Conflicts of Interest in the Pharmaceutical/Medical World

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:


About creativeconflictwisdom

I spent 32 years in a Fortune Five company working on conflict: organizational, labor relations and senior management. I have consulted in a dozen different business sectors and the US Military. I work with a local environmental non profit. I have written a book on the neuroscience of conflict, and its implications for conflict handling called Creative Conflict Wisdom (forthcoming).
This entry was posted in Conflict Processes, Economic Conflict, PERSONAL CONFLICT RESOLUTION: CREATIVE STRATEGIES, The Conflict Model, Types of conflict, Ways to handle conflict and tagged , , , , , . Bookmark the permalink.

8 Responses to Conflicts of Interest in the Pharmaceutical/Medical World

  1. Tony Gee says:

    I remember back in the late 80’s or early 90’s when the president signed the bill into law that drug company’s were going to be able to advertize prescription drugs on TV.

    I was so against that everyone I talked to thought I was crazy. I told whoever would listen that this would create a drug culture, and the irony is we were already engaging in, “The War on Drugs,” fighting against the drug lords of Central America.
    Well the unintended consequence in my opinion was higher healthcare cost. Everyone needs the newest drug to cure their symptoms when diet and exercise can solve many. Now healthcare is 20+% of our GDP what a disaster. Lives have been saved for what to live longer to support the healthcare industry and have it grow to unsustainable levels. This has created the mindset that individuals feel that it is a right to be healthy even if they don’t take care of themselves. “Give me the drug so I can live and eat the way I care to, the drug will protect me, hell I can go to the emergency room and the team of doctors have to heal me and get me stable so I can walk out the door and be back next month and if I don’t have the money who cares let someone else pay.” I have employees who chose not to have insurance and go to hospitals for a stomach ache, even when there is a quick med. just down the street cost $100 cash or will except a payment plan, but choose to go to the hospital and we all know how much that cost.

    • @Tony Gee. I absolutely agree. It is part of the consumer society that we have infantilized people to expect instant gratification, instant no-effort solutions to problems. This cuts across how I was raised, which was that things worth having take personal effort! I think both sides of the political divide are guilty on this one: the conservative side for exaggerating what markets can do, and the liberal side for exaggerating what government can do. Ultimately many things like personal fitness and personal happiness, successful families etc are nothing to do with markets or government, they are down to us as people and as groups of like minded people to fix. Education can help but it is not the solution in itself.

      • tony Gee says:

        Short reply….”I agree!!!” I must add more….

        As the leaders go so do the followers….Corrupt leaders breeds corrupt followers. We see it in families, in the churches, the work place, civic organizations whether, it is home owners association, auto club, hospital organizations, blogs, as well as our local, state and federal governments.

        Agree we must look at ourselves and hold a high standard so we can command that standard to those around us and yes we can change.

        I recall my favorite football team was the Miami Dolphins starting in 1970 and I learned in the early 80’s that Don Shula (the winningest coach) year after year received the lest penalties in the negative against his team. Why he would throw the flag in practice he would call his players out when they held, clipped, offside’s and so fourth. He would not except illegal action on the field in his players and it showed on game day Don Shula exemplified leadership. We need leaders

      • Tony. I completely agree with you about leaders. They need to clean up their act if they are to have any followers, though I think we can all be leaders to some extent by living morally through hard work, treating others right etc. We set an example. We need McCain Feingold re-instated to help our political leaders clean up their act. It is hard to run against an opponent with ten times your funding through corporate or union donations. I guess we need a constitutional amendment to fix campaign financing and get round the Supreme Court ruling. Though there is a move to create a voluntary system and hold congress to it via publicity of those who take contributions. Not strong enough for me. In the UK each Member of Parliament I think is allowed about $7500 in election expenses, and there are no political TV or radio ads, just volunteers putting flyers through people’s doors. Works pretty well.

        Your reference to the Miami Dolphins reminded me of an exercise I plan to use. I was going to get people from two opposing football teams and show them different on-field actions and get them to call penalty or not. In some the identity of the team would be masked and I would see if they called penalty on their own team, and in others the identity of their team would be seen, and we could see if there was bias in how many calls they made. I would then finally show the team identity on the first exercise and see if they wanted to change their call if it was their team. I really like the Don Shula approach as he would pass my test with flying colors! What a guy! 🙂

  2. tony Gee says:

    I have more on leadership on the post about growth. So I understand we are on the same page but it’s for others who might read it and not this one.

  3. tony Gee says:

    One more thing….. I like your idea about the analogue to really understand the emotion of farness in the realm of football fouls called in a game. This reminds me of a Psychologist columnist who put scenario like you have stated above to understand the behavior results in the project he was exposing. I wish you the best!

    • Tony, I really annoy some folk here when I say that I support Michigan AND Ohio or Michigan AND Michigan State, but why would you not respect the opposing team if you like your own team? If you beat the opposing team, you have beaten another good team, and it makes your team look good. And if you lose to a good team, it makes your loss seem less hard to bear. And surely the whole aim of the game is to watch good football and that comes from two nearly equal teams meeting on the field. Or am I missing something? In Wales where I come from, the Welsh love drinking with the other side after a rugby match, whoever won and simply celebrating if it was a really good, close game. The only thing the Welsh dislike is poor losers, those who claim they were robbed by the referee….

  4. Tony Gee says:

    When I do watch a game, I usually root for the underdog or the team that has the ball. As I have stated in your blog before I have lost interest in Pro sports, I do like collage but with the most resent scandals it can be distracting because it is all about money not the love of the game.

    I taught my son the officiating is part of the game, there WILL be bad calls for both sides thru-out this years games. It is the team who can pull thru the challenges of their opponents talents and strategies along with the officials mistakes, remember it is a game of abilities, teamwork and overcoming the emotional challenges. Let the games began and may the winning team be congratulated is sportsman like fashion.

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