How do you like this education, doctor?

Posted on August 16, 2008. Filed under: Everything you wanted to know about doctors, medical ethics, Medical marketing, Self-deception |

Chances are, if your doctor seems quite successful, he is a drug rep. He may not even know it. He surely won’t admit it, especially not to himself. It probably started out as a part of his continuing education.

I wrote: In my next post, I’ll talk about the real leaders in doctor “education”; they weren’t included in this one because it’s not official CME. I’ll also throw in some first-hand, saw-it-with-my-own-eyes anecdotes. Here it is; I know you’ve been waiting with bait on your breath.

You’re sitting in your doctor’s waiting room. You have the first appointment of the afternoon, yet there are five others waiting as well. They are all relatively young women in very nice outfits. They’ve got some cleavage working, and they’re shod in FMP’s, the good kind, maybe Jimmy Choo’s. They don’t seem to be ill. They’re pharmaceutical reps. (NOTE: if your doctor is a woman, these people will instead be athletic-looking youngish men, or perhaps an occasional older, plainer chick, no cleavage. Nothing suggesting competition). They are waiting to help your doctor with his continuing medical education. In fact, statistically, they are the major source of your doctor’s new knowledge about medicines. You will be ushered to an examining room and told, “The doctor will be with you shortly.” One or two of them will see him in his private office before he comes to see you. And so the day will go.

For some doctors, this scene may occur only one day per week. For some, one per month. I’ve known some doctors who would not allow any reps, ever. But do these people allow a regulated schedule to discourage them? Absolutely not! The reps will bring lunch for the office staff, whether or not they see the doctor. At one office in Mississippi that I visited, there was a large calendar on the wall of the employees’ lounge. It was for the pharm reps to sign up for lunch “opportunities”. EVERY day, for three months into the future, was booked. On the day I was there, there was some confusion, and two reps from competing companies showed up, along with their caterers, with full lunches for a staff of twelve. Cat fight.

Why would the companies do this? Well, they purchase access to prescribing records (did you know that most pharmacies sell their records to pharm manufacturers? I didn’t, until I got involved; strangely, the #1 dispenser of medication in the USA, Wal-Mart, does not [did not ?; I’m retired] participate). The reps know far more accurately than the doctors exactly how many prescriptions they write for their products, as well as for their competitors. If your doctor writes one or two prescriptions a month for their product, and the same for their competitors, he will not get much “continuing education”. They also know that the receptionists and the nurses control access to the doctors (most doctors never even see their own waiting rooms; they don’t know what goes on out there). When you win the hearts and minds of the gate-keepers to the “big writers”, you win the opportunity to show him the cleavage. The others sit in the waiting room, regardless of breast size.

You probably know that business encounters between pharm reps and doctors fall within the “strict” guidelines of FDA regulation. Reps cannot make any claims that are not written in the FDA-approved package insert. But what if the doctor asks about some non-approved usage, or some undocumented claim of superior efficacy, or those worrisome side-effects he’s been hearing about, like going blind or dying? Every rep carries a binder with reprints from prestigious medical journals to address the positive spin to those questions or issues; it is quite within FDA guidelines to  display the reprints to the “mark”, along with supporting commentary. Did I mention cleavage? How do these articles get published in the first place? Refer to  my previous post; skip down to the part about medical “thought leaders/whores”.

All legally available therapeutic drugs in the USA have FDA approval, obtained after many years of research and trials, with development expenses approaching one billion dollars per product. There are several to pick from in every category. What’s wrong with prescribing the one that the cutie with the cleavage is selling? Well, what about “patient doesn’t need drugs”? See the Overcoming Bias posts here.

I promised anecdotes. Here they come. If I’m lyin’, I’m dyin’ (sooner).

I came to the office after surgery one afternoon. I was a stickler for seeing patients on time. My receptionist (all of my office personnel were with me for my entire career; we loved one another) said: “I want to bring in a drug rep before we get started.” There were three patients in the waiting room when I arrived, although I was not late;  I intended to see them first. She said, “No, I think you need to see this rep.”  I bowed to her judgment.  I was between my second and third marriages at the time, that is to say, single. The rep appeared in my office. She had been “Miss fill-in-the-blank-town” in our area, and she was about 25. She was wearing a diaphanous white organza pants outfit, accented with a violet bra and thong. And, she was sweet and smart.  I was in a small specialty pond, but within it, I was a large frog. She wanted me to prescribe a drug that I felt was inferior to the competition in my field. I told her so. She leaned forward over my desk, cleavage a-bulgin’, and said that she was a new rep, and that her assignment was to capture over 50% of the market share in her territory within 6 months. She was one of the most gorgeous women I have ever seen. I wished her well. She was gone in 6 months.

In my field, there were two dominant oral medications (the third was that of the organza chick). One, the biggest seller, was manufactured by the largest pharm company in the world, with a sales force of over 100,000. The other was a later arrival, from a small company primarily financed by Bill Gates, with a national sales force of 200; I felt this latter one was a superior drug. According to the company’s records, I prescribed more of their drug than any other individual doctor. The rep for the preferred drug was a young man who took me golfing (I had my first hole-in-one while playing with him) and arranged for private lap-dancing with some of the most gorgeous/friendly women imaginable. Yep, both actions violate federal law (for him, not for me).  The other drug, manufactured by the big-hitter, had five different reps calling on me. One was a one-visit-per-quarter “specialist” from a near-by town who, when her brother was terminally ill, told “her doctors” to prescribe extra amounts of her drugs while she was at his bedside, to help her through a rough time; the records subsequently showed that they did. She was smart, beautiful, unmarried, and only about ten years younger than me. She wasn’t wealthy, but she might as well have been, because her company gave her an unlimited expense account to deal with high-volume ‘scrip writers. I wanted to marry her, or at least have her for my girlfriend; I didn’t want to push her medication. One evening, she invited me to a “round table discussion”; translation: an expensive dinner with her and some other reps at a top restaurant. After several martinis, the crowd had thinned, and the round-table conversation somehow turned to breasts. She had ’em. I mentioned that I preferred prominent areolae, and she volunteered that hers were like “sand dollars”. As everyone left, she asked me to walk her to her car. She mentioned her drug, and asked if I would like to see the “sand dollars”. I replied that indeed I would, and she pulled up her top and bra, in the parking lot. She mentioned her drug again, and asked if I would like to taste the “sand dollars”. I confirmed that I would, and they were magnificent. She again mentioned her drug, and asked if I would like to feel how wet she was. Ever curious, I checked, and sure enough, she was ready to sell a lot of pharmaceuticals. I suggested that we continue our discussion at my near-by apartment. While looking directly into my eyes, she put away the “sand dollars” and said she’d see me next quarter, after the new prescribing reports came out. Then she got in her car and left. I didn’t prescribe any greater volume of her med, and the next quarter, she appeared with a five-carat diamond from another doctor. He bought her the former governor’s house, and they married. I retired and wrote a blog.

Well, folks, that’s continuing education for your doctors!

If you want to see what the drug reps really think about doctors and each other, check this.


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4 Responses to “How do you like this education, doctor?”

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fantastic series of posts, RU.

… wow.

Anonymous (and you truly are to me; I have no nerd skills at all!):

Was that wow(good), wow(bad), or wow (insert here an offensive word describing vile vermin)?

Good on you, Urologist. This is the first time I’ve seen someone write in plain language about drug reps.

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    The director of the Sexual Medicine Center leaves penile implants behind, and launches a quest for knowledge about Artificial Intelligence, extended life, and the issues inside the health-care industry.


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