Drug companies and my colleagues

9

Category : Medical Rants

My colleagues disagree with my position on drug reps – Just say no to drug reps.

Their arguments concern a capitalistic approach to the pharmaceutical market and the possibility that drug reps make physicians aware of medical advances. One colleague compares drug reps to car salesmen – a comparison that I cannot quite accept.

My problems with drug reps are several. The first comes from the rationale behind pharmaceutical marketing. They are trying to influence us to use their drug. Drug reps use all the classic tools of the psychology of influence (as pioneered by Robert Cialdini).

Cialdini defines six “weapons of influence”:

* Reciprocation – People tend to return a favor. Thus, the pervasiveness of free samples in marketing. In his conferences, he often uses the example of Ethiopia providing thousands of dollars in humanitarian aid to mexico just after the 1985 earthquake, in return to past gestures Mexico had with Ethiopia.
* Commitment and Consistency – If people agree to make a commitment toward a goal or idea, they are more likely to honor that commitment. However, if the incentive or motivation is removed after they have already agreed, they will continue to honor the agreement. For example, in car sales, suddenly raising the price at the last moment works because the buyer has already decided to buy. See cognitive dissonance.
* Social Proof – People will do things that they see other people are doing. For example, in one experiment, one or more accomplices would look up into the sky; the more accomplices the more likely people would look up into the sky to see what they were seeing. At one point this experiment aborted, as so many people were looking up, that they stopped traffic. See conformity, and the Asch conformity experiments.
* Authority – People will tend to obey authority figures, even if they are asked to perform objectionable acts. Cialdini cites incidents, such as the Milgram experiments in the early 1960s and the My Lai massacre.
* Liking – People are easily persuaded by other people that they like. Cialdini cites the marketing of Tupperware in what might now be called viral marketing. People were more likely to buy if they liked the person selling it to them. Some of the many biases favoring more attractive people are discussed. See physical attractiveness stereotype.
* Scarcity – Perceived scarcity will generate demand. For example, saying offers are available for a “limited time only” encourages sales.

I can buy a car without engaging a car salesman. I need not listen to their sales pitch. I can test drive different cars, and get information from many sources.

I can get information from many sources about new drugs – but too few physicians do this. I object to the unethical marketing that many drug companies encourage.

I cannot equate buying a car (for myself or my family) with writing prescriptions for patients. These are not parallel activities.

By refusing to see drug reps, I force myself to seek objective data on new drugs. Those who see drug reps are (in my mind) taking a dangerous shortcut. Given the many revelations about drug companies, how could I trust anything that the reps say? If I cannot trust anything that you say, why should I waste my time to talk with you?

I stand by my previous statement. Drug reps have a job to do. I have a more important job to do. They want me to prescribe their drug – and they really do not seem to care if that drug is appropriate for the patient. I want to find the best and if possible least expensive way to treat my patients. I want to minimize drug use and especially minimize side effects. Since I believe that talking with drug reps could negatively impact my goals, I will continue to refuse seeing them. In doing so, I hope my patients benefit.

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Comments (9)

By all means, don’t see them if you prefer not to. That is very different from arguing that none of us should see them, or that they have a maleficent effect, overall, on the use of pharmaceuticals. I’d still like to see your case to that effect.

DB writes: “By refusing to see drug reps, I force myself to seek objective data on new drugs. Those who see drug reps are (in my mind) taking a dangerous shortcut”- It is great that DB seeks objective data on new drugs. All physicians should be so virtuous. Unfortunately most docs dont read this much as several studies have shown. They do take short cuts. What we should impress upon physicians is that if they choose to use this information (from drug reps) they must scrutinize it. They must verify for themselves that the information is correct or biased or bunk.

