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Posing as pals, drug reps sway doctors' choices


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Posing as pals, drug reps sway doctors' choices

Mon Apr 23, 2007 8:00 PM ET


By Julie Steenhuysen


CHICAGO, April 23 (Reuters) - As much as doctors would like to deny it, subtle attention from friendly drug sales representatives can have a big impact on what drugs they prescribe, according to two U.S. studies published on Monday.


"Physicians underestimate their own vulnerability. They think they are smarter ... but they are not trained in recognizing this kind of manipulation," said Adriane Fugh-Berman, a Georgetown University Medical Center researcher and co-author of one of the studies.


Fugh-Berman teamed with Shahram Ahari, a former drug representative for Eli Lilly and Co., who now works at the University of California, San Francisco's school of pharmacy.


Their study, which appears in the Public Library of Science journal PLoS Medicine, details the elaborate methods used by drug company sales representatives to make friends and influence drug sales.


"Reps scour a doctor's office for objects -- a tennis racquet, Russian novels, '70s rock music, fashion magazines, travel mementos or cultural or religious symbols -- that can be used to establish a personal connection with the doctor," Fugh-Berman and Ahari wrote.


"A friendly physician makes the rep's job easy because the rep can use the 'friendship' to request favors, in the form of prescriptions.


"Physicians who view the relationship as a straightforward goods-for-prescriptions exchange are dealt with in a businesslike manner. Skeptical doctors who favor evidence over charm are approached respectfully, supplied with reprints from the medical literature and wooed as teachers," they wrote.


Sales representatives also ingratiate themselves by lining up paid speaking engagements for doctors and arranging educational grants to those who frequently prescribe their drugs.


The study comes as drugmakers are smarting over the public revelation this month from an AstraZeneca drug sales representative, who said in a unauthorized newsletter to staff: "There is a big bucket of money sitting in every office. Every time you go in, you reach your hand in the bucket and grab a handful."


An AstraZeneca spokeswoman said the manager was fired and the company was looking into the incident, which she said violates a core value of serving patients.




Another study found that even a brief visit by a drug sales rep could have a powerful impact.


The study analyzed surveys done by a market research firm that chronicled a doctor's intention to prescribe the epilepsy drug gabapentin during the period of 1995 to 1999, when it was sold by Warner-Lambert under the brand name Neurontin.


Pfizer Inc., which acquired that unit in 2000, paid a $240 million fine four years later for illegal promotion of the drug for unapproved uses such as migraines or pain.


The surveys involved 116 visits to 97 doctors.


They found that after 46 percent of the visits, the doctors said they intended either to prescribe gabapentin more often or to recommend it to colleagues more often.


"The remarkable thing is how effective a very brief visit by a drug representative -- most often less than five minutes -- can be in influencing physicians' choices to use a drug for an unapproved indication," Dr. Michael Steinman of the San Francisco Veterans Affairs Medical Center said in a statement.


Besides free drug samples, salespeople often bring gifts, lunch for the doctor or office staff, new pens and coffee mugs. "The doctor feels subtly, even subconsciously, indebted to the representative," Steinman said.


? Reuters 2007. All rights reserved. Republication or redistribution of Reuters content, including by caching, framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

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My Mom is an RN who has worked in private practice, as well as 25 years in ER/OR and Recovery.


She's been telling me this for years--and I didn't believe her. I do now.


I just sent the article to her.


Thanks for posting it!!!



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They , also, bring lots of food and feed the staff often. This allows them to get appointments with the docs - bribing the office staff , nurses ,etc.


I worked in a clinic last year and we had lunch brought in at least once a week. I figured this is why my presciptions cost so much.


I told my husband , I'd rather buy my own lunch and pay less for scripts !!

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I know a person who is rep-- a few months back they got an email that they needed to use $1500 in food expense during the next week. They HAVE to buy food for the dr's and offices. These are often full catered meals. I have family in the medical profession and they talk about "subway day" - "mexican day" etc. The office staff have standing orders... so the rep knows what they want on their sandwich.


Obviously... I know this is life and sales. Afterall the reps get commission for every script the dr. writes-- and they have to make a living too, and they do work hard for their paycheck. I also should add that I am very very appreciative of the occasional "free" sample.


But it seems there should be a balance to all of this-- ???

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