Interactions between physicians and the pharmaceutical industry: Medical reps

 

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). 

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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.