Drug reps: an ambivalent relationship


The drug reps come by the bunch

They frequently bring in a lunch

     I try not to whine

    When they’re taking my time

And putting me into a crunch.   

 

Pharmaceutical manufacturer’s representatives, aka drug reps, are a necessary part of the medical industry in the 21st century. I couldn’t write about my work without mentioning them and our ambivalent relationship.

During my residency’s Supervised Rural Practice Elective in Thermopolis, Wyoming, a  drug rep made a sales call and took me and one of the other doctors out to lunch.  The rep pitched a high blood pressure drug, but the internist and I quizzed him about pathophysiology and he updated us.

Reps bring biased information.   I take that into account the slant of the presentation.  Invariably a competitor brings equally slanted information; in the long run, one balances the other. 

If a new drug has a truly unique indication I start using it within 3 months of release, but if it has a competitor I don’t start prescribing it for a year.  We’ve had some truly promising drugs that got pulled off the market because of problems. 

Drug reps do the same job as manufacturer’s reps do in any field.  I knew a person who represented a wholesale food operation. Just like the drug reps, his work involved a lot of driving, nice clothes, and great social skills. 

I pay the price of time for information.  Even if I spend only five minutes with a rep, at the end of the day, six reps have taken half an hour, down from a previous hour and a half a day before we limited slots for reps to six.  I try to ask politely for new information and if the rep says, “Well, I just wanted to emphasize…” or “just reiterate…” I will interrupt, and ask for NEW information. 

I resent the sales technique that asks the question, “How does my drug fit into your practice?”  I will respectfully point out that answering that question brings me no new data but takes up my time.

Sometimes I’ll dodge a canned presentation by asking information about physiology and metabolic pathways and I receive a mini refresher course. 

I don’t mind expending time with the reps as a doctor even when I don’t get paid for it.  I have given reps advice about migraines, sleep, family relationships, exercise, alcoholism and co-alcoholism, diet, and skin care.

Twenty-three years ago a lunch brought by the rep happened so rarely that it rated announcement the day before.  Now we have to limit the lunches to four weekly and the breakfasts to once weekly. 

Most of the lunches don’t come close to what Bethany packs for me.

The reps don’t bring the trinkets that they used to, which is just as well.  Most of the freebies were just so much junk.  I quit using drug company pens four years ago; I carry a Waterman, a gift from a patient.

Sometimes the rep brings a specialist in to pitch their drug, and those sessions have proven their worth.  I got started checking Vitamin D levels that way; another lecture improved my detection rate of bipolar disease.

Cost benefit ratio for drug rep info averages six to one; it takes six minutes to get from a rep the information I could have learned by reading for one minute.  Educational TV has the same ratio.

I’m not sure I’ll see drug reps in the year that I go walkabout.  I wonder how much worthwhile information I’ll miss.

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