LAST WORD

Why I welcome drug reps

By Peggy E. Chatham-Showalter, MD

Walking to my office, my patient asked, "Am I on this brand-name antidepressant because of the saleswoman sitting in the waiting room?"

The question startled me. Evidently, my patient had noticed the woman's name tag, which included the trade name of the well-known drug. There's a clinical rationale for my decision, I said, and went on to explain what it was. "By the way," I added, "you know those samples you take if you run out of medication before your refill arrives in the mail? She's the one who supplies them."

My patient seemed reassured. But her question was important—and worth considering seriously.

Some doctors view drug reps as hucksters who lead us to prescribe inappropriate and costly medications; others view them as benign salesmen (and women) whose come-ons we are too savvy to be taken in by.

Both stances are dangerous, I believe. My personal policy—a more balanced approach—has evolved over the years and is based on my response to questions I've asked myself:

• If medications A and B are basically the same, will I be tempted to prescribe more of A because I really like drug A's rep but can't stand drug B's? Probably, so I try to factor out "personality" from my decision making.

• If I don't prescribe much of drug X because of a troubling side effect, would a wonderful presentation and a modest meal cause me to set aside my concerns? I'm certain that it wouldn't—and hasn't.

• Would a company-sponsored symposium in a pleasant setting get me to consider drug Y, a good medication that until now I've overlooked? It very well might.

• Would I become an early adopter of drug Z because of a splashy launch campaign? Not likely. My conservative drug-adoption policy has endured numerous launch campaigns.

• And, finally, would my practice be improved if I banned all pharmaceutical reps? No, since the benefits to me outweigh my concerns.

The cynical attitude toward drug reps ignores these benefits to doctors and patients alike.

For example, before I ask a patient to purchase a prescription, it's helpful if I can supply a course of sample medication. That way, if patients are embarrassed or ambivalent about their diagnosis, the initial cost of treatment is less likely to be a barrier to compliance. Samples also help patients bridge deductibles, gaps in coverage, and periods between mail deliveries.

For doctors and staff, companies offer a variety of educational opportunities—CME events, roundtable discussion dinners, and the like. When I attend some of these, I don't check my good clinical sense at the door.

The policy and procedures manual that I give to new patients—and to all patients annually—makes clear that I see pharmaceutical reps and do some private consulting for them.

When discussing medication selection with patients, I always raise the issue of financing. We discuss generic substitution, formulary preferences, and, of course, samples. I ask about the direct-to-consumer advertising they've seen, their awareness of popular brands, and what medications their family and friends are currently taking. Finally, I review the basis for my own recommendations.

Why such a frank exchange? To allay patient suspicions that economics, not clinical judgment, is responsible for my choices. Perhaps this kind of frank and open practice style permitted my patient taking a brand-name antidepressant to ask the question she did.

All patients should feel equally comfortable asking questions—and are equally entitled to the best thought-out answers we can give them.

The author is a psychiatrist for the Department of Veterans Affairs in Allentown, PA. The opinions expressed herein are hers and relate to her work as a private practitioner and do not reflect the views of the department.

 

Peggy Chatham-Showalter. Last Word: Why I welcome drug reps. Medical Economics Oct. 24, 2003;80:80.