Most people who read this blog understand how drug companies use their reps to try to influence the kinds of medications that physicians prescribe. The question is: do they really have an effect on how most doctors practice medicine?
Below, an insider’s look at how drug reps operate from the Carlat Psychiatry Blog. A former Eli Lilly rep may sum it all up when he says: “Gift giving is the key. You are programmed as a human to reciprocate . . . As a matter of fact, the smaller the gift, the greater the sense of obligation.”
Thursday, March 27, 2008 : A Drug Rep Tells All
Shahram Ahari, former Eli Lilly drug rep, recently spoke to the Tufts Progressive Medical Students Organization. It was a fascinating talk, because Ahari told us about how he and his colleagues used every trick of salesmanship in the book to increase prescriptions of Prozac and Zyprexa and therefore to maximize their bonuses.
The key criteria of employment as a drug rep, he said, are being good
looking and mastering the art of small talk. No huge surprise here, but
it’s helpful to remember that drug reps do not come to doctors to
educate, but rather to persuade.
"Gift giving is the key," he said. "You are programmed as a human to
reciprocate. You feel obliged to return the favor. As a matter of fact,
the smaller the gift, the greater the sense of obligation."
Do you consider samples to be a part of the company’s civic duty? Think
again. "Samples are a marketing tool. They always have strings
attached. Typically, we would provide two weeks worth of samples, which
worked out wonderfully. Just like a drug dealer, the first one is free,
and then you’re hooked."
A member of the audience who had once been a consultant to industry
made an interesting comment about samples. His job was to track
doctors’ prescribing behavior in response to sampling practices, and to
provide physician-specific "response curves" to companies. Using these
curves, reps determined how to maximize their "return" on sampling. If
you "hit" Doctor Smith 10 times per year with samples, he might
prescribe more product than Doctor Jones, who might require less
sampling. To drug companies, doctors are pawns in a game of
Ahari recalls well that food makes doctors more receptive to the
message. "We took painstaking efforts to determine what you like. We
had a $60,000 budget for food, and we used this to make ourselves seem
a necessity to clinics who wanted to make their staff happy."
But food pales compared to what Ahari called "the most sinister tool in
our armamentarium: our computer." He was referring, of course, to
prescription data-mining. "We knew all your prescribing data, and we
used it fine-tune our pitch."
Do you think drug reps are there to provide you with crucial medical
information? Fuggedabout it! "I was in your office in order to
influence you to prescribe Prozac or Zyprexa. We focussed on providing
information to manipulate your prescribing, not to teach you how to
treat your patients. Mostly, we wanted to build a good relationship, so
that you’d like us. We are the one spot of sunshine in your day, a
person who steps in the door and is actually interested in how you’re
doing. We’re fun, witty, attractive, and we come bearing gifts. No
wonder we’re accepted into your offices."