Samples of promoted branded medications are the number one influencer of the prescribing habits of health care providers. 
 
 
Some time ago, I worked for a very small drug company that allowed prescribers to fax in a form to request samples of respiratory medications I promoted.  Afterwards, my drug employer would UPS the samples to the prescriber's location. 
 
 
So I printed off these forms available on the internet, mailed them to all prescribers in my assigned territory, and waited to see what would happen. 
 
 
Within my first 6 weeks of employment, I was ranked number 4 out of about 200 drug reps with prescription growth.  I never visited one prescriber in my territory to achieve this ranking.
 
 
Inducements are the second most influential catalyst for the prescribing habits of others.  But not always.  There is no way to assure reciprocity from those one gifts as a drug rep.  In fact, I think largely quid pro quo desired by the drug company does not materialize.
 
 
Most of those prescribers paid with money by drug reps. are gifed as such because the employer of the drug rep strictly enforces that the drug rep. spend their assigned promotional budget.  Most reps do not have the desire or intention of specifically bribing prescribers for their benefit.  They simply are trying to keep their jobs.
 
 
Most if not all promotional data available to a drug rep from their employer is overtly embellished if not entirely fabricated- related to the superior benefits of their promoted products over the competitors.  My last several years as a drug rep, I never shared this data with prescribers.  And I still was an above average drug rep because of the samples I left with prescribers in my territory.
 
 
Yes, I'm fairly intelligent, and have a clinical background- a medic in the military, as well as a physician assistant for several years.  But most drug reps are not particularly bright, are narcisstic, and have the persuasive abilities of a toxic microbe. 
 
 
They are not the manipulators they are perceived to be by others.  They are just shallow and narrow minded individuals with quality genetic stock who strive for others to have an affinity for them.  I am void of these undesirable intrinsic traits, I can assure you.
 
 
To summarize:
 
You Have Now Been Sampled
 
While the pharmaceutical industry’s image and reputation has and appears to continue to suffer, added damage has expressed itself with costly patent expirations.
Yet the big pharma task forces still insist that reps provide incredible value, and the more the better. 
 
The pharmaceutical company's drug representatives are the giver of gifts. 
 
This happens to ensure reciprocity will occur in the form of prescriptions from the gifted prescriber.
 
The samples reps dispense are around 20 billion a year, along with the reps themselves costing about 5 billion a year by the pharmaceutical industry.
 
It is possible for prescribers to order samples on the internet to be delivered to their practice, but this remains rare presently.
 
As a big pharma ex drug rep for over a decade, which during that period the number of drug reps actually tripled, the drug rep’s vocation has become more ridiculous. 
 
Ridiculous, and possibly void of any true sense of accomplishment due to their customers preventing them from interaction with them. Some doctors refuse the rep's presence in their clinic.
 
The job has become nothing more than doing lunches and leaving samples at offices, for the most part.
 
My perception formed from my own analysis of how drug reps operate in today’s environment in the medical community has led me to draw such conclusions, which I believe to be accurate.
 
So they may be named at times in different ways, these promoters will be referred to now only as drug reps, which number close to 100,000 in the U.S. presently.
 
Their job is to influence close to 1 million prescribers in this country, it is believed.
 
Yet the number of drug reps is probably less now due to big pharma cutting thousands of reps recently.
 
The cost to the pharmaceutical industry of these drug reps is around 5 billion dollars a year.
 
Income for each rep grosses close to or above 100,000 grand a year on average, along with great benefits and a company car. 
 
Also, drug reps often get stock options as they gladly work from their homes and set their own hours, which I understand is much less than 8 hours a day.
 
The main function these days of drug reps, I believe, is primarily to offer doctors various types of inducements of a certain value that are not gifts, but bribes, by definition. 
 
And these prescribers visited by drug reps are known as targets.
 
Targets are determined by what is known as ‘data mining’. 
 
The American Medical Association releases identifying information on doctors that allows pharmaceutical companies to track their prescribing habits. 
 
If a doctor, for example, is a high prescriber of prescriptions for particular disease states, or a doctor has an affinity for a product promoted by a drug company, they become a target.
 
The drug sampling of doctors may be considered an inducement, and a rather valuable one for the drug rep.
 
These drug samples are what ultimately influence the doctor’s prescribing habits over anything else, including invalid clinical statements from drug reps.
 
Perhaps this may be why the drug industry spends around 20 billion every year on samples.
 
Yet I want to be clear on what I am saying: drug reps are some of the smartest people you will meet that do in fact have great paying jobs with great benefits.
 
Most importantly and my opinion, I believe most reps really WANT to do well for their employers, yet are prohibited from doing so now.
 
This is because of how their employers are now viewed in their medical community.
               
Many years ago, drug reps have used their persuasive, yet ethical, abilities to influence the prescribing habits of doctors in an honest and ethical manner. 
 
Drug reps. focused on the benefits for the doctor’s patients with a particular drug that the detailer may promote to such a doctor.
 
However presently, most health care providers now simply prevent drug reps to speak with them- now this is especially true when they are in clinic treating and assessing patients.
 
More and more medical establishments are completely banning drug reps from their locations, and I speculate that this is occurring for many reasons, which may include the following:
 
The doctors lose money. Doctors are normally busy, so their time is valuable.
 
