Gifts, Bribes, or Necessity: Managing Conflicts at the Organizational and Individual Level

Most physicians feel that while others may be swayed by pharmaceutical marketing, they are bastions of incorruptibility. This is not the case, argued Douglas Diekema, MD, at Monday's plenary session of the AAP's National Convention and Exposition.

The average pediatrician meets with eight different reps a month, and most receive gifts from them - things like pens or food. The giving adds up, since more is spent on promotions than on medical school. $13 billion goes to promotions, $5.5 billion for physicians alone. It boils down to between eight and thirteen thousand dollars per physician: there is one sales rep for every five doctors.

"What they're doing," said Dr. Diekema, a bioethicist at the University of Washington School of Medicine, "works." He offered statistics showing that marketing is as much a science as the R&D of new drugs. Physicians who consult for certain drugs, for instance, end up prescribing the drug in question up to 70% more than before they accept the consult.

Marketing isn't always as recognizable as an advertisement. It presents in hidden forms -- social events, sponsored CME, funded research, and paid-for trips. Our brains are wired to make decisions mostly based on emotions, and when we receive a gift -- even a pen -- we feel an emotional need to reciprocate.

Often reps use "subliminal" means of setting up a rapport with a physician. Such selling techniques include asking easy question - "Do you care about your patients' health?"- to force yes responses. Calls to authority, friendship, and social validation are also all used to make a sales target more likely to buy. It sets up a positive relationship between rep and doc, the real purpose of all the marketing.

There is nothing wrong with a company trying to sell its products, Dr. Diekema repeatedly stressed. But physicians must recognize their ability to be swayed by the numerous means of selling. "Every interaction you have with them," he said, "is a form of marketing."