In the business of representing drug companies, the name of the game is to get doctors to write the prescriptions that will increase sales. To accomplish their purpose, sales people all have a working script as a guide and they follow it as well as or better than a Hollywood actor.

“Drug reps increase drug sales by influencing physicians, and they do so with finely titrated (measure and adjust dosage) doses of friendship,” according to Adriane Fugh-Berman of Georgetown University Medical Center and Shahram Ahari, a former drug rep for Eli Lilly who now works for the School of Pharmacy at the University of California San Francisco.

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 physician’s personalities, practice style and preferences and to relay this information back to the company. Personal information may be more important than prescribing preferences. “Good details are dynamic and the best reps tailor their messages constantly to their client’s reaction,” say Fugh-Berman and Ahari.

“A friendly physician makes the rep’s job easy because the rep can use the ‘friendship’ to request favors in the form of prescriptions. Physicians who view the relationship as a straightforward goods-for-prescriptions exchange are dealt with in a businesslike manner. Skeptical doctors who favor evidence over charm are approached respectfully, supplied with reprints from the medical literature and wooed as teachers. Physicians who refuse to see reps are detailed by proxy. Their staff is dined and flattered in hopes that they will act as emissaries for a rep’s message.”

Pharmaceutical companies carefully monitor this investment of time and energy in doctors through prescription tracking. The major pharmacies sell their records of prescriptions written by doctors and this information is then linked to individual doctors via a physician identification number provided through agreements with the American Medical Association. In 2005 alone, it is estimated that the AMA coffers benefited to the tune of $44 million providing this information on their members to drug companies.

Physicians are ranked on a scale of one to ten based on how many prescriptions they write with “high-prescribers” lavished with attention, gifts and unrestricted “educational grants.” The fact that physicians are often overworked, under-appreciated and overwhelmed with paperwork makes them susceptible to the charm, warmth and sympathy of a friendly and cheerful drug rep according to Fugh-Berman and Ahari.

It’s all about getting physicians to use the product and samples that plays a large role in this game. “Reps provide samples only of the most promoted and usually most expensive drugs. Patients given a sample for part of a course of treatment almost always receive a prescription for the same drug.” When this occurs, the drug rep has done their job by increasing drug sales of the product they are pushing. And it all happens through a person carefully chosen and trained to follow the company script with the foremost goal to influence the prescription-writing habits of physicians.

Source: The Public Library of Science 2007. http://www.eurekalert.org/pub_releases/2007-04/plos-dru041907.php and http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040150&ct=1A