The (Honest) Truth About Dishonesty

One particularly interesting practice is the “dine-and-dash,” where, in the name of education, doctors can simply pull up at prespecified take-out restaurants and pick up whatever they want. Even medical students and trainees are pulled into some schemes. One particularly creative example of this strategy was the famous black mug. A black mug with the company’s logo was handed out to doctors and residents, and the company arranged it such that a doctor could take this mug to any location of a local coffee chain (which shall go unnamed) and get as much espresso or cappuccino as he or she wanted. The clamor for this mug was so great that it became a status symbol among students and trainees. As these practices became more extravagant, there was also more regulation from hospitals and the American Medical Association, limiting the use of these aggressive marketing tactics. Of course, as the regulations become more stringent, pharma reps continue to search for new and innovative approaches to influence physicians. And the arms race continues …^*

A FEW YEARS AGO, my colleague Janet Schwartz (a professor at Tulane University) and I invited some pharmaceutical reps to dinner. We basically tried the pharma reps at their own game; we took them to a nice restaurant and kept the wine flowing. Once we had them feeling happily lubricated, they were ready to tell us the tricks of their trade. And what we learned was fairly shocking.

Picture one of those pharma reps, an attractive, charming man in his early twenties. Not the kind of guy who would have any trouble finding a date. He told us how he had once persuaded a reluctant female physician to attend an informational seminar about a medication he was promoting—by agreeing to escort her to a ballroom dancing class. It was an unstated quid pro quo: the rep did a personal favor for the doctor, and the doctor took his free drug samples and promoted the product to her patients.

Another common practice, the reps told us, was to take fancy meals to the entire doctor’s office (one of the perks of being a nurse or receptionist, I suppose). One doctor’s office even required alternating days of steak and lobster for lunch if the reps wanted access to the doctors. Even more shocking, we found out that physicians sometimes called the reps into the examination room (as an “expert”) to directly inform patients about the way certain drugs work.

Hearing stories from the reps who sold medical devices was even more disturbing. We learned that it’s common practice for device reps to peddle their medical devices in the operating room in real time and while a surgery is under way.

Janet and I were surprised at how well the pharmaceutical reps understood classic psychological persuasion strategies and how they employed them in a sophisticated and intuitive manner. Another clever tactic that they told us about involved hiring physicians to give a brief lecture to other doctors about a drug they were trying to promote. Now, the pharma reps really didn’t care about what the audience took from the lecture—what they were actually interested in was the effect that giving the lecture had on the speaker. They found that after giving a short lecture about the benefits of a certain drug, the speaker would begin to believe his own words and soon prescribe accordingly. Psychological studies show that we quickly and easily start believing whatever comes out of our own mouths, even when the original reason for expressing the opinion is no longer relevant (in the doctors’ case, that they were paid to say it). This is cognitive dissonance at play; doctors reason that if they are telling others about a drug, it must be good—and so their own beliefs change to correspond to their speech, and they start prescribing accordingly.

The reps told us that they employed other tricks too, turning into chameleons—switching various accents, personalities, and political affiliations on and off. They prided themselves on their ability to put doctors at ease. Sometimes a collegial relationship expanded into the territory of social friendship—some reps would go deep-sea fishing or play basketball with the doctors as friends. Such shared experiences allowed the physicians to more happily write prescriptions that benefited their “buddies.” The physicians, of course, did not see that they were compromising their values when they were out fishing or shooting hoops with the drug reps; they were just taking a well-deserved break with a friend with whom they just happened to do business. Of course, in many cases the doctors probably didn’t realize that they were being manipulated—but there is no doubt that they were.