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Studies: Friendly Pharmaceutical Reps Sway Doctors' Decisions

Two new U.S. studies reveal that subtle attention from pleasant pharmaceutical sales representatives may have a significant impact on the type of drugs doctors prescribe.

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

Method of Manipulation

The first study, published in the Public Library of Science Journal PloS Medicine, outlines the method of manipulation drug reps often employ to become friends with doctors and influence sales.

“Reps scour a doctor’s office for objects—a tennis raquet, Russian novels, ‘70rock music, fashion magazines, travel mementos or cultural or religious symbols—that can be used to establish a personal connection with the doctor,” said Fugh-Berman and other co-author of the study Shahram Ahari, a former Eli Lilly and Co. drug representative who now works for the school of pharmacy at the University of California, San Francisco.

“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-prescription 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 added.

Drug representatives also manipulate doctors by setting up paid lecture engagements and arranging educational scholarships to physicians who commonly prescribe their drugs.

Brief Visits Effective

In the second study, researchers found that even a quick visit by a pharmaceutical sales rep could have a strong impact on doctors.

The study evaluated surveys conducted by a market research company that chronicled a physician’s intention to prescribe Neurontin—Warner-Lamber’s epilepsy drug—between 1995 and 1999.

The surveys included 116 drug rep visits to 97 doctors. Researchers found that after almost half the visits, the physicians claimed they would either prescribe Neurontin more frequently or recommend it to other doctors 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,” said Dr. Michael Steinman of the San Francisco Veterans Affairs Medical Center.

Other than free medication samples, drug reps often buy gifts for doctors, take them out to lunch, or bring in new coffee mugs and pens. “The doctor feels subtly, even subconsciously, indebted to the representative,” said Steinman.

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