Drug Reps

Today, I heard a pretty fascinating talk by an ex-pharmaceutical sales representative about his perceived interaction between drug companies and physicians. The problem is that each group is motivated by completely separate things. Physicians are (ideally) oriented towards the patient's best interests; the ethical duty of a doctor is to serve his patients. On the other hand, pharmaceutical companies want to make money; for them, the bottom line is their shareholders. This dichotomy creates a great tension between the two groups. Pharmaceutical companies will go to an incredible extent to affect a physician's prescribing habits.

Sales reps are chosen because they charismatic, good-looking, friendly, and well-dressed. They are the only ones at your clinic without complaints, not trying to get you to sign forms, willing to bring you lunch, distributing free pens and pads of paper. At the end of the day, they sympathize with you for your long hours; they say something like, "Let's grab a bite to eat; it's on me. We won't talk drugs, I promise." And they don't. Yet, your prescribing habits change to favor them. They employ psychological tactics like good cop/bad cop. They have learned to speak the lingo and cite the studies that support their drug, even if they haven't taken a single biology class past high school. They know how to downplay the downsides of their drugs but remind you of the weaknesses of their competitor's. They can infiltrate your clinical care team by learning which flowers your secretary likes and when her birthday is or convince your nurse that their drug is ideal. So when your nurse proposes it, your defenses are down, but they still get at you, all the same. These drug reps build up entire databases of your information; they know how old your kids are, where you went to medical school, what books you read. They also know your prescribing habits (by buying compiled information from pharmacies) and can direct their 5 minute talk to reinforce some of your habits and change others.

Whether this is ethical or not probably depends on your ethical schema. It might make perfect sense to a utilitarian (you have to maximize the good of your shareholders) or an objectivist (you want to maximize your own effectiveness and happiness). But it seems ethically reprehensible to a Kantian (which I happen to be - a topic for another post). But regardless, companies do this. It's a cutthroat world in marketing out there.

So everyone should be aware of the marketing tactics used by pharmaceutical companies to change a physician's prescribing habits. One should also know that most of the influence of a drug rep is not from the information they give, but rather from the relationship they develop with the physician. A physician can limit the influence of the drug companies by opting out on giving away their prescribing habits. A physician should always keep in mind that his duty is to his patient and to eliminate those with undue influence on the care of his patients.