Influence Of Drug Reps On Physician’s Prescribing Habits
The idea of science attempting to study or explain the interaction between doctors and drug reps seems strange.
So I checked out the original article that had been reviewed as objective science. I put it all together. I decided that none of the studies that were slopped together to make this meta-study were going to impress me. I can’t remember seeing anything that looked scientific as I poked around. We are talking about “naturalistic” studies here. Doctors really don’t seem to want to believe that anyone can control their thinking. Some might get contrarian and avoid prescribing things that are too aggressively presented. Maybe others do succumb. The idea that the drug reps bring a lecturer and somehow useful information might be exchanged is idealistic at best. Let us switch from science to reality. I remember the muscled male French drug reps they sent to me in the hospital. I remember when the dean of the medical school married a gorgeous female drug rep — a sort of midlife-change direction marriage — leaving behind someone who had once been described to me as a barracuda like entity.
You may not be surprised to find out that most of these young women were beauty queens before getting into the drug rep business. I remember a particularly young and attractive drug rep at a central California outpatient clinic. I asked her — in all naiveté — about one of the pre-FDA approval studies and she started to cry. Literally, she broke down and started bawling right there in my office. She had never heard of the study and she could not answer the question. I apologized profusely, and she wrote down the question and said she would ask her boss, or someone else back at the company like an uber-pharmacist or something.
When I left academic medicine and started my own private practice, my husband and I were treated to a pleasant interlude in a resort in Arizona (by a major drug company, of course). This was a research meeting, and I justified it by telling myself I would learn lots of new research stuff. But to be honest, I was just thrilled that a doctor was esteemed by the company and given perks. I was told I had been chosen to be on an “expert panel.” It did not take long to figure out that when they said they wanted to use the information they were trying to get from us to increase the intelligent use of their drug, the people whom they wanted to prescribe the drug more often and intelligently were us.
I remember sitting around a table with a bunch of psychiatrists, and a giant microphone in the middle. We had signed something that they had the rights to everything I said. It was not too hard to decide not to say anything. Oh — and we could ever leave the resort property except to shuttle back to the airport. No shopping or shows in the city. We were birds in a gilded cage.
Just recently the lead therapist of a clinic where I had been contracted to come assist basically told me I was coming to lunch. I told them I had no interest in their food, and that my lunch usually consisted of a wedge of brie cheese. Well, the two drug reps brought me a rather fatigued piece of domestic faux-French brie. They listened and tried; points.
The drug rep introduced the “expert” speaker (someone 50 miles from home with PowerPoint slides) and read a disclaimer that this presentation was bound by FDA regulations regarding the making of claims and of promoting specific treatments and yadda-yadda-yadda. The speaker was slick and had obviously been rehearsed or schooled. One of the things he had been trained to handle was someone like me who tried to ask pertinent questions. If the question or its answer was “off script” he turned everything around and tried to put words in my mouth.
I asked about certain side-effects which I knew his company’s nostrum caused (the type that are in fine print or spoken in speeded-up recordings at the end of TV commercials).
Not getting the information I requested from the speaker, what I did was talk to the rep on the way out. She took dutiful notes, and said she would ask someone and get back. Just like the little girl drug rep in Central California so many years before, this drug rep never got back to me with the answers to my embarrassingly technical questions. Sometimes I wonder if I am one of the doctors in the messy set of articles reviewed above. I struggle, really struggle, to give my patients the best possible stuff. Idealistic, naive, still trying. Avoiding invitations from reps to drug company-sponsored dinners, is easy now. I went to all-too-many of them and finally learned to sit on my hands to avoid raising them and asking questions nobody can answer. Patients and chemistry and drugs – Oh My!
Professional marketers try everything that could work, and are guided by people who know what they are doing — what they are selling to the masses and making money with. Me, I am just a woman who pushes molecules around the brain with passion. The kind of spirit you want on your side.