Analysis: Former drug rep reveals tactics

By STEVE MITCHELL, UPI Senior Medical Correspondent  |  April 23, 2007 at 8:01 PM
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WASHINGTON, April 23 (UPI) -- A former pharmaceutical company insider and a physician who researches drug marketing reveal the tactics used by drug reps to manipulate physicians' prescribing habits in an article released Monday and argue that doctors should seek more credible sources of information about pharmaceuticals.

In the article, which appears in the April issue of PLoS Medicine, Shahram Ahari, a former Eli Lilly rep, and Adriane Fugh-Berman, of Georgetown University Medical Center, detail the ways in which drug reps use the allure of friendship, gifts and other well-crafted strategies to influence even the most skeptical of physicians.

"I hope physicians will read this article and realize the friendships they think they have with drug reps are actually business relationships in which they're being emotionally manipulated," Fugh-Berman told United Press International.

"That's not an appropriate place to find scientific drug information," she added. "The concept that reps educate physicians is absurd. They're sales people; they have a very limited and distorted view of the medical literature."

Fugh-Berman asserted pharmaceutical companies have too much influence over physicians' prescribing behaviors and should be banned from having these relationships with doctors.

"It's not the only thing that needs to happen, but banning drugs reps would be a great step forward in loosening the hold pharmaceutical companies have over physicians' prescribing habits," she said.

Ahari, who is now with the school of pharmacy at the University of California San Francisco, said physicians would have to make that decision themselves, but if it was up to him, he would want to limit the contact with sales reps.

"I would be pushing for some sort of restriction to access," Ahari, who has testified about Lilly's tactics for promoting Zyprexa, told UPI. "The relationship needs to be more about science and less about friendship."

Zyprexa is the subject of several lawsuits over assertions Lilly hid the drug's potential to cause diabetes or weight gain. The company has doled out more than $1.1 billion to settle more than 26,000 claims.

In the article, Ahari and Fugh-Berman detail how a drug rep goes about establishing a friendship type of relationship with a physician. This includes gifts, taking them out to dinner and finding out personal information about them, such as family life and hobbies.

The drug rep also provides the physician with free samples of drugs. Although this provides the physician an easy way to make the patient happy, its intended benefit is for the pharmaceutical company by getting patients hooked on their drugs, Ahari said.

Even physicians who refuse to see drug reps aren't immune to the pitches; the drug reps will wine and dine their staff in hopes that they will, in turn, persuade the doctors.

One of the biggest pitfalls for physicians is themselves, said Ahari. Physicians often think they -- but not their peers -- are too smart to be influenced by sales reps. But this isn't true, he said, noting there is a correlation between gifts from drug reps and increased prescribing by these doctors.

Ahari said he was never instructed to do anything illegal or lie outright, but he was less than forthcoming with the truth.

"We're not instructed to lie, but we are taught and trained to obfuscate and come in with our own particular agenda and sugarcoat it as if it was objective scientific data," he said.

One tool drug reps use is the prescribing behavior of individual physicians they are able to obtain from companies, such as IMS Health. This provides them with very detailed information, such as how much and which drugs doctors prescribe.

The drug reps also can use this information to develop a strategy that will best appeal to the physician, Ahari said.

Fugh-Berman said the prescribing data is key to the drug rep-physician relationship, and banning the sale of that information could help curtail the influence drug companies have over doctors.

New Hampshire passed a law that would ban selling prescribing information for commercial use and is now involved in a legal challenge from IMS Health and Verispan. The judgment on that case, which could have ramifications for whether other states pass similar laws, is expected soon.

Pharmaceutical and Research Manufacturers of America did not respond to UPI's request for comment by press time.

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