In a unique collaborative paper in PLoS Medicine, a former drug rep and a physician who researches drug marketing reveal the tactics used by drug reps to manipulate physicians into selling drugs.
“Drug reps increase drug sales by influencing physicians, and they do so with finely titrated doses of friendship,” say the authors, Adriane Fugh-Berman (Georgetown University Medical Center) and Shahram Ahari, a former drug rep for Eli Lilly who now works for the School of Pharmacy at University of California San Francisco.
The specific strategy used by a drug rep to manipulate a physician, say the authors, depends very much on the personality of the doctor. A friendly, outgoing physician is the easiest to influence, because the rep can use the “friendship” to request favors, in the form of prescriptions. If a physician refuses to meet with a rep, “their staff is dined and flattered in hopes that they will act as emissaries for a rep’s message.” Physicians who end up prescribing the rep’s drugs are amply rewarded with gifts, such as golf bags or silk ties.
In the paper, Mr Ahari shares his experience as a company insider. For example, when faced by a physician who preferred to use a competitor drug rather than Mr Ahari’s drug, “the first thing I want to understand,” he says, “is why they’re using another drug instead of mine. If it’s a question of attention, I commit myself to lavishing them with it until they’re bought.”
Drug companies purchase data on physician’s prescribing habits in order to identify those prescribers who might be open to influence by drug reps, say the authors. Many doctors don’t even realize that data on their prescribing habits can be bought by drug companies. Another technique that drug reps use is to give doctors “free” drug samples, which the doctors can give to patients as a gift. Studies consistently show that samples influence prescribing choices, say Fugh-Berman and Ahari. “Reps provide samples only of the most promoted, usually most expensive, drugs, and patients given a sample for part of a course of treatment almost always receive a prescription of the same drug.”
A sales force of 100,000 drug reps (one drug rep per 2.5 targeted physicians) is providing “rationed doses of samples, gifts, services, and flattery” to those physicians who are likely to prescribe the rep’s drug. “Every word, every courtesy, every gift, every piece of information provided is carefully crafted” say the authors, “not to assist doctors or patients, but to increase market share for targeted drugs.”