6. Draining and Constraining Agency

1 Jamie Reidy, Hard Sell: The Evolution of a Viagra Salesman (Kansas City, MO: Andrews McMeel Publishing, 2005), 69. A number of former pharmaceutical sales reps have written books in a roughly confessional genre. Reidy’s is the most cheerful, because he is trying to tell a story of himself as a likeable slacker who happened to land a golden opportunity. Others in the genre tend to be more angry, about either their authors’ own mistreatment at the hands of pharma or about the misdeeds being done to patients, or both.

2 Michael Oldani, ‘Thick Prescriptions: Toward an Interpretation of Pharmaceutical Sales Practices’, Medical Anthropology Quarterly 18, no. 3 (2004): 325–356, at 334.

3 Michael Oldani, ‘Thick Prescriptions: Toward an Interpretation of Pharmaceutical Sales Practices’, Medical Anthropology Quarterly 18, no. 3 (2004): 325–356, at 335.

4 Kimberly Cheryl, Escape from the Pharma Drug Cartel (Denver, CO: Outskirts Press, 2007), 62.

5 Michael Oldani, ‘Thick Prescriptions: Toward an Interpretation of Pharmaceutical Sales Practices’, Medical Anthropology Quarterly 18, no. 3 (2004): 325–356, at 36.

6 Adriane Fugh-Berman and Shahram Ahari, ‘Following the Script: How Drug Reps Make Friends and Influence Doctors’, in Sergio Sismondo and Jeremy A. Greene, eds, The Pharmaceutical Studies Reader (Chichester, UK: Wiley Blackwell, 2015), 123–132.

7 Jamie Reidy, Hard Sell: The Evolution of a Viagra Salesman (Kansas City, MO: Andrews McMeel Publishing, 2005), 75.

8 Jamie Reidy, Hard Sell: The Evolution of a Viagra Salesman (Kansas City, MO: Andrews McMeel Publishing, 2005), 73.

9 A number of studies have shown that samples affect prescriptions, and tend to encourage the use of more expensive drugs. See, e.g. Richard F. Adair and Leah R. Holmgren, ‘Do Drug Samples Influence Resident Prescribing Behavior? A Randomized Trial’, The American Journal of Medicine 118, no. 8 (2005): 881–884.

10 Kimberly Cheryl, Escape from the Pharma Drug Cartel (Denver, CO: Outskirts Press, 2007), 42.

11 John Virapen, Side Effects: Death – Confessions of a Pharma-Insider (College Station, TX: virtualbookworm.com, 2010), 26.

12 Michael Oldani, ‘Thick Prescriptions: Toward an Interpretation of Pharmaceutical Sales Practices’, Medical Anthropology Quarterly 18, no. 3 (2004): 325–356, at 348.

13 Shubham Mod, ‘A Medical Representative Faces These 6 Types of Doctors’ <http://tips-for-medical-representative.blogspot.ca/2015/02/a-medical-representative-faces-these-6.html> [accessed 24 January 2018].

15 Quoted in Adriane Fugh-Berman and Shahram Ahari, ‘Following the Script: How Drug Reps Make Friends and Influence Doctors’, in Sergio Sismondo and Jeremy A. Greene, eds, The Pharmaceutical Studies Reader (Chichester, UK: Wiley Blackwell, 2015), 123–132, at 128.

16 MedReps.com, ‘The 6 Doctors You May Encounter During Sales Calls’, 22 September 2014 <https://www.medreps.com/medical-sales-careers/the-6-doctors-you-may-encounter-during-sales-calls/>.

17 Kimberly Cheryl, Escape from the Pharma Drug Cartel (Denver, CO: Outskirts Press, 2007), 44.

18 John Virapen, Side Effects: Death – Confessions of a Pharma-Insider (College Station, TX: virtualbookworm.com, 2010).

19 Evan Hughes, ‘The Pain Hustlers’, The New York Times, 2 May 2018.

20 Adriane Fugh-Berman and Shahram Ahari, ‘Following the Script: How Drug Reps Make Friends and Influence Doctors’, in Sergio Sismondo and Jeremy A. Greene, eds, The Pharmaceutical Studies Reader (Chichester, UK: Wiley Blackwell, 2015), 123–132.

21 Michael Oldani, ‘Thick Prescriptions: Toward an Interpretation of Pharmaceutical Sales Practices’, Medical Anthropology Quarterly 18, no. 3 (2004): 325–356, emphasis removed.

