Just Say No to Drug Reps

Medical schools are now teaching future docs how to resist those pharmaceutical pitches

Dr. Adriane Fugh-Berman wishes more doctors would greet marketing pitches from drug companies with skepticism. So she is taking her message to medical schools. An associate professor of physiology and biophysics at Georgetown University, she has spent the past six months lecturing med students at Georgetown and neighboring schools on how to resist sales reps' overtures, such as doling out free drug samples to physicians and bringing lunches for office staff.

Often, the audience starts out belligerent, Fugh-Berman says, protesting that they're "too smart to be bought by a slice of pizza." But that changes when "we correct them with the numbers," she says. A doctor who spends just one minute with a sales rep typically ends up prescribing 16% more of that rep's product than he or she was prescribing before. And a four-minute encounter is likely to prompt a 52% jump in prescriptions, says Fugh-Berman.

Programs such as hers are rolling out at medical and nursing schools across the country, funded by $21 million in grants from a consortium of state attorneys general. The money came out of a $430 million settlement Pfizer (PFE) reached with state and federal legislators in 2004 over allegations that its Warner-Lambert division—prior to being acquired by Pfizer—had improperly marketed the epilepsy drug Neurontin for uses not approved by the Food & Drug Administration.

More than 30 educators won grants to develop for-credit courses, role-playing exercises, and other programs designed to prepare future prescribers for their encounters with sales reps. Many educators incorporate actual drug reps into their programs. Fugh-Berman's Web site, PharmedOut.org, features seven YouTube (GOOG) videos of former and current salespeople describing their experiences. In one, a rep says his strategy for using free samples is much like the one "your typical street dealer employs on the corner when hes selling crack. The first ones free, then you pay, then youre hooked." The rep—in shadow to conceal his identity—explains how easy it is to coax doctors to write prescriptions for drugs in return for a handful of samples.

Dependent on a limited pool of grants, the professors may be outgunned by the drug industry, which pours about $1 billion a year into medical education. Guest speakers who appear in "grand rounds"—clinical discussions attended by residents and other medical trainees—are often sponsored by drug companies. And the industry pays for most of the continuing ed courses doctors take throughout their careers.


Educators can't match that. But they can prepare future doctors by placing them in simulated sales scenarios. At the Mount Sinai School of Medicine in New York, med students spar one-on-one with an actress playing a patient. After complaining of heartburn, the actress whips out an ad for Nexium that she says she found at her hairdressers salon. "I think this is the drug for me," she declares, reciting the ads promise that the drug controls acid better than any other product.

The students, armed with studies showing the drug is no better than cheaper over-the-counter alternatives, try to persuade the faux patient to try something else. Lauren Peccoralo, a third-year resident at Mount Sinai, says the exercise is valuable because patients often do arrive in the doctor's office with ads in hand. It takes practice to "convince patients they should trust what the doctor recommends instead," she says.

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