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Pharmaceutical sales representative access to physicians has been getting increasingly difficult. Sales representatives have been the main channel for transmitting marketing information through “detailing” to physicians for the past 50 years,¹ accounting for 60% of all sales and marketing expenditures.² Currently, all marketing information by sales representatives to physicians are regulated and enforced by the Food and Drug Administration (FDA) under the newly named Office of Prescription Drug Promotion to ensure that all information delivered is consistent with FDA-approved product labeling. In 2010, about 11% of American physicians have “severe” or “no-see” (meaning sales representatives cannot see physicians in their office) pharmaceutical representative access limits and up to another 34% have some restrictions.³ Significant geographic variation in access limits exist around the United States.³ There has been progressive tightening of access-limit policies resulting in an increase in physicians having severe or no-see ratings over the past few years.³ These increasing access limits and outright bans of contacts with industry representatives have occurred as more academic articles, policies at medical schools, and physician anti-detailing campaigns call for such restrictions.^4–16 Legal arguments have advocated limiting First Amendment protections of pharmaceutical commercial speech to physicians and banning the selling of physician prescription information.^17,18 Challenging this research are arguments that limiting commercial speech and more tightly regulating academic-industry research relationships will do more harm than good.^19–23 Empirical evidence exists showing that sales and marketing are associated with an increase in the adoption of new clinical evidence that is beneficial to patients.²⁴ The industry has argued against sales force access limits and revised its code of conduct to correct for past abuses and to prevent future infractions.^25,26 The US Supreme Court recently ruled 6–3 a Vermont law as unconstitutionally restricting the distribution of prescriber information to pharmaceutical companies and sales representatives as a way to limit detailing to physicians.²⁷ The Court majority opinion also noted: “If pharmaceutical marketing affects treatment decisions, it does so because doctors find it persuasive.… Indeed the record demonstrates that some Vermont doctors view targeted detailing based on prescriber-identifying information as “very helpful” because it allows detailers to shape their messages to each doctor’s practice.”²⁷ Critics have noted that the decision is a setback for efforts to curtail detailing in the pursuit of protecting patient health, reducing unnecessary expenditures on new drugs where therapeutically equivalent generics exist, and protecting physician and patient privacy.^28,29

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