As guardians of the nation's prescription pads, doctors are the gatekeepers that stand between American patients and the pharmaceutical companies that have drugs to sell them.
Physicians' choices -- whether to medicate, with which medication, generic vs. brand-name drug, and for how long -- profoundly affect sales of a drug company's products. So pharmaceutical manufacturers focus the bulk of their marketing budgets to influence those choices. The drug companies' promotional efforts reach into physicians' offices, pervade their medical specialty organizations and often shape the messages that doctors receive in educational settings.
"There is a big bucket of money sitting in every office" a drug representative visits, said an AstraZeneca marketing director in a widely circulated newsletter interview. "Every time you go in, you reach your hand in the bucket and grab a handful," said Mike Zubillaga, who was fired after his blunt comments made their way onto the Internet last April.
Each day in the United States, an army of roughly 100,000 pharmaceutical company sales reps storms the waiting rooms and offices of the nation's 311,000 office-based physicians. Called "detailers" -- and earning, on average, $81,700 per year -- they are the smiling, well-dressed men and women often seen in a physicians' waiting room toting a cavernous briefcase and making small-talk with the receptionists. Their ranks have more than doubled in the last 10 years.
Sales reps say they want nothing more than to drop off drug samples that doctors can dispense at no cost to their patients, and to brief physicians on the FDA-approved benefits and risks of the prescription drugs their companies make. That's an accurate job description. But it doesn't nearly capture the sophistication of their efforts or the complex web of relationships that marketing departments cultivate with physicians. In recent years, drug-company insiders have come forward to detail the enticements, persuasive techniques and market-tracking systems that their organizations use to nudge doctors' prescribing decisions to boost sales. The picture they provide is of an industry in hot pursuit of physicians' hearts and minds.
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Relationships with drug reps
