Chapter 3 Index

A. The Business of Private Practice

B. Dealing with Pharmaceutical Representatives

Dealing with Pharmaceutical Representatives

Guidelines re Pharmaceutical Representatives: A Need for our Pediatric Residency Program

Introduction: Our program is not unique in having no written guidelines for dealing with pharmaceutical representatives.  A review of 378 residents from 14 randomly selected Internal Medicine programs showed that half of the programs did not have written guidelines (J of General Internal Medicine 1993;8:130-4).  Some programs have developed a Pharmaceutical Representative Evaluation Form to help determine the accuracy of their presentations (Family Medicine 1995;27:581-5).

The exposure to pharmaceutical representatives for our residents now primarily includes: provision of samples in clinic; pens, toys, other “inexpensive” items; free lunches with some introductory remarks by representative; sponsor of events such as retreat, guest speakers, events at national and state meetings such as free dinners, sports events, etc.; observation by residents that “experts” are on the payroll of various drug companies.

A Few Reasons Guidelines Are Desirable For Our Program:

1.  There is one pharmaceutical representative for every 15 practicing doctors (BMJ 1996;312:1494-1497).  In practice they are an important part of the daily life of the pediatrician, and residents need to learn how to deal with them.  The representatives are often, if not usually, easy to talk with, have good interpersonal skills, and appear to have a complete knowledge of the medication they are promoting.

2. Information given by pharmaceutic representatives is often wrong.  (Canadian Family Physician 1997;43:941-5).  One study (JAMA 1995;273:1296-8) analyzed 106 statements made about drugs during 13 presentations by pharmaceutical representatives; 11% of the statements were incorrect, and were in fact in conflict with the company’s own literature; only one in four clinicians was aware that the information was incorrect.

3. Residents are unaware of the effects on their prescribing patterns that result from their interactions with pharmaceutical representatives.  One study showed that the more interactions with the representative, the higher the prescribing cost (Archives of Family Med 1996;5:201-6).

Another study (JAMA 1994;271:684-9) found that requests by physicians that drugs be added to a hospital formulary were strongly associated with interactions with pharmaceutical representatives manufacturing those drugs.

4. At MCG, we are giving two messages to our residents: one is that they should not believe all the information given by drug reps, the other is that the drug companies are an important financial resource for physicians, and their support should be sought.

Conclusions:  It is easy to condemn physicians who depend on pharmaceutical representatives for their information about medications.  However, the vast majority of physicians in practice utilize them in this way.  Residents as well as practicing physicians do not like to admit that their prescribing patterns are affected by reps.  Our residency program needs to develop a rational approach for residents to deal with, and understand the effects of, this large group of people: such as the development of the STEP program to analyze meds (safety, tolerability, effectiveness and price).  (BMJ 1996;312:1494-1497).

On Dealing with Pharmaceutical Representatives

The problem of dealing with drug representatives is that it is an unbalanced relationship.  They need your business to survive.  Residents have observed faculty taking and taking from drug reps for years: they provide free lunches, give free gifts such as pens, give free samples, sponsor travel to meetings, sponsor speakers, and provide entertainment at national meetings.

Each doctor must answer the following questions about his or her practice:

1. Are you going to take things from drug reps and, if so, how much?

• free samples of medications (how much does this affect your antibiotic choice?)
• pens and pencils (if patients seeing you writing with a Cefzil pen, does that affect their way of thinking about you?)
• meals (our pediatric department already receives meals from them; what about extra dinners and lunches?)
• meetings (would you consider being a sponsored speaker at a meeting paid for by a drug company)

2. What access to your office will you give pharmaceutical representatives?

• free access (if so, prepare for frequent interruptions in your daily routine)
• limited access (if so, prepare for the wrath of the drug company rep whose livelihood depends on your endorsement of their products)
• in-between.

Possible Approach: Meet with drug reps only on a certain day at a certain time - have them make appointments.  Give 30-45 minutes every other week for this activity.  Refuse to meet with them as the catch you “just for a moment” between patients.

Another approach: Ask drug reps to interrupt you only if they have a new product to demonstrate.  Problem with this is that they rarely have a new product, but still need your signature on their paper - the result is that you are still interrupted.      

CONCLUSION:  The physician, not the drug rep, should make the rules and stick to them.  Always remember why the drug rep is so friendly.

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004