Mr. WOLFF. Anxiety but not depression?

Mr. BRANNAN. Yes. The whole situation of the game is terms and words. A doctor who went through medical school some time ago uses one word and we use different words and we are sort of educating him.

Mr. WOLFF. You said something in your opening lines there about using it for itchy feet. Did you ever recommend using Valium for itchy feet?

Mr. BRANNAN. I didn't recommend it but I had a lot of doctors tell me that they used it for indications beyond the indications on the package insert. I don't want to say Valium is not a good drug because it is a very exceptional drug.

Mr. WOLFF. Do you have any idea of some of those uses? Could you give us an example?

Mr. BRANNAN. I'm trying to think.

Mr. WOLFF. We are not trying to discredit your testimony but trying to elicit information. It seems to me that there are certain elements of this whole procedure of detailing and the lack by the medical profession of adequately requiring the doctors to receive education on their own, and to depend upon the detailing work that is done by folks like yourself who are out in the field.

Are you a pharmacist?

Mr. BRANNAN. No, I'm a biology graduate-chemistry.

Mr. WOLFF. Did you take any additional training when you went to work for this company?

Mr. BRANNAN. Right. We had ongoing training.

Mr. WOLFF. What type of training was that? Was that sales training or really in pharmacology?

Mr. BRANNAN. It was both. It was both kinds of training. They called it—oh, Valium advanced qualification testing type of thing. It was more on pharmacology. And you were given tests, and you had to pass these tests to be able to promote the drug.

Mr. WOLFF. Now, a pharmacist is not permitted to prescribe for a patient, someone who comes in with a prescription or without a prescription. And here you are as a detailman attempting to prescribe to the man that does the prescribing. I think that is the major problem that I see.

Mr. BRANNAN. Well, unless a doctor goes to ongoing training and seminars and things, how much training does he get in psychotropics? Valium was introduced

Mr. WOLFF. Can you enlighten us on that at all? How many doctors did you have on your route?

Mr. BRANNAN. I had a total of 400 but I called on about 200, 250. Mr. WOLFF. Did you work for any other company than HoffmannLa Roche?

Mr. BRANNAN. No.

Mr. WOLFF. How long did you work for them?

Mr. BRANNAN. Almost 7 years.

Mr. WOLFF. I take it you have some other material.

Mr. BRANNAN. I don't really feel I competently or completely answered your question. You know, you can have something in writing and it is easy to put something in writing. It is company policy to

disclose only information on the package insert. And yet, when it comes down to doing it, it is just easier to be quiet and have the information sent to the doctor if he wants to know about Valium in a use other than the package insert.

Mr. WOLFF. Well, inasmuch as there is a void, is it not a responsibility of somebody at least to fill that void?

Mr. BRANNAN. Right. And ethically I did it for that period of years. Because I was on the doctor's side. But when you get the tremendous pressure to

Mr. WOLFF. Did you have any quotas of any kind?

Mr. BRANNAN. Well, of all the product line we had quotas. Roche doesn't use the word "quotas." They use the word "sales goals." Mr. WOLFF. What happened if you fell below those goals?

Mr. BRANNAN. It is part of your evaluation. You meet standards or exceed standards or are below standards. I don't know whether you had a chance to read my statement about the DDD data system. They know about every bottle in your system that you are promoting, and they take it back to the national area and determine the percentage of the market you have in your area. Valium would do 58 percent of the psychotropic drugs.

Mr. WOLFF. Was it promoting against other like tranquilizers? Was it promoting against Librium, for example, or another type of psychotropic drug? Or was it promoting Valium on its own as a palliative of some sort?

Mr.. BRANNAN. If you are in California where substitution takes place, the sales picture is different than in other States where substitution doesn't take place. If you prescribe or have the doctor prescribe Valium he gets it, as in other States, but if he prescribes Librium it goes generic in California, and it could be Roche's generic that is used or Roche's product or another product that is used. So the object in California was to use Valium, in which Valium was used over Librium, but we would compete against other benzodiazepines-diazepam.

Mr. WOLFF. What is the difference in the cost between a generic and something like Valium?

