Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Thursday, January 25, 2007

Drug Reps and Skepticism

Dr. Anonymous thinks he can outwit drug reps at their own game:
Through my medical school training, I've been taught to question all information that is given to me - whether it's a patient's vital signs, or physical exam, or lab work, or whatever.
No you haven't, and neither have I. We've been taught to trust our findings and what the patient tells us, and only to go questioning them when something doesn't add up. (Patient says she has a fever but the thermometer reads 98.6. Patient says he doesn't drink but the transaminases are off the wall and his CBC shows macrocytosis. [blood test results strongly suggestive of alcoholism])

Drug reps are taught, trained and conditioned to tell you things in a way that makes perfect sense, using a style of presentation that is almost impossible to argue with. They are professionals, and many of them are damn good at it. It's just hubris to think that you can remain skeptical enough of a rep's pitch to take away only objective information. Look again at those studies you referenced.

As for not having time to keep up on the latest research, neither do I. But I read The Medical Letter religiously, and try to leaf through JAMA before pitching it. Besides, I pride myself on being a "late adopter" of new therapies. Let someone else's patients discover that some new drug makes their penis turn purple and fall off. Baycol; Vioxx; Ketek; the list goes on and on. Thinking of drug reps as a valid source of information -- especially the newest of the new -- can be as dangerous as it is inappropriate.


At Thu Jan 25, 08:13:00 AM, Blogger Dr. A said...

Ok, since I got called out on this....

You believe that there is something called "unbiased" in medicine? That's like saying there is such a thing as "nonpartisian."

Yes, there's even bias with the Medical Letter, JAMA, the New England Journal, Annals, and whatever other journal that you want to hold up there. Why not add television, newspapers, and any media source as well.

Granted, reps have a huge amount of bias and journals - for the most part, have a less amount. But, bias is everywhere and people have to be aware of it and try to learn to deal with it.

I admit that this is probably a naive way of thinking. But, that's where I'm at with it right now in my profesional life. My point of view could change today for all I know....

Thanks so much for your thoughts on this subject. I find them valuable (really).

At Thu Jan 25, 09:47:00 AM, Anonymous Anonymous said...

D, c'mon Vioxx was pretty damn good if you used it for 2 weeks.
I agree 100% otherwise... I am considered out of step among my peers for not accepting drug rep stuff. Although, I know they are jusy trying to make a living so I will hear what they have to say but only very briefly and with nearly no discussion. Not accepting gratutity for my time is the only way I can accomplish this.

Want to know how ingrained drug reps are in the system? One of my stupid ass partners, known for lack of work ethic, BROUGHT a drug rep to my pod in the ER while I was getting my ass kicked and said "Trenchy, do you have a second for this nice fellow... I know you don't take drug rep stuff but he gave us lunch today".

I couldn't believe it. Idiots.

At Thu Jan 25, 09:48:00 AM, Blogger Dr Dork said...


Gotta agree. Sorry Dr.A.

Drug reps, for the most part, don't care about quality evidence.

Well - NONE do, in terms of their job description.

Conflict of interest is a little more prevalent in pharmaceutical employees than medical journals, one thinks.


At Thu Jan 25, 01:47:00 PM, Blogger Medblog Addict said...

Personally, I think you owe someone a drink.

At Fri Jan 26, 12:15:00 AM, Blogger Sid Schwab said...

I never saw them. Eventually, my quite large clinic banned reps entirely.

At Fri Jan 26, 06:08:00 AM, Blogger #1 Dinosaur said...

MA: Paid up.

At Fri Jan 26, 07:15:00 AM, Blogger MedStudentGod (MSG) said...

What I've taken away thus far in my medical training is that drug reps are quite attractive, a little pushy, and great sales-women (rarely ever see a male). However, what I've also taken away is that when asked questions related to their drug's side effects or the benefits of a more expensive drug vs. one that is generic I find them to be completely unable to deliver good information. I don't trust them and will do all in my future career to avoid them. Even with free samples.

At Tue Jan 30, 10:18:00 AM, Blogger Dr Scott said...

As in any profession, there are good and bad drug reps. The pushy ones get pushed out the door. The best reps I've met know their product, don't oversell it, and try to add what's now known as value-added service. Examples: a vaccine rep reports his company has a service to work with payors to make sure we are being reimbursed above purchase cost. A rep for an asthma product brings a CD with a program that tracks patients, med use, compliance with guidelines, includes pt handouts, etc.

Incidentally, more than half of my reps are male. I've found gender makes no difference: of my three favorite reps, one is female and two are male. And of my least favorite, it's also a fairly even split.

At Sun Feb 25, 11:49:00 PM, Anonymous Anonymous said...

Free birth control ... good enough. It's all birth control.

Bunch of Advil (*ahem* for the staff), okay.

Whatever else you got, if I have someone who's already taking it and can't afford it but needs it to live, gimme.

Of course, I tell the reps, "Oh, Okay, Okay, Sign Where, Gotta Run."

Also, I spend a lot of time putting people *back* on their old meds -- largely having to do with docs switching them from their old meds to "es-" variants.

I play a game with myself at dinners. In the first five minutes, I have to know "Which Drug is Great," or No Dinner For Me.

Strategies in Diabetes = "Avapro is Great" (within two minutes) won me dessert.

Which seems a bit ... odd.



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