Just Saying "No" to Drug Reps
Stop the presses! DB and I agree on something.
The good Dr. Bob has not one but two posts about the perniciousness of drug reps pushing their wares. Frankly I have been saying the same thing for years; to their faces, though not on a blog.
Here's my take on it -- freely shared with reps who call on me:
- Everything they say is propaganda.
- They are better at it than I am (that is, even if I listen "criticallly" and "skeptically" they will compensate accordingly and therefore something will get through, whether I want it to or not.)
- I only take samples for drugs I already write for (comes in handy to hold folks over when their mail order is delayed)
- I will not accept *any* gifts. No pens/pads/kleenex/candy (even though it kills me to pass up chocolate) nor will I participate in any dinners or programs, no matter how "educational" you try to spin it. (See #1 above)
- If I have time, I will happily listen to stories of (or check out pictures of) your kids/pets/weddings/etc.
- I will not listen to any of your drug spiel (to the point of putting my hands over my ears and chanting "na-na-na I'm not LIStening".)
- If you keep on trying (or slip studies onto my desk while I'm in with patients) I won't let you back into my office.
One rep's twins are growing *so* fast it's unbelievable. Another rep never fails to get down on the floor with my doggie and rub her tummy (the dog's, that is.) One guy's son is in my son's scout troop; we're planning to get together for dinner one Sunday night. Another rep with kids the same age as mine kept crossing paths with me at school sports events. Despite the fact that I haven't written his drug for years, he's a real friend. And another's black lab puppy is *too* cute. One of my best rep friends left to become a nurse; she's going to be an awesome one. Another married her med student fiance and moved to DC for his surgical residency; I went to her baby shower a few months ago, and just sent a baby present to her new daughter.
While I don't resent the reps as people, I don't feel their profession should exist. When you stop to think about it, I neither buy nor use their product. Nevertheless, I'm the one they must "sell" on it. I can't think of a worse reason to prescribe a given drug than, "The rep is a nice guy." Five of the six "weapons of influence" quoted by DB are routine for them. Drugs should not be *sold*.
DB's commenters disagree.
One points out our "responsiblity to listen [to drug reps] critically." See #2 above. We do not have the information readily at hand to counteract the spin they have been carefully trained to deliver. Studies have shown that even when we think we are listening critically, our behavior (ie, prescribing patterns) are still affected.
Another laments that he is "not as virtuous" as DB (or me, for that matter) for not finding out about new drugs and pharmaceutical developments on our own; independently of reps. I don't think it's a question of virtue, but of responsibility. I agree that listening to drug reps as a primary source of new drug information is risky at best and foolhardy at worst. In addition to Vioxx and Celebrex, they were pushing Ketek like there was no tomorrow. I admit to being quite proud of my status as a "late adopter" when it comes to most drugs.
Now, as soon as DB recognizes the absurdity of his arguments for so-called "patient responsibility," we'll all be just ducky.
Update: DB's commenters continue to elaborate on all the above points.