Our conversation dried up. I glanced over at my cousin at the bar who laughed and squealed at whatever the bartender had just said.  Bill’s bored eyes scanned and occasionally rested upon the asses and breasts of various female bar patrons. I asked him what he did before he ran his business empire from an apartment on The Strip. His face lit right up. 

           “Oh, me?  I used to work for a smallish drug company, Caribou Pharmaceuticals.”

           Right out of college, Bill had spent five years as a “detailer.”  Detailing is when drug reps go to a doctor’s office and explain to the physician the benefits of the product they’re representing. Detail Men (and Women) are those young, attractive people that you see sitting patiently in your doctor’s waiting room with a massive briefcase or rolling luggage bag near their jouncing leg.  I’ve jealously noted how many of these detailers could be models on the cover of GQ or Elle.  Their carrying cases are filled with brochures, charts and the latest studies on the drugs that they’ve been assigned to promote.  Aside from literature packets, they also bring plenty of free drug samples and promotional items—pens, memo pads, wall clocks, anatomical charts of female bone structure, full-color illustrations featuring cross sections of hearts, the muscles and tissue cut away to expose ventricles and chambers filled with plaque build-up, clipboards, stethoscopes, little cheap digital clocks and key chains—all of these gimcracks bearing the brand names of their company’s products. 

           “For the first year or two, I really enjoyed it,” he told me.  “Pretty good money, you know.  And I excelled at it.”

           Bill was assigned certain regions of LA County.  In his case, it was Compton, North Long Beach and a few surrounding cities.  Bill’s employer gave him information regarding his doctors’ prescribing patterns—for example, he knew that Dr. “Smith” almost always prescribed Drug X, a competitor’s drug. 

           Bill exclusively hawked prescription insomnia cures.  He would tell a skeptical doctor that yes, if your patients were having trouble staying asleep, continue prescribing them Torporine, because overall, it’s a good, effective drug.  There is no question that it puts you in a deep sleep, he’d continue.  But the problem with Torporine is its well-publicized side effects: sleep-eating, and even sleep-driving, for example.  My company’s drug, Somnambulex, he’d coo, is milder; it won’t discombobulate you like Torporine.  It might not be as powerful as Torporine, but you’ll still wake up refreshed; Somnambulex is for people who need a milder, gentler sleep aid without the worry of wondering whether you’ll wake up with jelly donut filling all over your face, hanging upside-down from your seatbelt in your overturned SUV ten miles from home.  Then Bill would give the doctor photocopies of new studies from various reputable medical journals, and he would continue to visit his client until he was persuaded into at least having some of his patients try out Somnambulex as an alternative. 

                                                                                               

Nothing that Bill described sounded particularly insidious.  Who wouldn’t want their doctors to receive the most up-to-date information about newer, safer and better medications?  But then I wondered about how he procured information about doctors’ prescribing patterns.  Also, he said something about gifts and other “incentives,” things that went beyond the few sample capsules or a branded, four-color clicky pen.  Bill said that he received a commission on every prescription of Somnambulex that his client doctors prescribed, so of course he was motivated to influence the doctors in any way that he could, within the constraints of current federal laws. 

           I asked, “How does your company find out that they prescribed more of Somnambulex?  Did the doctors tell you?”

           “No; they’d probably say that it’s none of my business.  And it’s illegal; doctor’s code of ethics and whatnot.”

 

A few weeks later after my conversation with Bill, I Googled “drug detailing” and found an article entitled “Following the Script: How Drug Reps Make Friends and Influence Doctors,” published in the Public Library of Science.  Authors Adriane Fugh-Berman and Shahram Ahari confirmed everything that Bill had described.  Basically, the pharmaceutical companies mined legally obtained data that tracked physician’s prescription patterns.  This, in effect, allowed drug companies to monitor the “investment” that they’d made in their detailing of specific physicians.  Bill’s employer went to companies like Verispan, IMS Health, and Dendrite—health information organizations—who purchased prescription records from participating pharmacies.  The records didn’t reveal patient information, but they included the physicians’ DEA numbers or state license numbers.  The next step was for Bill to match up the doctor’s ID numbers with information garnered from licensing agreements with the American Medical Association (AMA).  The AMA “maintains the Physician Masterfile, a database containing demographic information on all US. physicians (living or dead, member or non-member, licensed or non-licensed)” (Fugh-Berman, Ahari).  Only a few years ago, the sale of these Masterfile records made well over 40 million dollars for the AMA.

 

If the pharmacy records revealed that Bill’s new friend, the prescribing doctor, wrote more prescriptions for Somnambulex, then Bill’s commission would climb, and the doctor would receive more visits, free lunches, friendly chats, maybe even dinner and drinks after hours, which sounds strangely to me like some kind of legalized prostitution.  If the doctor seemed to fit a specific personality profile, then a detailer would ask if the MD wanted to make some good money on the side of his or her practice.  Before long, these same doctors would be whisked off to information sessions in New York or other major cities, with all expense-paid flights, luxuriant room accommodations, and scads of “per diem” money to spend on the town.

 

According to Ahari, the “reps may be genuinely friendly, but they are not genuine friends.  Drug reps are selected for their presentability and outgoing natures, and are trained to be observant, personable, and helpful.” Allow me to translate: Corporate-Sponsored Drug Pushers will pretend to like you, smile in your face with their eye on the bonus prize and increased market share; drug pushers are selected for their pretty/handsome face, their nice rack and how their rock-hard aerobicized asses fill out their tight business trousers or short skirt, and for their ingratiating, kiss-ass mannerisms.  They are master manipulators, always adjusting their tactics depending upon the behavior of the physicians that they’re soliciting.  “Drug reps increase drug sales by influencing physicians,” claims Ahari, who once worked as a detailer, “and they do so with finely titrated doses of friendship.”