Can we talk drug reps?

guest416560 · May 12, 2010

I would assume you could go eat lunch outside of the office or bring in your own lunch. If you're going to eat the food the drug rep brings in then I suppose you are under a bit of an obligation to hear them out. If you don't want them in your office quit seeing them. You won't have samples but I'm assuming your patients can live without them.

VivaRN · May 12, 2010

There is a growing body of evidence out there: drug reps do influence the way we practice, gifts (even small gifts) create a sense of obligation, drug rep literature is biased, giving samples can start a patient on a drug that may be more costly to continue or not the best drug for them.

The scary thing is that most of this is unconscious. The provider is not aware of the effect but it shows up in analysis of prescription patterns. The drug reps are not there to be your friend, they are there to sell a product. They have strategies for how to sell to you, and how to confront opposition. It is really quite sickening. I challenge anyone to review the literature and prove me wrong.

Perhaps the other providers in your office are not aware of how far this field (influence of drug reps on providers) has advanced. Do you think they would be open to a change? The other option is to opt out and try to educate those who ask you why you made that choice. It can make social waves so you have to decide what is worth it to you.

ABOUT US - this is the no free lunch website

Dr. Daniel Carlat's piece in the NY Times about speaking for a drug company:

Effexor XR - Drugs - Pharmaceuticals - S.S.R.I.s - Antidepressants - Depression - Medicine and Health - New York Times

carachel2 · May 13, 2010

Thanks both of you for your comments. I am the new provider in this small practice and at the moment I cannot make decisions as to whether or not these lunches take place. I *will* continue to make an effort with my prescribing pattern to make sure it is not influenced in any way and will be more aware of the sample effect. I hate the whole coupon game!

I DO find I am having to "undo" prescriptions that are heavily branded and help the patient transition back to a generic. So far I have no complaints!

mammac5 · May 13, 2010

I worked in a FP residency clinic prior to coming back to school. We did not allow drug reps into the office. Period. No lunch, no breakfast, no bags of chocolate, no samples, no allowing them to influence our brand new docs-in-training. We had one doc in particular who really detested pharm reps and pushed for the policy. He was supported by the fact that our office was JC-accredited as part of a hospital and we were dismal failures at keeping an exact pill count of all samples at all times.

When the policy was initially instituted some pts were a little ticked off about our not having samples. But with the $4 list at Walmart we found there wasn't such a huge need on a daily basis for most things.

MissDoodaw · May 14, 2010

Playing devil's advocate...

I like being able to ask someone to tell me in 2 minutes why there product is different than it' competitors, i like having someone that has time to give me info, find the research studies backing up what they say and give them to me, if I use my reps as a resource properly, I can, and thourgh me my patients can benefit from this training. Otherwise, although I m active in my local np group, attend pri-med and other conferences as much as possible, I don't heaqr about these new meds- I did miss the announcement of the once a day amoxicillin dosing.

Yesterday I had one give me a coupon for a free starter pack of Chantix for a particular patient, last week I had one who spent a couple hours dealing w/ a patient's insurance company to help me get them a continous glucose sensor. I think it may help this pt recover a ense of normalcy to her life, if not save her life.

I actually had a prospective employer tell me she had asked the reps about my reputation with my peers and patients...this Dr. felt how I treated folks-even reps was representative of my chracteristics. Hmmm....not sure how I feel about this.

Finally, the drug companies are not pure evil all about a buck ALL the time...read the story of Ray Merck and river blindness. I do have a soft spot for this company for sure after reading this story....

MedVision · May 15, 2010

As a former drug rep starting NP school this fall I had to chime in! I think drug reps "CAN" provide valuable information. Clinical data is constantly being released and I would imagine it difficult to remain current with all this information especially for practitioners that treat a broad range of patient types/conditions. Having said that, there are some that don't take their jobs seriously and just focus on getting "scripts" and could care less about bringing value to the practice.

VivaRN · May 15, 2010

Hmmm, I would argue that there are unbiased sources of drug information. Why not educate yourself with that vs. allowing your education to come from a potentially biased source? It might take a little more work and is less passive on the provider's part, but isn't it worth it to know you are making evidence-based decisions for your patients?

This is part of the problem, that we allow our education about new drugs to come from the people selling them. Conflict of interest, anyone? I hear you that it may depend on the individual drug rep and his/her ethical makeup, but why take a chance?

littleredmare · Jun 16, 2010

I bring my lunch. I don't know about everyone else, but I am way to busy lately to take a lunch break, let alone sit and gab with a drug rep. Don't get me wrong, some have some very interesting information...but so far I can get everything I need to know from a book, the pharmacy, or the drug package insert, or Up to Date. I would go and ask them a question if needed, but I'd never eat their food. Though, I'm a vegetarian so that sets me apart from the start.