There is a shocking piece on Dan Ariely’s blog on conflicts of interest and unethical selling techniques in the medical/pharmaceutical world. It also illustrates the use of cognitive psychology in unpicking how people can manipulate us in conflict and other social situations. See also Dan’s excellent book ‘Predictably Irrational’, as well as other postings on his blog:
A Dinner with the Drug Reps
Janet Schwartz of Tulane University and I recently spent an evening with a few pharmaceutical reps, men who used to be in the business of selling a wide range of drugs to treat all kinds of diseases and conditions, from fibromyalgia to depression to restless leg syndrome. As drug representatives, they would go from doctor to doctor attempting to convince physicians to prescribe their company’s drugs. How? They would typically start by passing on informative pamphlets and give out products like pens, clipboards and notepads advertising their drugs.
But we knew that there was more to the story, so we tried the pharmaceutical reps at their own game – we took them to a nice dinner and kept the wine flowing. Once we got them generously lubricated, they were ready to spill. And what we learned was fairly shocking.
Picture these guys: attractive, charming young men. Not the kind of guys who would have trouble finding a date. One of them told us a story about how he was once trying to persuade a reluctant female physician to attend a seminar about a medication he was promoting. After a bit of schmoozing, she finally decided to attend – but only after he agreed to escort her to a ballroom dancing class. This was a typical kind of quid pro quo where the rep does a personal favor for the doctor and the doctor promotes the rep’s product in return.
Another common practice was to bring meals to the doctor’s office (one of the perks of being a receptionist), and one office even required alternating days of steak or lobster for lunch in exchange for access to the well-fed doctors.
Even more shocking to hear was that when the reps were in the physician’s office, they were sometimes called into the examination room (as “experts”) to inform the patients about the drug directly. And the device reps experienced a surprisingly intimate level of involvement in patient care, often selling medical devices in the operating room, while the surgery was going on.
Aside from learning about their profession, a very interesting feature of this dinner was realizing how well these pharmaceutical reps understood classic psychological persuasion strategies, and how they employed them in a sophisticated and intuitive manner. One clever tactic that they used was to hire physicians to give a brief lecture to other physicians about a drug. Now, they really didn’t care what the audience took from the lecture, but were actually interested in what the act of giving the lecture did to the speaker himself. They found that after giving a short lecture about the benefits of a drug, the speaker would begin to believe his own words and soon prescribe accordingly. Psychological studies show that people quickly start believing what is coming out of their own mouths, even when they are paid to say it. This is a clear case of cognitive dissonance at play; doctors reason that if they are touting this drug, they must believe in it themselves — and so they change their beliefs to match up with their speech.
The reps employed other tricks like switching on and off various accents, personalities, political affiliations, and basically served as persuasion machines (they may have mentioned the word “chameleon”). They were great at putting doctors at ease, relating to them as similar working people who go deep-sea fishing or play baseball together as peers. They used these shared experiences to develop an understanding that the physicians write prescriptions for their “friends.” The physicians, of course, did not think that they were compromising their values when they were out playing with the drug reps.
I was recently at a conference for the American Medical Association, where I gave a lecture about conflicts of interest. Interestingly, the lecture just before me was by a representative from a device company that created brain implants. In his lecture he made the case for selling devices in the operating room because the doctors may need help learning how to use the device. And in order to fight conflicts of interest, the company no longer takes physicians to Hawaii for their annual conferences — and instead they have their conference in Wisconsin.
So, what do we do? First, we must realize that doctors have conflicts of interest. With this understanding we need to place barriers that will prevent this kind of schmoozing, and to keep reps from accessing doctors or patients. They, of course, have the right to send doctors information, but their interactions should stop there.
I have one more recommendation: What if we only hire people to be drug reps if they are over 75, misanthropic and unattractive? Not only would these individuals have more personal experience with the healthcare system, but it could at the same time reduce conflicts of interest and open up job opportunities to an undervalued population.
This is Dan: