Tuesday, October 22, 2013

Docs and Drug Reps

If you’ve been to a doctor’s office any time recently, you’ve probably seen them.  Nicely dressed in suits or pant suits.  Dragging their little bags that look like the carry-ons with wheels you see at airports.  Mostly nice looking and young, male or female. Patiently waiting for the office staff to call them to come in the back.

You don’t generally see what’s going on in the back with them, but these are the drug reps.  The detailers.  The pharmaceutical company salesmen.  They used to bring assorted gifts to the office like pens and other paraphernalia with drug logos on them, but now they mostly come bearing drug samples and lunch.  Due to a recent change in the law, doctors have to “report” any such favors into a database, but hardly anyone looks at it.

The drug reps are there to tell the docs about their latest products. They have to stick to the information approved by the Federal Drug Administration. The doctors certainly need to hear about the newest medications. So what’s the harm?

Well, potentially, plenty.  Most “new” drugs do pretty much the same thing as old established drugs.  Sometimes they have different side effects, some of which are better for the patient and some of which are in fact worse.  Being under patent, they are of course way more expensive than generic drugs which are often just as good or just as tolerable.

As readers of this blog know, the drug companies have been studying the psychology of doctors for decades, and have developed a lot of tricks and misleading tactics to increase sales of their brand named drugs. These techniques are quite powerful, and many doctors do not understand how they are being manipulated, sometimes to the significant detriment of their patients.

As a critic of these marketing techniques, I belong to a group called “Healthy Skepticism.”  Many members of this group argue that doctors should have NO contact at all with drug companies in any form whatsoever. They point to the fact that most doctors think they are not being unduly influenced, and yet believe that most of their colleagues are! The high sales of brand named drugs when generics are available prove, they go on, that no doctor is immune to pharmaceutical marketing tactics. So therefore drug reps are the enemy.

You think I would agree, but I do not. Just because a lot of doctors think they are not being influenced but actually are does not mean that some doctors believe they are not being unduly influenced, and in fact are not. Not everybody kids themselves. It is true that everyone is influenced by others to some degree. So by that reasoning doctors should avoid talking to members of Healthy Skepticism, because then they will be unfairly influenced against the drug companies.

How are we really going to understand misleading marketing techniques if we never personally witness them? How do we keep our eye on Pharma if we are averting our eyes?

Also, there’s that troublesome little fact that we live in a capitalist country, and if capitalists are properly regulated, that’s a good thing.  While I believe deceptive advertising should of course be stopped far more effectively than it has been, I nonetheless do believe in the company’s right to portray their products to physicians in the best light.

Also, when a new drug first comes out, the drug rep may actually be a good if not the only source of information - provided the doctor listens with a critical  ear.  

As Carolyn Rabinowitz, former president of the American Psychiatric Association, was quoted as saying in the September 20, 2013 issue of Psychiatric News, “Drug Companies perform a useful function, and they must make money or they won’t invest in our field." 

I do not blame the drug companies for misleading doctors as much as I blame the doctors for not knowing when they are being misled.

Adriane Fugh-Berman, M.D.

Sanita Sah and Adriane Fugh-Berman of Georgetown University, the leaders of industry watchdog Pharmed Out, recently pointed out in the same article that if doctors know and understand their marketing techniques, then they are in a fairly good position to see what they are doing and to not be taken in. 

Maybe I’m kidding myself, but I let the reps buy me lunch, and yet I still almost never prescribe brand-named psychiatric drugs unless a patient does not respond to, or is completely unable to tolerate, generic drugs in the same class. And so called “diagnostic inflation,” so that everyone seems to need a drug – well readers of this blog know how I feel about that.

For most of the time that I was the director of a psychiatric residency training program, the drug reps provided lunch for the residents at certain classes and for "journal club." The reps were allowed to give the residents a short sales pitch for one of their new drugs, and then they would leave leave the room. After the reps left, I  would critique what they said and point out any exaggerations or misleading information. That way, hopefully, these future psychiatrists would learn to be wary consumers of this type of information.

Now, the drug reps have been banned from providing lunch for the residents, so the residents no longer get this valuable training. When they graduate, they will be less able to resist a sales pitch, not more able. Bad idea.

The biggest psychological trick that drug reps use is taking advantage of our natural tendency towards reciprocity. You do something for me, and I feel obligated to do something for you. It’s not the pen or the pizza, it’s the relationship with the person who brings you those things.

Drug reps are hired more for their likeability and social skills than anything else. As the article states, “And flattery, whether it’s a pleasant conversation over the archetypal pizza or an invitation to speak at a prestigious meeting, gets them everywhere.”

Doctors need to learn this, but most have not. There oughta be a course in medical school about his. Forewarned is forearmed.


  1. I don't think there's any other way to put this: History demonstrates many doctors, particularly psychiatrists, are not bright enough to see through sales reps' tricks. Or they don't care.

  2. In the restauarant where i worked, big pharma and mostly the same doctors dined once a month, obviously free for the good doctors, could see that by all that champagne for aperitif..... still my familly doctor has pens paper and a calendar all sponsored by big pharma. Of course it has an influence, if only certain drugs are more easily brought to mind.

  3. docs know all their tricks yet they wont respond out of mercy

  4. I've been practicing for 26 years, and like our good host, who has more experience, I have never felt influenced by these peddlers. Nice guys and gals, but nothing than can claim or do will influence my prescribing practices, and I have a track record to prove it. If they bring me and my office staff lunch, that hardly compensates for my time when I could be seeing patients instead. I accept their "charitable" provisions of samples and vouchers only because some of my patients have responded to one of their drugs and have inadequate insurance or other means to afford such medications.
    In my years of practice, I have only witnessed a few breakthroughs in pharmacotherapy...Prozac, Clozaril, and Zyprexa come to mind (though they've also had their share of adverse effects like most drugs)...and my opinions of their efficacy are based on my direct usage of them in sick patients, not the industry sponsored claims of pharmaceutical reps.
    Dr. Allen's mention of the word skepticism harkens me to a quote from the great philosopher Santayana, whose sage advice has guided me in my interaction with snake oil salesmen over the years..."Skepticism is the chastity of the intellect, and it is shameful to surrender it too soon or to the first comer."

  5. Nice post, You are right doctor's need to learn this and specially medical students. Its very important part of pharmacy.