How doctors and pharmaceutical sales representatives interact and
communicate Jérôme Grefion
The relationship between pharmaceutical representatives and doctors can be described
as one involving solicitation of a dominant professional. I examine how the imbalance
of positions in this relationship is manifested in the doctors’ mastery of conditions of
daily interactions in their ofices or at the hospital. In detailing how doctors control the
frequency of visits, waiting time, and visit duration of pharmaceutical representatives, I
elucidate the means at the disposal of the ‘dominated’ –pharmaceutical representatives– to regain a measure of control over the interactional environment, which is necessarily
linked with the quality of their work conditions. The article is based on interviews with
ethnographic observations of pharmaceutical representatives from a large multinational
company, plying their trade in France.
The promotion of medications to doctors by the pharmaceutical industry is the subject of recurring criticism in media, medical, political, union, and academic spheres.
Research literature on the subject usually sets out to identify the place of medication
marketing among the many sources of information that doctors have on medications,
and to understand its impact (as well as that of indirect remunerations such as gifts) on
the prescriptions they write.
To understand this important part of a medication’s ‘life
course’ –its promotion and marketing– researchers usually base their study among
doctors. the observation by Van der geest et al. (1996), about the absence of anthropological attention for pharmaceutical sales representatives (hereafter frequently
referred to as ‘representatives’) remains true today, with few exceptions (Kamat 1997; Greene 2004; Martin 2006).
Because access to pharmaceutical businesses is not easy,
representatives’ interactions with doctors are almost always described by former representatives, in the form of romanticized accounts (Ménin 1981; Reidy 2005) and
rarely in scientiic articles (but see, Oldani 2002, 2004; Fugh-Berman & Ahari 2007).
Ver:Todo sobre Jamie Reidy en PHARMACOSERÍAS
The literature rarely examines the interactions between representatives and doctors (except Oldani 2004; 2006), and it has not previously engaged with an important
question about this relationship: what makes this relationship functional within the
everyday life of doctors, since they are the dominant professionals with most power
in the situation?
Oldani, M.J. -2002 tales from the ‘script’: an insider/outside view of pharmaceutical sales practice.
Kroeber Anthropological Society Papers 87: 147-76.
-2004 thick prescriptions: toward an interpretation of pharmaceutical sales practices.
Medical Anthropology Quarterly 18: 325-56.
Under what conditions would they grant an hour per week to listen
to the product marketing of the pharmaceutical industry?
Observation of the interactions between representatives and doctors reveals that doctors are probably more
inclined to receive pharmaceutical representatives if they feel they control the faceto-face relationship and its timing, and if it is compatible with the time management
of their medical activity.
These are part of the conditions for their interactions with
representatives being sanctioned. Doctors who have the feeling of losing control over
these interactions may thus stop receiving representatives. But why do the majority
of doctors even accept seeing representatives from the pharmaceutical industry at all?
Doctors draw a certain number of beneits from their relations with representatives,
beyond frequent lattering and pleasant representatives. Some doctors may use the visits as an economical and convenient form of continuing education.
Additionally, pharmaceutical representatives furnish a number of services and advantages, especially
useful to doctors in reinforcing their professional network (for example, logistical and
inancial aid for various types of medical conferences) or their career at the hospital
(inancing of clinical studies, travel to conventions).
Finally, advantages in the form
of gifts persist, although regulated since 1946 (Grefion 2011). With pharmaceutical
prices fixed by the state, the industry arranges wide access to urban and hospital-based
doctors, thus giving priority to the volume of sales of its products.
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