DB also writes: “They want me to prescribe their drug – and they really do not seem to care if that drug is appropriate for the patient” DB is right- the drug rep’s job is not to determine appropriateness for an individual pt. Their job is to sell you on a drug’s usefullness. It is incumbent on each physician to decide appropriateness of a drug to each individual patient. Even if a drug rep gives 100% unbiased info it is still a physicians job to decide applicability. A pt’s comorbidities or frailness may turn us away from using a proven (even cheap) therapy if the risks outweigh the benefits.

I haven’t attended a drug rep lunch or office display in over three years. Those of my colleagues who still do try to argue that they can be objective about prescribing in spite of the obvious ( and non-obvious) pressure techniques being used. I am skeptical that they can really pull this off, but I can only speak for myself. When I was still attending the lunches, I asked myself: how can I say no to these well educated attractive people who bring me food, various other free gifts and seem eminently reasonable? Since the answer to that question was that I couldn’t, I decided to no longer attend.

I’m with you on this 100% DB. I see no drug reps, don’t even use their pens or branded pads.

Their role is purely increasing sales of their product. Nothing else. They would not be employed by pharmaceutical companies if they did not produce an economic return, through biasing physician prescribing.

The classic example is the drug rep carting about the one or two perhaps dubious studies favouring their product, yet forgetting to mention the many other studies perhaps not so skewed in their favour.

Sure, lazy and ignorant phsyicians are more susceptible to being affected by misinformation…but, when all is considered…in what way do drug reps benefit patients? This is the crux for me.

A drug rep is a biased information source by definition – that’s their job!

DB has done a great job of listing some of the most basic sales concepts used today. What a doctor needs to add to this is that the drug companies have years of experience on what works and what does not work. The drug reps engage in role playing activities as part of their training so that they can deliver a pitch in as little as 15 seconds. This is a contest you will loose. Why take the time to listen to a sales pitch when you have to verify all of the information?

On a personal note I find it demeaning when I hear a doctor regurgitates a sales pitch for a drug. Some of these are so blatant as to make me, the patient, wonder if the doctor has even read my chart. Many are just simply inappropriate for my situation. JUST SAY NO!

I would encourage doctors to then take the next step. Generics first. In the next few years nearly $40B worth of patented drugs will go generic. This offers both doctors and patients an opportunity to have a dramatic impact on the overall medical cost of this country by simply staying with existing medications, or sticking with tried and true medications with known side effects in a large population.

A recent example of sales push over testing data is Avandia (diabetes). A Dec. 5 WSJ article shows that the tried and true generics do as well as the trumpeted up new drug at a fraction of the cost. Not only this, but a footnote to the study, showed an increase in fractures for the Avandia users requiring additional study. An important issue when dealing with an older population.

GENERICS FIRST!

Steve Lucas

I actually agree with you. Co-rant here.

Wow this is really interesting. From what I am gathering certain physicians are trying to say “no to drug reps”which does not really put an end to the actual problem. Ok lets see so theres a patient suffering from hip pain she goes to her general physician and the doctor says you need anti-inflammatories and you may have nerve damage. Doctor states you need an MRI. So she takes her medication and takes all the precautions,tests and still suffers. She then is referred to a Orthopedic surgeon who says you have no nerve damage its bursitis. Doctor states you can either take more anti-inflammatories or get a cortizone injection. Also its ok to do your daily activites ,but wait the story gets better patient is then referred to a Physical Therapist and he states no daily activiites and need to take more anti-inflammatories.
So you all are saying say no to drup reps how about saying no to doctors when you can’t even get a straight answer on what to do and its extremely time consuming to run from doctor to doctor with three different answers don’t you think??
Instead of blaming the pharmaceutical companies and reps how about you all come up with a program where you can tell a patient one diagnosis and one therapy to follow not several and leave the patient confused.
People have to stop blaming and pointing fingers when the education needs to start in the offices themselves. Pharmaceutical reps are not as educated as the doctors but they have a job to do just like you. It is your perogative to refuse the rep but just remember before you accuse the reps of taking up too much time take closer look as to what you are doing in your offices and to your patients.

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