The Corpus Callosum

Practice Tip Number One

in case you are a physician looking for a reason to avoid drug reps,
you should read this article on PLOS Medicine.  It is an
enlightening, if sickening, inside view of pharmaceutical sales

the Script: How Drug Reps Make Friends and Influence Doctors

Fugh-Berman*, Shahram Ahari

24, 2007

the door-to-door vendors of cosmetics and vacuum cleaners, drug reps do
not sell their product directly to buyers. Consumers pay for
prescription drugs, but physicians control access. Drug reps increase
drug sales by influencing physicians, and they do so with finely
titrated doses of friendship. This article, which grew out of
conversations between a former drug rep (SA) and a physician who
researches pharmaceutical marketing (AFB), reveals the strategies used
by reps to manipulate physician prescribing…

The article includes a couple of tables showing the tactics used by
drug reps to influence physicians.  Most of these are things I
had already figured out, but it is still upsetting to see it all laid
out in black and white.

may be genuinely friendly, but they are not genuine friends. Drug reps
are selected for their presentability and outgoing natures, and are
trained to be observant, personable, and helpful. They are also trained
to assess physicians’ personalities, practice styles, and preferences,
and to relay this information back to the company. Personal information
may be more important than prescribing preferences. Reps ask for and
remember details about a physician’s family life, professional
interests, and recreational pursuits. A photo on a desk presents an
opportunity to inquire about family members and memorize whatever
tidbits are offered (including names, birthdays, and interests); these
are usually typed into a database after the encounter. Reps scour a
doctor’s office for objects—a tennis racquet, Russian novels,
seventies rock music, fashion magazines, travel mementos, or cultural
or religious symbols—that can be used to establish a personal
connection with the doctor.

Right.  These people do not have photographic memories.
 They have contact management software that has data fields
for the names of your spouse and kids, pets, sports, whatever.
 After they see you, they go out to their car, pull out their
laptop, and enter any new tidbit they’ve gleaned from you or your staff.

Plus, they know what you do with your prescription pad:

companies monitor the return on investment of detailing—and
all promotional efforts—by prescription tracking. Information
distribution companies, also called health information organizations
(including IMS Health, Dendrite, Verispan, and Wolters Kluwer),
purchase prescription records from pharmacies. The majority of
pharmacies sell these records; IMS Health, the largest information
distribution company, procures records on about 70% of prescriptions
filled in community pharmacies…

…In 2005, database product sales, including an unknown amount from
licensing Masterfile information, provided more than $44 million to the

Don’t worry, there is no patient-specific information in these records,
so there is no privacy rule being violated.  Still, it is kind
of creepy to realize how much people are tracking what you do.
 The reason why is fairly obvious:

example, Medical Marketing Service “enhances the AMA
Masterfile with non-AMA data from a variety of sources to not only
include demographic selections, but also behavioral and psychographic
selections that help you to better target your perfect

The goal of this demographic slicing and dicing is to identify
physicians who are most susceptible to marketing efforts…

…In Pharmaceutical Executive, Ron Brand of IMS
Consulting writes “‥integrated segmentation analyzes
individual prescribing behaviors, demographics, and psychographics
(attitudes, beliefs, and values) to fine-tune sales targets.

Oh, so I’m a “sales target,” now?  Thank you for the


  1. #1 NJ
    April 30, 2007

    Oh, so I’m a “sales target,” now?

    But aren’t we all?

    Not to diminish the slightly creepy nature of it, but hey, the publisher’s reps who troop in here when it’s text selection time aren’t really my best friends. Nor are the staff at Best Buy, or Sears, or the Honda dealership.

    These guys have taken it to the next level. It’s just that the next level is, well, creepy.

  2. #2 Jim
    April 30, 2007

    You might find Robert Cialdini’s book, “Influence: The Psychology of Persuasion” interesting as several of these techniques are performed in the PLOS article you reference. I wrote a parody of sitting adjacent to a sales rep (in a completely different field) employing these techniques on a customer. It’s very creepy when combined with a CRM (customer relationship management) system like Act, or Siebel. Yet this practice is common.

  3. #3 Joseph j7uy5
    April 30, 2007

    The difference is that if you walk into Best Buy determined to get a 12″ television, you know ahead of time that they are going to try to sell you a bigger one. You’re prepared and everything is right out in the open.

    the other thing is this: in the article, the authors point out that doctors generally think they can outsmart the drug reps. That may be true in general, but what they don’t realize is that the drug reps have entire teams of people who spend their entire careers figuring out how to manipulate doctors, while doctors only spend a few minutes on the problem of how to resist the influences. It is inherently asymmetrical.

  4. #4 Jason
    May 1, 2007

    The salesmen at Best Buy and Honda also don’t (directly) influence the health of their customers.
    To me this is more akin to (although more serious than) a representative from a large food manufacturer lobbying grocery stores to replace an item on the shelf. There is a chance that the replacement item is superior, but there’s also a chance that it’s not. Either way, making the change is going to effect a large number of people, and therefore should only be done without coercion.

  5. #5 NJ
    May 2, 2007

    you know ahead of time that they are going to try to sell you a bigger one. You’re prepared and everything is right out in the open.

    followed by

    the authors point out that doctors generally think they can outsmart the drug reps

    So, the doctors also know there’s going to be an attempt at an upsell.

    realize is that the drug reps have entire teams of people who spend their entire careers figuring out how to manipulate

    And Best Buy doesn’t pour millions into marketing and psychology, then filter that into training for their reps?

    Don’t get me wrong: I find it more than a bit appalling, too. But it’s like I said initially: The drug reps have just taken it to the next level.

New comments have been disabled.