Many pharmaceutical sales representatives are assertive and persistent in increasing the visibility of their company’s products within a doctor’s office — often offering gifts to doctors in exchange for an increase in prescriptions for a name-brand drug. Unfortunately, it may come at the price of patients’ health and well-being.

“The drug they give you may not be the best drug for you,” said Jennifer Shaw, a former antidepressants pharmaceutical sales rep, in an interview with Fox 11 LA. “It may be because a rep just left in a little skirt and begged the doctor to write a certain prescription.”

Because pharmacies usually sell their prescription records to organizations such as IMS, an information distribution company that procures records on about 70 percent of prescriptions filled in community pharmacies, pharmaceutical sales reps are able to track individual doctors and know exactly which drugs doctors are prescribing most often.

Pharmaceutical sales reps, also known as drug reps, then use this information to target doctors and coerce them into writing more prescriptions for their particular drug. And, in the commission-based occupation, a drug rep’s job is usually on the line if they can’t convince physicians to use their products.

In 2005, it was estimated that pharmaceutical companies spent $29.9 billion on marketing, with one estimate as high as $57 billion. Over 25 percent of this money was spent on detailing physicians — the one-on-one promotion of drugs to doctors by drug reps.

During the practice of detailing, doctors are offered perks that are designed to foster familiarity and comfort with the drugs. According to a 2007 journal entry published by the Public Library of Science, many prescribing doctors receive pens, notepads, and coffee mugs, which are all items that are kept close at hand, ensuring that the drug’s name stays in a physician’s mind.

However, these gifts can take on a more lavish nature. High prescribers can receive higher-end presents like silk ties or golf bags. Additionally, according to Shaw, doctors are paid between $1,000 – $1,500 to attend a dinner and speak for 5 to 10 minutes about a product.

As a result of the kickbacks and incentives given to doctors, the US government has filed several lawsuits against pharmaceutical companies — including Bristol Meyer Squibb, Novo Nordisk, EMD Serono, and AstaZeneca.

Still, event or travel tickets are also being offered as incentives.

E. Haavi Morreim, a professor of Human Values and Ethics at the College of Medicine at the University of Tennessee, outlines a study following two groups of 10 doctors who were taken on an all-expenses-paid vacation by pharmaceutical companies. One group was hosted by the makers of an intravenous antibiotic (Drug A). The other group was hosted by makers of an intravenous cardiovascular medication (Drug B). Each day, the doctors participated in “educational” seminars for several hours hosted by the drug makers.

All the doctors were interviewed after the vacation and the majority of them stated they were in no way influenced in their prescribing habits.

However, the study then compared the physician’s prescription patterns for two years prior to the trip to prescription habits for almost a year and a half after the trip. In the first group, prescriptions for the Drug A tripled from 81 units before the trip to 272 afterwards. In the second group, prescriptions for Drug B doubled from 34 units to 87 units, which went well beyond the nationally agreed-upon standard of care.

Pharmaceutical sales reps also provide doctors offices with samples of particular drugs. Samples may be useful for several reasons: they help decide whether a patient does well or poorly on a particular drug; they provide a time cushion for patients to get to the pharmacy for the rest of a prescription; they can be used by poor patients; and patients are generally excited to receive them because they are free.

In the long run, however, the samples aren’t free. Drug reps only leave samples for the newest, most expensive drugs — often in limited quantities. When the limited supply runs out, doctors almost never switch a patient to a less expensive drug.

Not only do they these prescriptions end up being more expensive, but they may also be more dangerous. Newer drugs have not been out long enough for doctors to fully understand or appreciate the potential side effects.

According to the National Institute of Drug Abuse, almost 50 percent of visits to emergency rooms for drug-related reasons were due to adverse drug reactions to drugs taken as prescribed.

Shaw decided to get out of the pharmaceutical sales rep profession when a drug her company sold proved to make patients sick and nauseated. All the while, the company she worked for encouraged her to continue selling the medication to doctors, putting these dangerous drugs in the hands of consumers.

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