Mr. BRANNAN. Again, it depends on what pharmacy you go to. If they use it as a loss leader in the business, which is a drug that is lower priced, and the patient comes in with a second prescription, the object is to get the second prescription and they charge normal prices. But on Valium prescriptions they might buy it for $7 a hundred and the prescription before substitution went in would be $14 to $16. And I would say on Librium there is the same type of thing. The percentage can drop 20 to 30 percent, and then the price wars are on in the chains. Mr. WOLFF. Did you do much sampling of Valium?

Mr. BRANNAN. I did not carry samples. I mailed a lot of Valium. That is why in my testimony I had several things that were not included in my statement like

Mr. WOLFF. What I'd like to do is recess now because we have a vote on, and will come back, and if you would gather some of those high points of your statement, I'd appreciate it.

The committee will stand in recess.

[Recess.]

Mr. WOLFF. The committee will resume.

Mr. Brannan, will you proceed, please.

Perhaps you can summarize your statement. I interrupted your summary before.

Mr. BRANNAN. I wanted to state my statement was a logical, orderly statement of when I was hired and included examples in the field, and I took it for granted that you knew all this information, of which there is quite a bit in here.

Mr. WOLFF. We have to get these things on the record, which is most important.

Mr. BRANNAN. I was told this was on the record so I assumed this was all on the record.

Mr. WOLFF. Your complete statement is included as part of the record. You can amplify any of those areas you wish to.

Mr. BRANNAN. So consequently, things were coming out disjointed and out of order, and it was not very orderly. I was trying to make it orderly.

To expand on this, you asked me about samples.

Again, in the industry there are words you use for synonyms. Roche does not sample and they can say, "Roche does not sample." Yet, they can say, "We use clinical trials, starter supplies, free goods." But again, you know, if you ask me do I sample, I don't sample; I use free goods, I use clinical trials, I use starter supplies.

This paper I have in front of me is a Free Goods Control Report in 1976 in which in my division alone we were budgeted to give out $45,000 of Valium for the division alone, to give out $108,000 of free goods— not samples, free goods-clinical trials, starter supplies.

Mr. WOLFF. Do you get any report back from the doctor as a result of that sampling?

Mr. BRANNAN. Do I get a report?

Mr. WOLFF. Yes, if it is a clinical trial you must get some sort of report.

Mr. BRANNAN. I am just using words. Instead of "samples" they use "free goods."

Mr. WOLFF. Free goods?

Mr. BRANNAN. But again unsolicited samples-we do not give out unsolicited samples. Technically we do not give out unsolicited free goods. But you have to ask a question: If we are not giving out unsolicited free goods, how come we are budgeted for $45,000 of Valium to give in that year to physicians?

Mr. WOLFF. If a doctor asks you to give free goods, what do you give him?

Mr. BRANNAN. Well, in the statement again it said what I could mail to him. I don't carry the controlled drugs. I carry Bactrim and Larotid, antibiotics. But he signs a form I have, and I could send him 100 Valium, 200 Valium, up to 300, and mail it to him to his home or wherever he wants it. And that is what this budget inventory is, so I don't mail too much but I don't mail not enough.

Mr. WOLFF. You said you had $45,000 in your district.

Mr. BRANNAN. In my division. There are 45 divisions, and if you multiply it out it's about $1 million of free goods. But it's how do you budget it? Maybe from last year, how much we gave out.

Mr. WOLFF. That's at wholesale prices, I take it.

Mr. BRANNAN. Roche's retail prices.

Mr. WOLFF. At Roche's retail prices?

Mr. BRANNAN. Yes, retail and wholesale are very close, within 5 percent. But when you expand out $107,000 times 45 divisions, you're talking about $5 million in free goods. And these are for doctors' use. Or if you send him strip packs, which he can rip off one at a time, he can give those to patients.

The whole context of the thing was that in order to sell drugs you need samples, free goods, or whatever you want to call them, because the competition is unloading trucks and dumping tons of it in the doctors' offices. The object as a salesman was to take his drugs and shove them in the back and put yours in the front so the doctor again would see the drugs. That's why I was hired. That's why I was there. That's why I would mention Valium first. He would remember that for months, versus the second and third products. That was my job, to make sure.

Advertising is happy if one piece of mail hits that doctor's desk with Valium on it. They are happy with 1 out of 100-just exposure. Samples have tremendous exposure value to get that doctor to prescribe your drugs. If he picks up a sample of Serax and Tranxene and Valium, he will prescribe one. If he only has the first two, he will forget Valium. But depending on the state of health you are in or the welfare system-it is very complicated.

