Medicine / Psychiatry

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?

11 thoughts on “The Drug Rep Dilemma

  1. Not to fret it happens in other fields as well. You did the right thing, listened to the facts (sounds like you had to dig through the BS to find the facts) and will prescribe when needed. The only difference (I know of) between the medical field and engineering is engineering has a check and balance where a supervisor will check the specification or drawing (engineers can kill thousands at a time with a simple screw-up or simple corruption), where the Dr. has no back up unless the patient goes for a second opinion. Whether we are flying on a air plane built with the lowest priced parts specified by a wined and dined engineer, or picking up a script written by a wined and dined Doc. It all boils down to trust.

    • Very true, trust is key! One of the reasons I chose not to go into private practice straight out of residency is because i wanted to make sure i had others i could turn to in case i needed to consult one of my colleagues and get another opinion within minutes. And even after i’ve been practicing >50 years (god forbid), i’d still consult my colleagues! i actually haven’t prescribed the drug since then (hasn’t been indicated, except once since i inherited a patient already on it), but knowing how much conscious sifting through the BS i had to partake in shows how hard it can be not to be influenced!

  2. I’d love to see more blog posts like this. You are an excellent story teller. As for your parting comment….lol. I found myself laughing while reading it at my desk. “Thanks, you are very entertaining” is perfect. Brought to my mind the expression: damning with faint praise.

    • Thanks Tom! i’m a much better story-teller in writing compared to telling stories aloud (i have no patience to give more than the 2minute version)…will hopefully be inspired enough to write more stories! glad u appreciated my choice of words lol

    • Hi! It was for one of the newer antipsychotics. Vortioxetine is FDA approved for major depression (at least in the US)…i didn’t even know it was promoted as an antiemetic!

      • Thanks for your reply. I was kidding about vortioxetine. I really meant “emetic” (not a typo). Users report a lot of nausea and vomiting with “Brintellix.” Also, itching all over!

        Looks like the antipsychotic might be Brex. The reps are talking about a launch party on

        I appreciated the story you told in your column by the way.

  3. I love this! It’s good to keep a unbiased mind when dealing with drug reps. They often have useful information, but at the end of the day, it’s about money not the patients.

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