Sunday, April 09, 2006

Drug reps and their whores - the commercialization of medicine

A successful drug rep ("pharmaceutical sales representative") will commonly earn over $150,000 a year. They know which physicians prescribe what, and they adjust their targeting appropriately. The AAFP attempted to block an organization that fights the corruption of physicians from appearing at the annual scientific assembly (this brain-dead decision was reversed when the membership began to howl). The most common strategy to corruption is to start small (pens, sponsored books) and then gradually ramp up -- the slippery slope is shallow at first.

The Atlantic is doing well these days; this article on the buying of physicians and the work of the drug rep is among the best of a good lot. Carl Elliott is a U of MN professor who lectures medical students about reps; here he writes sympathetically about both the drug reps and their physician partners. He makes a convincing case that both physicians and drug reps are increasingly similar cogs in the market machine of modern medicine.

Their are some simplifications. He writes as though most physicians believe they are not influenced by drug reps. I suspect many are more realistic, and know they've sold a bit of their soul. I'd like to read a study that asked three questions: "Do you accept gifts and samples from drug reps?" "Are your colleagues influenced by drug rep gifts?", and "Are you influenced by drug rep gifts and visits?". I think the most common answer would be yes, yes, no and next would be yes, yes, yes.

Drug reps know which physicians prescribe boringly, following the Medical Letter party line. They're polite to those physicians, but they don't spend a lot of time on them. They favor those who like the fashionable trends, and they leverage direct-to-patient marketing to make being fashionable ever more appealing. Back before they had that data, when I was in practice, they already knew not to bother with me and my partners -- but we were space aliens. Most of our colleagues were more welcoming, but I think they knew they were supping with a pleasant devil.

It's a fascinating tale of how commerce works, and how good people go sort-of-bad. I work in industry now, and I don't believe I'm incorruptible either. It's a tricky world, no doubt, and sales folks are a lot of fun ....

Update 4/16/06: The study I wished for has been done.
A 2001 study of medical residents found that 84 percent thought that their colleagues were influenced by gifts from pharmaceutical companies, but only 16 percent thought that they were similarly influenced.
The above quote came from a behavioral economics paper. I'd like to see if the percentage who realize they're influenced by gifts rises with years of practice or if it's a persistent result of a fixed personality trait (ie. insight).

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