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    Drug reps: Understanding the hand that feeds you

    Henry Rosevear, MDDr. RosevearWe had Chinese on Tuesday. There was Mexican on Wednesday, but the best part of that meal was the dessert tray. It was a nice touch, as most reps don't bring dessert.

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    I was sitting at my desk after lunch Wednesday waiting for my first patient to be roomed (and enjoying my second cookie of the day) when I started thinking about the modern relationship between drug reps and physicians. Our practice allows industry reps to visit, so you could argue that I have already formed an opinion on reps. But the stark contrast that exists between my experience in the real world and that of my residency program, where industry reps were not even allowed on campus, is enough to give me pause and make me consider their role in medicine today. 

    As anyone who has read this blog before would guess, I started by researching the history of the drug rep industry to better understand how we got to where we are today. Drug reps (also called industry reps or "detail" reps for their ability to give details about a drug) have been around since the 1850s. The evolution of their job paralleled dramatic changes in medicine as a whole.

    Originally, drugs were directly marketed to consumers and the drug rep concentrated on what would nowadays be considered direct-to-consumer advertising. In the early part of the 20th century, the American Medical Association started promoting the concept of an “ethical” drug company, defined as one that worked with a physician with no direct-to-consumer advertising. This moved the industry rep into the physician’s office, where his interaction with the physician was not only accepted but encouraged.

    Later, especially after World War II, as the pharmaceutical industry became more complicated and as the number of marketed drugs dramatically increased, the role of the industry rep evolved into providing "details" about drugs directly to physicians. These hybrid salesman/pharmaceutical experts soon realized that doctors gave them more time if they came bearing gifts, in essence establishing a feeling of reciprocity.

    It turns out that there is an entire social science showing that simply giving a gift, even a small one (remember when drug reps gave out pens?) increases the feeling of reciprocity between the physician and the rep. What is reciprocity? It is the tendency for most of us to be nice to someone if they are nice to us, and in this case it means that I am more likely to prescribe a drug if a rep has been nice to me.

    By the 1980s, as some of my more experienced colleagues may remember, it was not uncommon for drug reps to give expensive gifts to physicians. This changed in 1990, when the FDA began to outlaw "gifts of substantial value." While this decreased the giving of gifts, it simply made gifts of meals and travel more common.

    Next: Direct-to-consumer advertising

    More from Dr. Rosevear

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    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.

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