Sunday, November 25, 2007

Big Pharma: The "finely titrated doses of friendship" edition

Do read this piece by Daniel Carlat (a professor of clinical psychiatry at Tufts) about one of the shadier techniques used by Big Pharma: hiring doctors as glorified sales reps.

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Two related articles cited by Dr. Carlat in his article:

Christopher Lee in the Washington Post: Drugmakers, Doctors Get Cozier.

Adriane Fugh-Berman, Shahram Ahari in PLoS: Following the Script: How Drug Reps Make Friends and Influence Doctors.

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A few weeks later, my wife and I walked through the luxurious lobby of the Millennium Hotel in Midtown Manhattan. At the reception desk, when I gave my name, the attendant keyed it into the computer and said, with a dazzling smile: “Hello, Dr. Carlat, I see that you are with the Wyeth conference. Here are your materials.”

She handed me a folder containing the schedule of talks, an invitation to various dinners and receptions and two tickets to a Broadway musical. “Enjoy your stay, doctor.” I had no doubt that I would, though I felt a gnawing at the edge of my conscience. This seemed like a lot of money to lavish on me just so that I could provide some education to primary-care doctors in a small town north of Boston.

Along the way, we learn about how the American Medical Association allows data leak on who prescribes what:

The American Medical Association is also a key player in prescription data-mining. Pharmacies typically will not release doctors’ names to the data-mining companies, but they will release their Drug Enforcement Agency numbers. The A.M.A. licenses its file of U.S. physicians, allowing the data-mining companies to match up D.E.A. numbers to specific physicians. The A.M.A. makes millions in information-leasing money.

Once drug companies have identified the doctors, they must woo them. In the April 2007 issue of the journal PLoS Medicine, Dr. Adriane Fugh-Berman of Georgetown teamed up with Ahari (the former drug rep) to describe the myriad techniques drug reps use to establish relationships with physicians, including inviting them to a speaker’s meeting. These can serve to cement a positive a relationship between the rep and the doctor. This relationship is crucial, they say, since “drug reps increase drug sales by influencing physicians, and they do so with finely titrated doses of friendship.”


  1. Anonymous said...

    "Doctors as glorified sales reps" - Groopman's "How doctors think" has an entire chapter on it.

    Very much prevalent in India as well.