This article is part of the Arthritis Archives.
Dateline: February 18, 2001
Are Doctors Influenced By Pharmaceutical Sales Reps?
An article in U.S. News & World Report (2/19/2001) took aim at the impact pharmaceutical sales reps have on the prescribing habits of physicians. Are the decisions doctor's make about which drugs to prescribe based on knowledge, expertise, your needs, or are they influenced by drug sales reps?
Here are some staggering numbers to consider.
- In America, prescription drugs are a $120 billion/year business, with the potential to double by 2004.
- Aggressive campaigns by drug companies for the purpose of winning over doctors and patients cost $13.9 billion in 1999.
Do doctors and patients believe they are being influenced and manipulated?
There have been a few doctor's offices which have closed their doors to drug sales reps, realizing that it is the job of the rep to sway them toward new and heavily promoted drugs. However, the key word here is "few". It is not the majority of doctors taking this action.
Most doctors claim they are not influenced by marketing ploys but research has shown otherwise. A study published in a 1994 issue of JAMA, reveals that doctors who made specific requests to insurance companies that a particular drug be added to the formulary list were 13 times more likely to have met with a rep promoting the drug than doctors not making any such request.
Drug companies claim that promotion serves to educate doctors and patients about new treatment options. However, sales pitches and promotions can influence doctors and lead them to select new drugs, in spite of higher cost and concern over safety, according to studies.
On our arthritis forum we asked, "Did you ever wonder how doctors choose which medication they prescribe? Do you think the free samples they get have anything to do with the selection, or is it trial and error, success stories from other patients, or just pure knowledge of what is best?"
Karen replied, "I think it is all of the above. I would guess that some element of each of your suggestions play into the decision. Now the question would be how much each element plays into it and that I would guess changes through time for each doctor. For example a drug sales person might get the doctor to prescribe Celebrex but as the doctor sees success he prescribes it based on that. I would hope if they saw it wasn't working, no matter what a salesperson says, it wouldn't be prescribed."
Goldie replied, "I know my rheumatologist likes to go with the tried and true first and see how they work, but I do think the free samples play a BIG part in the decision, since for many of the patients who do not have prescription coverage this is their only hope of getting medication."
The marketing frenzy begins with medical students and residents, and gets into high gear as physicians enter into practice. Free lunches for medical students and fancy dinners for doctors are not uncommon. Sometimes doctors are paid by the pharmaceutical companies to attend or speak at the dinners.
There are also the door-to-door sales reps armed with comfort foods like donuts and pizza, and an array of logo-bearing items such as:
- mouse pads
- golf balls
This is designed to get the rep in the door and to keep the name of the drug being promoted foremost in the mind of the doctor.
Free samples seem to be among the most powerful promotions. While patients are appreciative of the free samples, eventually the free samples run out and a prescription needs to be written. Often the doctor will write the prescription for the same drug even though the doctor may have actually considered a different drug.
The newest marketing scheme involves direct-to-consumer advertising. The concept, embed the name of a new drug on the mind of a patient so the patient will carry it into the doctor's office, often with a request to try it. In the past three years, ads for drugs have appeared on television and in magazines like never seen before. Doctors and insurance companies view this as one of the least favorable marketing tactics, believing that it lures patients to high-price drugs when other available drugs are often cheaper and possibly as effective.
As heavily marketed, expensive drugs gain popularity, healthcare premiums and out-of-pocket costs are driven up. It's high-priced healthcare. Something nobody wants.
How can you take yourself out of the game?
- Ask your doctor to be aware of cost and effectiveness when choosing a drug to prescribe.
- Ask both your doctor and pharmacist about the availability of a generic substitution for the drug prescribed.
- Inquire about drugs seen in ads but don't insist on a prescription for the drug. Encourage and allow your doctor to use his best judgment.
Source: Prescriptions: How your doctor makes the choice, Shapiro & Schultz, U.S. News & World Report, 2/19/01
First published: 02/18/2001