Free pens, free lunch, and drug reps

I may not have seen a pharmaceutical rep for over five years, but still the branded pens they gift to medics continue to infiltrate my house and my handbag. I conciously throw out the drug company pens I find, but they just seep back in: every time I lose my own plain biro, there is another pen somewhere near, in a ravishing colour or with streamlined design, beckoning to take its place.

The reasons why I don’t like seeing drug reps are several. But mainly they come down to this: time is precious, and unbiased appraisals of evidence are better delivered elsewhere. Reps are there to sell, and fair evidence should not need ’sold’.

But this may not be quite enough. An interesting paper in the Archives of Internal Medicine has examined the effect of exposing medical students exposure to brand logos on equipment – stickers on clipboards or branded notepaper – prior to being asked about the implicit attitudes towards these drugs. The students who had been exposed to the promotional material held higher implicit values for the promoted drug compared with the control group.

There are obvious limitations to this study – it is a single study performed with one cohort of students, and it does not necessarily mean that prescribing is going to vary with the presence of promotional gifts. Yet we don’t know that it doesn’t. Here is a report in Pharmaceutical Field magazine calling on reps to find those ‘rare but lovely creatures’ – GPs who see reps daily. We now have the internet and excellent sources of information. I do not think that pharmaceutical sales reps are needed, or advantageous to patient care.

A couple of other potential harms bother me. First, pharmaceutical reps are usually highly qualified and very able individuals. They are utterly wasted in being drug reps. And second, do people seeing their doctor feel any differently for the presence of branded goods in the consulting room?

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4 Responses to “Free pens, free lunch, and drug reps”

  1. Brian Finney May 19, 2009 at 1:42 pm #

    Quite apart from product placement in the surgery, the other issue I have with drug reps is when they provide ‘ free training’ to a group of NHS staff sometimes involving a short residential stay.

    What is needed is the NHS to provide training for its staff in a more formal, transparent and comprehensive manner and for Trusts, GP practices etc to hold a Register, available on-line, that states when any contact with a drug company has taken place and the monetary value of any benefits in kind received.

  2. chris johnson May 20, 2009 at 9:54 am #

    Brian is absolutely right. The main value of a drug rep is to make prescribers aware of “facts” they did not already know, and incidentally, unlikely to be researching on the internet being unaware.
    When this function is provided by NHS themselves, then the main reason for the rep disappears.

    The on-line register will enable patients and auditors to challenge prescriptions should motives be suspect.

    I hardly imagine the medical world can become a brand free zone. We are all consumers and brands touch us all in profound ways. Yes, it is reassuring to see brands, especially when they are brands you recognize – nearly everybody prefers the comfort of familiar surroundings.

    As for the reps themselves, I would not worry too much. It is a notoriously hard training ground for would-be sales people, and rep turnover is high

  3. Derek Tunnicliffe May 20, 2009 at 6:09 pm #

    Chris Johnson is right, it’s a wonderful training ground. The work required to even get into the field is enormous. But it’s probably the best sales training anyone could hope for. Never mind the grind around GPs surgeries, you know how to SELL! (sometimes, even ethically).

  4. Margaret McCartney May 25, 2009 at 3:26 pm #

    I’m going to reply to Chris’ and Dereks’ comments with an short interview – will post in a few days once typed up.
    The education issue – Brian is right, for years the NHS has got off with not providing drs with time/resources for postgraduate training – nurses always seem to have been far better organised. But some ‘training’ (and expensive in time and money) I’ve been at has been very poor. The most time efficient way for me to continue training is via the internet, and via conversation over coffee with my peers. There is also an (independent) network of small groups of GPs who meet once a month to discuss pre-circulated anonymised cases and evidence. It is paid for by participants and is excellent.
    And yes, Brian, agree – we really need to know the pounds and pence to get the meaning of just how much ‘interest’ there has been.