22 Adriane Fugh-Berman and Shahram Ahari, ‘Following the Script: How Drug Reps Make Friends and Influence Doctors’, in Sergio Sismondo and Jeremy A. Greene, eds, The Pharmaceutical Studies Reader (Chichester, UK: Wiley Blackwell, 2015), 123–132.

23 Kimberly Cheryl, Escape from the Pharma Drug Cartel (Denver, CO: Outskirts Press, 2007), 18.

24 Kimberly Cheryl, Escape from the Pharma Drug Cartel (Denver, CO: Outskirts Press, 2007), 12.

25 Jamie Reidy, Hard Sell: The Evolution of a Viagra Salesman (Kansas City, MO: Andrews McMeel Publishing, 2005), 33.

26 Jamie Reidy, Hard Sell: The Evolution of a Viagra Salesman (Kansas City, MO: Andrews McMeel Publishing, 2005), 17.

27 Quoted in Melissa A. Fischer, Mary Ellen Keogh, Joann L. Baril, Laura Saccoccio, Kathleen M. Mazor, Elissa Ladd, et al., ‘Prescribers and Pharmaceutical Representatives: Why Are We Still Meeting?’, Journal of General Internal Medicine 24, no. 7 (2009): 795–801.

28 Blue Novius, ‘Get your Sales Reps Back to Doctors’ Offices’ <https://www.bluenovius.com/healthcare-marketing/pharma-sales-reps-visit-doctors-office/> [accessed 28 January 2018].

29 Quoted in Melissa A. Fischer, Mary Ellen Keough, Joann L. Baril, Laura Saccoccio, Kathleen M. Mazor, Elissa Ladd, et al., ‘Prescribers and Pharmaceutical Representatives: Why Are We Still Meeting?’, Journal of General Internal Medicine 24, no. 7: 795–801, at 797.

30 Kimberly Cheryl, Escape from the Pharma Drug Cartel (Denver, CO: Outskirts Press, 2007), 62.

31 Quoted in Michael Oldani, ‘Thick Prescriptions: Toward an Interpretation of Pharmaceutical Sales Practices’, Medical Anthropology Quarterly 18, no. 3 (2004): 325-356, at 325.

32 For their general sense of immunity, see, e.g. Michael A. Steinman, Michael Shlipak and Stephen J. McPhee, ‘Of Principles and Pens: Attitudes and Practices of Medicine Housestaff toward Pharmaceutical Industry Promotions’, The American Journal of Medicine 110, no. 7 (2001): 551–557. For the correlation with contact with the industry, see Brian Hodges, ‘Interactions with the Pharmaceutical Industry: Experiences and Attitudes of Psychiatry Residents, Interns and Clerks’, Canadian Medical Association Journal 153, no. 5 (1995): 553–559.

33 Advertisement for ‘Patient Adherence is the Next Best Thing in Healthcare’, eyeforpharma, 19 September 2011. <https://social.eyeforpharma.com/commercial/podcasts/podcast-patient-adherence-next-big-thing-healthcare>.

34 Leslie R. Martin, Summer L. Williams, Kelly B. Haskard and M. Robin DiMatteo, ‘The Challenge of Patient Adherence’, Therapeutics and Clinical Risk Management 1, no. 3 (2005): 189–199.

35 Anthropologist Kalman Applbaum also attended an industry conference focused on patient adherence, very similar to the ones on which I report here. His observations are very similar. Kalman Applbaum, ‘“Consumers are Patients!” Shared Decision-making and Treatment Non-compliance as a Business Opportunity’, Transcultural Psychiatry 46, no. 1: 107–130.

36 For example, Sandra van Dulmen, Emmy Sluijs, Liset van Dijk, Denise de Ridder, Rob Heerdink and Jozien Bensing, ‘Patient Adherence to Medical Treatment: A Review of Reviews’, BMC Health Services Research 7 (2007): 55.

37 Howard Brody and Donald W. Light, ‘The Inverse Benefit Law: How Drug Marketing Undermines Patient Safety and Public Health’, American Journal of Public Health 101, no. 3 (2011): 399–404. The inverse benefit law takes some inspiration from Hart’s inverse care law: ‘The availability of good medical care tends to vary inversely with the need for it in the population served’. See Julian Tudor Hart, ‘The Inverse Care Law’, The Lancet 297, no. 7696 (1971): 405–412.

38 Michelle Vitko, ‘Is Technology the Solution to Patient Non-Adherence?’, Cutting Edge Info, 2011 <http://www.cuttingedgeinfo.com/2011/technology-patient-adherence> [accessed 23 April 2012].

39 The speaker’s slide indicates that he is here quoting Stanford University health economist Alan Garber.