The Drug Rep Dilemma

I attend pharmaceutical dinners every once in awhile because: 1) I like to stay up to date with all the new drugs (or just a slightly modified version of the generic, but with a much fancier name and packaging); 2) Though I’m several years out of med school/residency, one thing I have maintained from those formative years is the mentality where I’d never pass up a free meal.  I know that pharmaceutical sales representatives (also known as drug reps) have been banned and limited in several institutions, and I completely understand the reasoning (it has been shown that drug reps’ marketing tactics influence physicians to write prescriptions they typically would not write, thus boosting pharmaceutical sales).  However, I also think it’s important for physicians to be self-aware of their existence and influence in order to make conscious decisions on their own.

A few months ago, I attended a pharmaceutical dinner sponsored by the manufacturer of one of the newest psychiatric medications.  These dinners always feature a physician, who describes the medication (the pharmacology, indications, side effects, etc), explains the existing research in support of the medication, and leads a discussion and answers clinical questions.  My initial impression of the night’s presenting physician: charming, and since his introduction boasts the research he conducts at a prestigious university, he must be highly reputable and intelligent.  But, as his talk progressed, I realized how narcissistic and full of sh** he was.  I sat in the very front, yet chuckled to myself and assumed every other clinician in this room picked up on his suave, yet unconvincing tactics.  I mean, who was this guy trying to fool by flaunting his European accent and stories of trips around the world??

However, I looked around the room and the entire audience of doctors and other clinicians were laughing and smiling in awe.  I tried to hide my disdain and cringing facial expressions, but I sat at the very front of the room, so I’m sure others noticed. Or maybe not…I mean, everyone in the room was mesmerized by this guy!  I figured that I should refocus my thoughts and give him another chance and caught up just in time to hear about his trip to Europe.  I shook my head and thought to myself, “wow, can you believe this guy?  And he gets paid tons of money to attend this dinner and talk about himself?”  I smirked and assumed his current, pointless story-telling (aren’t we supposed to be discussing the medication?) would be convincing enough to prove his bullsh**, fake persona, so I turned to look at the audience assuming others would catch on.  Still, all smiles.

At the end of the dinner, I found myself in a dilemma as I had to pass this man on my way out as I left the dining room.  I contemplated whether I should act just as fake as his schmoozing and say something along the lines of “hey, great presentation” or should I challenge some of the comments he made?  I settled for a more neutral comment and told him “thanks, you are very entertaining” as I shook his hand and smiled.

Then, I realized at that very moment I became just like everyone else in the audience who commended and complimented him.  For a temporary, quick second I even contemplated prescribing the medication.  The thought of prescribing the medication was short-lived, for, after I left the restaurant, I snapped out of it and wished I gave him a piece of my mind.

I thought, “oh well, instead I’ll just stick with my guns and won’t be overly influenced to prescribe the med, unless clinically indicated.” (I’d never deprive my patients of a medication that might possibly help).  I now realize even more why pharmaceutical companies used to frequently provide fancy trips, extravagant dinners, and expensive novelties before policies/rules became more stringent.  The speakers and drug reps can be quite hypnotic and mesmerizing, but it’s our duty not to be fooled by any marketing tactics.

Or have I already been swayed?