 30s and has worked for two foreign pharmaceutical companies, with a total of 15 years of MR experience. Currently in the position of supervising MR.

MR renews academic qualification on behalf of doctor

　First, we asked about the relationship between doctors and MRs before regulations were tightened.

　According to Mr. A, there were a number of requests unrelated to providing medical information, such as replacing fluorescent lights in the hospital and purchasing parts for plastic models, a hobby of doctors. In some cases, doctors who were unable to go to renew their academic qualifications signed their names at the reception desk and paid the renewal fees on their behalf. Nowadays, it seems that there are fewer such blatant requests from doctors.

　What about entertaining doctors? Mr. A says, ``More and more pharmaceutical companies are saying they can't pay or entertain their officials, and the industry is shrinking.It's only about 5% of what it used to be.'' When entertainment is provided, the MR has to pay for it out of pocket, or even if the company approves, the unit price, which used to be 20,000 yen, has dropped to about 5,000 yen.

　However, there are some pharmaceutical companies that allow entertainment under special conditions. For example, after a lecture requested by a doctor, it is possible to arrange a dinner for 10,000 to 20,000 yen in the name of ``comfort''.

　Regarding lectures, Mr. A's company is prohibited from paying more than 3.5 million yen per year to a single doctor and from requesting more than 36 lectures per year. The fee is 100,000 to 150,000 yen per hour for professors, 70,000 yen for associate professors and hospital managers, and 50,000 yen for all others.

　Also, if the lecture materials are huge or if a lecture is held in a local area for a whole day, it may be necessary to add color. If requested by a doctor, he will assist in the preparation of materials, but he will only provide data in accordance with company regulations.

　As compliance (legal compliance) not only for pharmaceutical companies but also for hospitals has become stricter, some companies have started to develop systems for making appointments with doctors. Dr. JOY Co., Ltd.” (Tokyo). According to its website, it was established in 2013 and began service in 2016. Capital and capital reserves are approximately 2.28 billion yen. The president, Hiroaki Ishimatsu, is also a doctor. As of February of this year, 1,919 hospitals including university hospitals have decided to introduce it, 1,895 medical companies including pharmaceutical companies, and approximately 530 million people are using it.

　The company claims that this service will also help strengthen hospital security, but Mr. A has some questions. First, if the MR and doctor already know each other's email addresses, they can communicate directly, so there is no need to schedule an appointment through this system. Still, the introduction of the system by the hospital means that it is doubting the actions of the working doctors, and in some cases may even lead to mistrust among the working doctors.

　Second, it costs 5,000 yen for an MR to make an entrance/exit card. ``If about 530 million people are using it, Dr. JOY must be making a lot of money,'' Mr. A quipped.

　We also asked about the actions of doctors that are inconvenient for MRs. ``Some doctors who have strengths in their medical fields do not meet our expectations,'' Mr. A said.

　For example, there are many drugs for high blood pressure available from different companies, so doctors have many options. Each pharmaceutical company asks doctors from hospitals with many high blood pressure patients to give lectures. For pharmaceutical companies, lectures are a place to imprint their products on the audience, and when a doctor accepts to be a lecturer, there is an expectation that the company's products will be used in the future. However, it is said that there are cases in which doctors only receive honoraria for lectures and end up not using drugs from any pharmaceutical company.

　What does this mean? Mr. A said, ``For a doctor, if he chooses a pharmaceutical company's drug just because he accepts a lecturer position, it becomes a collusion.He tries to be nice to each company and lectures, but the medicines he uses follow his own policy. "That means," he explains. This may be painful for MRs, but it is desirable for patients.

“Collusion in the name of investigation” that ignores patient interests

　As it is becoming increasingly difficult for a company to come up with innovative new drugs (Pica New), the reality is that if it is unable to differentiate itself from other companies through its products, it has no choice but to differentiate itself through its sales capabilities. One such example is requesting doctors to teach. However, in some cases, this can lead to collusion between doctors and pharmaceutical companies.

　Mr. A also points out ``collusion in the name of investigation.'' "Pharmaceutical companies pay for clinical research, and doctors receive money. Doctors report on the drug's effectiveness, and pharmaceutical companies see an increase in drug sales. It's a win-win relationship. Even with regulations and guidelines in place, This relationship will never end."

　As a result, even if Company B's drug is more effective than Company C's drug, hospitals that receive research fees from Company C will use Company C's drug. This raises questions about the ethics of doctors and hospitals.

　Mr. A confesses, ``Doctors are sales targets for MRs, so if you become hesitant at the start, you won't be able to carry out clean activities, or you won't be able to say things that go against the other person's ideas.''

　During employee training, pharmaceutical companies say, ``This is the age of science. Change the way teachers think with clean activities.'' The MRs employed are also becoming more highly educated and are becoming fewer and more elite. However, there are many doctors who seek some kind of convenience rather than providing logical medical information based on evidence. MRs who encounter such obstacles in the field and seek advice from their superiors are dismissed, saying, ``It's because you're not strong enough.'' Caught between doctors and companies, Mr. A confides, ``There will be some MRs who will get involved in delicate activities.''

　One possible measure to break down the ``adhesive structure'' would be for a third-party organization to review the research content of pharmaceutical companies, request appropriate medical institutions to carry out the research, and pay funds through a fund.