You might be surprised by the number of doctors who say that they are not influenced by the constant presence of Pharma reps (historically known as “detail reps”), that frequent nearly every educational event doctors attend following medical school. After all, these docs would not want anyone to think that they would succumb to marketing ploys designed to influence their clinical decision-making in favor of the economic agendas of pharmaceutical companies. And, with delusional doctors, that anyone, obviously, includes themselves.

However, logic tells us that Pharma would not spend the exorbitant amount of money they do procuring, training, grooming and educating their sales reps, (last I heard it was in excess of $100K per rep), if it was not at least, profitable for them to do so. Reps drive company cars and are given state-of-the-art electronics and computers. They enjoy lucrative benefits packages providing healthcare, prescriptions, counseling, dental and eye coverage. They also have large expense accounts and corporate charge cards and gas cards. So, reps rarely ever come out of pocket for most every day expenses.

Money talks, and a recent survey of drugs since 1997 with revenues over $200+ million in sales annually, tells the real story. This survey found that Pharma’s average return received for each dollar spent on direct detailing to doctors was $10.29. That’s a whopping return on investment, considering it is twice the return they made on journal ads directly targeting prescribers, and nearly 7 times the return on investment received with direct-to-consumer (DTC) advertising. You’ve seen the DTC ads and they are the ones that always end with, “Ask your doctor if so-and-so drug is right for you!” (The Drug Pushers, The Atlantic, 04/2006)

The Atlantic

Pharmaceutical reps are generally some of the most personable people on the planet. Many are even exceptionally attractive – both males and females. (Enjoy this clip about Pharma reps as seen on the sit-com Scrubs: https://www.youtube.com/watch?v=vmoVsbaFrHc )
Often, reps will know the names of doctor’s spouses, children, the church or clubs they frequent, what their favorite foods and restaurants are, even when their favorite sports teams play. Reps make it a point to know these facts of interest, because everything done for a doctor by a Pharma rep tends to have a personal touch to it, the rep having considered the psychological profile, as well as the prescribing habits of the physician, before they are “gifted”.
Otherwise, known in Corporate America as the “quid quo pro,” Pharma reps are constantly reminded by their superiors that they must “get” something in return for what they “give” to providers. In other words, you scratch their backs if they’ll scratch yours! When a doctor doesn’t play ball, their “goodies” are soon limited to the occasional box lunch or pens, pads and other promotional items. However, for those high volume prescribers who allow reps to haunt their corridors and provide corporate support at every turn, they can be treated to grand rounds in exotic locations, or receive gourmet, catered meals for their entire staff. They may even be invited to act as an Opinion Leader or be on the Speaker’s Bureau representing the company with his peers!

Of course, none of this constitutes bribery…officially. Or, does it? The definition of a bribe is: “anything given or serving to persuade or induce:” The Pharmaceutical Manufacturers Association has self-imposed rules and regulations regarding “gifts” and their acceptable values. However, reps are instructed by managers to hide most gifts and bribes, for accounting purposes, as continuing medical education or other legally accepted expenditures. In my personal experience, there are rarely moral conflicts-of-interest expressed in the bribing of doctors – only financial ones!

Contrary to popular beliefs, the pharmaceutical industry isn’t in the business of health and healing. They are in the business of disease management and symptom(s) maintenance. They are beholden to their shareholders and concerned about their corporate profit margins. The executives of these companies live and die by their “market shares” and bottom lines…pure and simple. The people largely responsible for those market shares and bottom lines comprise the sales force, which brings us back to my title: there is no FREE lunch in sales!