How Drug Reps change the way your doctor prescribes

The Pediatric Insider

© 2013 Roy Benaroch, MD

You’re at the doctor’s office, and you see strolling up to the window a good-looking, well-dressed professional. They’re usually pulling a little discreet cart, and after a few words with the receptionist they’re rushed right back. Sometimes they’ll bring a tray of cookies, or they’ll be followed by a caterer with a cartful of food.

You think they had an appointment? No, but you can be they’re here to see the doctor.

Take a look at this wonderful—and very dismaying—article from PLOS medicine, written by a physician and a former pharmaceutical sales rep. The practice of “detailing”, or in-person visits to doctors ostensibly to provide medical information on the latest pharmaceutical products, is a many-billion-dollar industry aimed at making sure your physicians prescribe what the industry wants them to prescribe. Hint: it’s the newest medicines with the biggest profit margins.

So what if the newest medicines aren’t the best for you?

You really ought to read the article. Summarizing it just won’t do it justice. You’ll see what specific techniques the reps use, and how they get the data they need to influence the doctors they’re pretending to befriend. I’ll just post one quote that sums it up:

“While it’s the doctors’ job to treat patients and not to justify their actions, it’s my job to constantly sway the doctors. It’s a job I’m paid and trained to do. Doctors are neither trained nor paid to negotiate. Most of the time they don’t even realize that’s what they’re doing…”

I’ll tell you that when the subject of drug reps comes up among doctors, most are offended by the very idea that we’re being manipulated. We think we’re far too smart for that—a bagel and smile isn’t going to change what we do. All those years of training insulate us from the effects of crass marketing, right?

Look: if it didn’t work, they wouldn’t spend billions doing it.

At my office, we have a strict policy: the reps drop off samples, and that’s it. No talking to docs, no food, no gifts allowed. I’d rather honestly go without the samples, but some families really do need them. Perhaps even allowing that is allowing the reps to go too far. I know I’m not immune. Is your physician?

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5 Comments on “How Drug Reps change the way your doctor prescribes”

  1. oldmdgirl Says:

    At the institution where I am training no drug reps are allowed at all.


  2. Durango Says:

    Is there a way to find out besides simply asking?


  3. anon Says:

    How does the Sunshine Act affect this? Does it make things better for the doctors or for the sales reps? I work for a pharma company, but in the discovery research side of things, so I have no idea what goes on in the sales and marketing depts. Despite that, I had to take the Sunshine Act training like all employees of pharma companies, which had something to do with what you are talking about, as far as I could tell. I like to believe that most of us nerds in the lab are trying to do our best to help humanity by finding drugs that will cure/help sick people, but I know that we are employed by a private corporation that of course cares about making money….does this new law protect the company or the public?


  4. Dr. Roy Says:

    anon, the Sunshine Act (which is actually part of the Affordable Care Act, AKA “Obamacare”) is fabulously complex, and I doubt anyone really understands how it’s going to play out. basically all items of value given by pharmaceutical firms or their marketing partners has to be tracked, and that information made publicly available. This will (maybe) help protect patients by making doctor’s “income” from these interactions public.

    In practice, I don’t know how this will work. Is your doctor took a $3 bagel, I don’t think that’s as potentially bias-worthy as a $10,000 golf junket. Will the public database make that clear? What if the doctor is providing a service for the drug company, like speaking on their behalf?

    Here, if you want, read the final rule on this from DHHS. Brew up some coffee first….


  5. anon Says:

    Thanks..yes, despite having to take the “training” on the Sunshine Act, I didn’t understand the legalese, especially since it doesn’t actually pertain to my specific job (I have no contact with doctors, patients or with the drugs the company makes for that matter), so I didn’t really pay attention. (oops) (Just leave me in the lab with my ELISAs and whatnot and I’m happy.)

    In my personal life, I try to discuss pros and cons of whatever drugs with my doctors and my children’s doctors and work with them to get the one that works best with the least side effects. Luckily, my children don’t really need much medication at this point. 🙂


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