Tactics used by drug reps to manipulate physicians revealed

In a unique collaborative paper in PLoS Medicine , Georgetown University Medical Center's Adriane Fugh-Berman and a former Eli Lilly drug rep 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," writes Fugh-Berman, associate professor of physiology and biophysics. Her co-author is Shahram Ahari, a former drug rep for Eli Lilly who now works at the University of California, San Francisco's School of Pharmacy.

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, Fugh-Berman and Ahari explain in the paper, "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.

Drug companies purchase data on physicians, prescribing habits in order to identify those prescribers who might be open to influence by drug reps, explain the authors. Another technique that drug reps use is to give doctors "free" drug samples, which the doctors can then in turn give to patients. Studies consistently show that samples influence prescribing choices, said Fugh-Berman. "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," write the authors, "not to assist doctors or patients, but to increase market share for targeted drugs."