Shahram Ahari, former Eli Lilly drug rep, recently spoke to the Tufts Progressive Medical Students Organization. It was a fascinating talk, because Ahari told us about how he and his colleagues used every trick of salesmanship in the book to increase prescriptions of Prozac and Zyprexa and therefore to maximize their bonuses.
The key criteria of employment as a drug rep, he said, are being good looking and mastering the art of small talk. No huge surprise here, but it’s helpful to remember that drug reps do not come to doctors to educate, but rather to persuade.
"Gift giving is the key," he said. "You are programmed as a human to reciprocate. You feel obliged to return the favor. As a matter of fact, the smaller the gift, the greater the sense of obligation."
Do you consider samples to be a part of the company’s civic duty? Think again. "Samples are a marketing tool. They always have strings attached. Typically, we would provide two weeks worth of samples, which worked out wonderfully. Just like a drug dealer, the first one is free, and then you’re hooked."
A member of the audience who had once been a consultant to industry made an interesting comment about samples. His job was to track doctors’ prescribing behavior in response to sampling practices, and to provide physician-specific "response curves" to companies. Using these curves, reps determined how to maximize their "return" on sampling. If you "hit" Doctor Smith 10 times per year with samples, he might prescribe more product than Doctor Jones, who might require less sampling. To drug companies, doctors are pawns in a game of cost-benefit analysis.
Ahari recalls well that food makes doctors more receptive to the message. "We took painstaking efforts to determine what you like. We had a $60,000 budget for food, and we used this to make ourselves seem a necessity to clinics who wanted to make their staff happy."
But food pales compared to what Ahari called "the most sinister tool in our armamentarium: our computer." He was referring, of course, to prescription data-mining. "We knew all your prescribing data, and we used it fine-tune our pitch."
Do you think drug reps are there to provide you with crucial medical information? Fuggedabout it! "I was in your office in order to influence you to prescribe Prozac or Zyprexa. We focussed on providing information to manipulate your prescribing, not to teach you how to treat your patients. Mostly, we wanted to build a good relationship, so that you’d like us. We are the one spot of sunshine in your day, a person who steps in the door and is actually interested in how you’re doing. We’re fun, witty, attractive, and we come bearing gifts. No wonder we’re accepted into your offices."