Look out, Pharma. The rebels are gaining on the apostles.

“Rebels” is the label a healthcare research firm has slapped on physicians who are deeply dissatisfied with--and speak out against–pharmaceutical companies. The so-called “apostles” are doctors who are satisfied with Pharma and who generate positive word of mouth about it.

While a TNS Healthcare poll found more apostles than rebels among U.S. general practitioners, the gap has narrowed.

The number of unhappy and vocal physicians here rose to 19 percent from 12 percent last year, while the number of apostles fell slightly, from 40 percent to 39 percent.

“While European countries traditionally have had a high proportion of ‘rebels’ dissatisfied with the industry–particularly in France and the U.K.–this is the first time we’ve seen such a negative pattern in the U.S.,” Andrew Brana of TNS said in a press release.

That should worry Pharma, Brana explains, because TNS’s research has found that companies should not have more than 15 percent of their customer base fall into the rebel category.

“When the percentage rises above that, it becomes increasingly difficult to overcome the negative buzz and promote successfully,” Brana said.

It takes three apostles to overcome the bad word of mouth generated by one rebel, Brana said, and the ratio in the U.S. has dropped to 2-to-1 from 3-to-1 a year ago.

“For the first time, U.S. (drug) companies are facing a truly negative market environment. We call the apostle-to-rebel ratio the Market Resistance Index – and it is basically the headwind working against you. The stronger the headwind, the harder it is to make progress with your customer base,” Brana said.

The survey, which was taken in December and January, does not identify why physicians are unhappy with Pharma, but TNS spokeswoman Ilene Siegalovsky speculated the dissatisfaction could be due to everything from cuts in drug companies’ sales forces to fewer free lunches and other goodies.

“Some of the free lunches and pens the doctors came to see as perks--they might not be happy that they’re going away,” she said.

Drug prices and direct-to-consumer advertising are other constant sore points.

James Hay, MD, rejects the “rebel” label, but he gives speeches against the marketing practices of drug companies.

“I’m not anti-pharmacy; I’m anti-pharmacy marketing,” said the family practitioner from Encinitas, California.

His targets are everything from me-too drugs and pricing to the lack of post-market research on drug efficacy. To emphasize his objections, he shuns the free lunches, pens, and coffee mugs delivered by sales reps and even replaced an office clock that featured a drug company logo.

“I just don’t want to be associated with it,” he says.

So is Pharma concerned?

“Despite the study’s findings, other surveys have found that physicians value information given to them by pharmaceutical representatives. Interactions between physicians and pharmaceutical representatives benefit patient care through the exchange of information about new medicines, new uses of medicines, the latest clinical data, appropriate dosing, and emerging safety issues,” read a prepared statement from Ken Johnson, senior vice president of PhRMA.