Therefore, to answer your earlier question, it is not an easy question because the picture is very, very complicated. Sales is the name of the game. I existed because I produced and sold Valium, and when evaluation time came I had to show them I had done my job and increased my territory 15 percent or whatever I was required to. And if I hadn't done it-you know, your salary increase wouldn't be as great, and then you were told by your division manager to take risks. While I was with them, my division manager, Phil Shapiro, did not work with controlled drugs. He didn't like it. Only after I officially went out did he start saying, "Use Valium, use Librium, use the controlled drugs to get the business on other products." You could use other types of samples to get the business in pharmacies. The object is to get your product bought by the patient.

Mr. WOLFF. Are there any tie-ins with pharmacies themselves? Did you have any responsibility to visit any number of pharmacies in order to try to promote the product?

Mr. BRANNAN. Again I mention it. I had over 100 pharmacies. Fifty were direct and sold direct from the warehouse, and 50 were nondirect. I would go in and make sure they stocked my products. That was my job. If a generic prescription came across the counter-this is why I mentioned California. You don't have half the problems here yet. Other States, Ohio and Florida, have the same problems with substitution.

If a pharmacist gets the prescription for Librium, here he has to fill it with Librium. In California he can use Zenith generic Librium. Maybe if the Roche salesman wants to keep his Librium business he throws in samples-and he is told to do it. Not Librium and Valiumyou can mail them out to the doctor to keep your business.

Mr. WOLFF. Were any incentives given to the pharmacies or to the doctors? Did you have an entertainment expense account or something like that?

Mr. BRANNAN. That was pretty rigidly controlled.
Mr. WOLFF. How about any other incentives?

Mr. BRANNAN. Again, there are always ways to get around policy. If you are told to get around policy, if your bonus and salary increase and even your job depends on it-that's the crux of it. These people in my paper that cracked and were fired, did company policy and were fired, broke company policy and were fired. They were ordered to break company policy by using samples and taking risks. Otherwise you are only going to get average salary increases and average bonuses. Unless you do this, if you are a family man and have a wife and two kids, you know your job is on the line unless you get the business. So consequently you get the business any way you can, and then you get fired for it. If you don't, you get fired for it.

Mr. WOLFF. Were you told to explain to the doctor the side effects or the dangers of Valium?

Mr. BRANNAN. Again, it was a good opening. You know, talking all these years, "Hey, Doctor, have I ever discussed the side effects of Valium with you?" and you start talking about the side effects and play it down, but you give it to him. You say, "There are that many causes of such and such, but that is not a problem."

Again, it's very sales oriented. You say enough but not enough. You don't want to put any negatives into his head. If he brings up negatives you want to clear them out, clear them up, handle them, and if you are not doing a good job with it, have Professional Services handle

it.

Mr. WOLFF. You are not working for the same company any longer? Mr. BRANNAN. No.

Mr. WOLFF. Are you in the pharmaceutical field?

Mr. BRANNAN. I am still on a medical disability but I hope to get better after I go through this whole mess. But after Phil Shapiro was fired, the manager who took his place was no different. I didn't want to go back into the same situation of compromising my ethics, principles, my morals, everything, in order to keep my job.

Mr. WOLFF. Since there is such free traffic-let me put it that way for want of another word-in the use of these free products, do you find any of the salesmen or detailmen that are selling samples?

Mr. BRANNAN. It goes on.

Mr. WOLFF. It does?

Mr. BRANNAN. Yes.

Mr. WOLFF. To whom do they sell these? Do they sell these to sources from which they find their way into the illicit market, so to speak? We do know there is a large illicit traffic now in this type of drug.

Mr. BRANNAN. Again, in California you don't carry controlled drugs. The samples that are carried by salesmen are antibiotics, things like that, decongestants. And these go to the pharmacy. And the pharmacist again, to get your products in if it's generic, he will order your product if you give him samples.

Mr. WOLFF. You indicate the profit motive is a strong incentive for the salesman.

Mr. BRANNAN. The same for the pharmacist. If you give him samples, that means he sells them to a patient and he hasn't paid for them. Mr. WOLFF. What I'm trying to say is: Is there this degree of illicit traffic to consumers-not to the pharmacy?