Drug detailers are specially trained to “assess physicians' personalities, practice styles, and preferences, and to relay this information back to the company” (Ahari).  Translation: they are trained fucking spies.  An astute detailer will glean any kind of information that would curry favor toward the target doctor: they might quickly scan photos on a desk, examine music CD jewel cases, trophies and mementos, and they may even ask the doctor about their kids, and their outside interests.  The detailer might come back with a golf bag, which falls safely under the $100 dollar mark, the amount allowable for tokens of appreciation.

 

Let me be clear now: I respect physicians.  They’re often brilliant people who train for over a decade and beyond so that they may save our lives and limbs.  And surely, all doctors cannot possibly be in bed with Big Pharma.  Right?  Unfortunately, according to a recent study, as much as 94 percent of doctors in the U.S. have some kind of “relationship” with pharmaceutical companies (Lee).  They’re either getting paid for speaking on behalf of a drug, or, as is mostly the case, they receive some kind of favor or benefit, free drugs, etc.  As Daniel Carlat states in his New York Times article “Dr. Drug Rep,” “when you are treated like the anointed, wined and dined in Manhattan and placed among the leaders of the field, you inevitably put some of your critical faculties on hold.”  After his training conferences, Dr. Carlat was handed envelopes filled with hundreds of dollars in checks so that he and his wife could party it up in New York.

 

In 2002, the pharmaceutical industry’s trade group adopted “voluntary guidelines limiting some of the more lavish benefits to doctors” (Carlat), but I know there is still some money, favoritism, and (figurative) love exchanging hands in doctor’s offices across the country.  Over the past year, I noticed at my mom’s doctor’s office in LA that the tiny waiting room was simply filled with drug detailers, more than I had ever seen in the seven years that I’d been taking her there.  Sometimes, drug reps outnumber the waiting patients, which to me is amazing, considering that the damn place is almost always bustling with the sick and injured.  My mom’s doctor sees her for five minutes, throws some sleeping and arthritis pills at her, and then, promptly at noon, he closes the office for a “Lunch and Learn,” abundant free food available to him and his employees while they listen to a sales pitch given by a conveniently attractive-looking detailer.

 

#

 

A girl screamed behind me as The Killers came on the thumping sound system, and all of a sudden, everyone in the place stood up and started dancing and someone’s beer rained down my back and soaked my ass.  Bill’s eyes wandered hungrily, but I pressed on with our conversation.

           “So you worked in North Long Beach?”  Post 9-11, after I was discharged from the Marines, I had lived for three years in North Long Beach, a predominantly Black, Latino, and Samoan community, economically depressed, a blue collar neighborhood. 

           Bill’s face twitched in answer. 

           I continued, “Um, I drove through recently and noticed that they’re doing a lot of renovations out there.”

           “Well…(he rolled his eyes) we’ll see what happens with that.  Good luck to them.”

           “What do you mean?”
           “I don’t mean anything, it’s just, you know…”

           This motherfucker was seriously starting to piss me off—that is, until the irony buried in his smirking insinuations hit me. Here we had a former detail man—an ex white-collar corporate drug dealer, offering up his privileged, armchair sociology disguised as dismissive comments about my old hood and the hard-working people that make it a community. For my own amusement, I bit my tongue and simply played along with him.

           “It’s pretty rough up there,” I offered as a noose.  “Gangs, drugs, prostitutes, violence…”

           “Yeah, so you know what I’m talking about.”

           “Did anyone ever, you know, give you any shit?  Like, ‘What’s this skinny cracker doin’ in my ‘hood?’  Seeing as you were in a business suit, lugging around a suitcase full of sleeping pills?”

           “Yeah…well, every once in awhile, I got looks and words.  But as soon as they saw me walking to their free clinic, they left me alone.  They knew I was probably going to provide their grandma’s doctor with the free drugs that she needed, seeing as they were all on Medi-Cal and welfare.  They respected me.”

           “Mm.”

           “You know, I’m not trying to stereotype or nothing, but I’ll be damned if on just about every corner, there was always someone with a pit bull.”

           “Really?”
           “Yeah, and sometimes they aren’t on leashes.  That scared the shit out of me.  You don’t know if they’re trained to attack white guys in suits, or what.”

           “Huh.”

           “Like clockwork, man, no shit—every clinic I stopped at, there’s a guy on the corner with a pitbull.  Jesus.”

           “Yeah, it’s a fucking cesspool up there.  People standing around on the newly installed red brick pedestrian walks, hopped up on Mad Dog 20/20 and Torporan, dealing drugs; wandering the streets with psychotic pit bulls slavering by their sides.”

           “Yeah…” he said, but he wasn’t listening to me anymore.  He asked distantly “so what do you do?”

           As I started describing my job, he excused himself, took his drink and swooped into an empty bar stool where a girl in cut-off denim shorts and a tight t-shirt, her firm mid-riff sparkling with glitter and spilled tequila, looked at him inquisitively, and Bill went right into his sales pitch.

Works Cited

 

Carlat, Daniel.  “Dr. Drug Rep.”  The New York Times.  Nov. 25, 2007.

Elliot, Carl. “The Drug Pusher.”  April 2006. 

Fugh-Berman, Adriane and Shahram Ahari.  “Following the Script: How Drug Reps Make Friends and Influence Doctors.” 

  Public Library of Science Med.2007 April; 4(4): e150. Published online 2007 April 24. doi: 10.1371/journal.pmed.0040150.

Lee, Christopher.  “Drugmakers, Doctors Get Cozier.”  Washington Post.com April 29, 2007.