As a drug rep, you are an incredible waste of their time.
 
Yet they will accept your samples still as a drug rep.
 
The credibility you possibly have thought you had and were perceived as such by doctors as a drug rep is no longer viewed to exist to any noticeable degree by the prescriber.
 
For example and this is based on my experience and my colleagues, doctors view any information you may provide to them as biased and embellished.
 
In my opinion, based on information and belief, their view regarding their assessment of you as a drug rep is accurate due to the statistical gymnastics the employers of drug reps engage in.
 
This effectively and ultimately is permitting and encouraging the drug reps to lie to the doctor and likely are unaware of the statements stated by them are misleading.
 
Doctors by their very nature seek answers objectively.
 
And doctors do in fact find out about drugs through other methods besides the representative of the drug’s maker. 
 
Such methods include the internet and experience with certain medications.
 
Most drug reps in this country in particular mostly hire drug reps based on such qualities as the candidate’s looks as well as their personality, overall.
 
Furthermore, it is possible that pharmaceutical companies desire their drug reps to be obedient and to not question what is asked of them.
 
Upon speculation, this can be possibly determined by the background of the candidate, which may indicate they seek popularity as well as are money driven.
 
In addition, most drug reps do not have degrees remotely related to any aspect of anything of a scientific or clinical nature.
 
During my decade as a drug rep, I would encounter on very rare occasion another rep that may have been a nurse or researcher. 
 
This is quite concerning that others do not have similar backgrounds because the type of training necessary is rare for a drug rep.
 
In fact, based on my opinion, many do not particularly care to acquire education related to such medical or clinical topics.
 
They learn the basics in order to sell their promoted products.
 
Yet anyone who has ever worked with doctors in a clinical setting, or in a hospital working in a clinical nature, likely they would agree that a drug rep should want to and seek all related to the complexities involved in the restoration of another’s health.
 
Many drug reps, it is believed, are void of any complete interest in medicine completely, and I believe this to be necessary.
 
In addition, ethical considerations due to their possible deliberate ignorance created by the necessity of what they are required to say or do by their employers may be viewed as a disturbing fallacy as well.
 
This allows them with the encouragement and coercion of their employer to embellish the benefits of their promoted products at times in addition to offering inducements to doctors in various ways.
 
These inducements, or remuneration are always tacit and selective.
 
These gifts are issued to select prescribers upon instruction of their employer.
 
Examples may be creating a check from your company to a certain supporting doctor and handing this check to thank a doctor for supporting your company’s products for doing little if anything for your employer to justify this check.
 
Or tangible items are given to such prescribers, such as TVs or DVDs which may or may not be utilized in a particular doctor’s office. It happens often, such activities.
 
From the drug rep’s perspective, it is unlikely they will even consider the possibility to question their pharmaceutical employer due to the great risk of losing income and benefits that they are unlikely to acquire at another place of employment.
 
Because of their consistent and conscious effort to keep their high-paying jobs, the drug reps always appear overtly anxious to please their superiors- regardless of any ethics or legalities regarding any activity they may be required to perform.
 
With big pharma in particular, each drug rep is given a variety of budgets, such as a chunk of cash for doctor office lunches that they are required to spend in a certain period of time.
 
Another chunk of cash may be assigned to a rep to pay assigned or registered speakers of their employer to speak to other prescribers about a disease state related to the drug rep’s promoted product.
 
These activities, in my time with big pharma, were never monitored or questioned by managers or superiors.
 
What I did notice is that my annual raises were greater than others according to the amount I spent for that particular year.
 
This tactic, according to a big pharma company, was a very objective and noticeable variable with securing and keeping your employment in big pharma.
 
While legally risky, the drug companies continue to dispense to their reps these large budgets their drug reps are in effect coerced to dispense with complete autonomy. 
 
This spending of this budget can be fabricated, which is too complicated to fully explain.
 
This design perhaps is why there are now various state and federal disclosure laws that are presently being considered to mandate the release of all funds dispensed from pharmaceutical companies.
 
This would include why a company’s funds were spent and for what reason or method.
 
Because, according to the lobbyists of pharma companies, they consistently insist that whatever they spend always is for the benefit of public health.
 
As mentioned earlier, presently such activities are quite covert.
 
Yet if such laws are mandated, it is likely the accounting of pharma companies will become rather creative and incomplete.
 
In summary, as a big pharma drug rep, my budgets were unlimited, and I typically spent more than I made though the activities I have mentioned so far.
 
And this is not an isolated case.
 
Historically, pharma lavished doctors with expensive gifts and trips. Now it is about funding for them, such as financial grants.
 
Basically, the two remain synonymous and ethically conflicting.
 
Then there is the issue is what again is referred to as data mining.
 
The American Medical Association sells this prescribing data on individual doctors to pharmaceutical companies or pharmacies, by providing others identifying numbers of a particular doctor, such as a state license number or DEA number.
 
This allows big pharma to track and analyze prescriptions a doctor writes for patients not far from real time availability.
 
This data shows the volume of scripts of a particular doctor and what the doctor has been prescribing for the doctor’s patient for their disease state.
 
And this data reveals competitor products to the drug rep as well.
 
Aside from being deceiving and dishonest, the data allows a pharma company to ‘reward’ those doctors who support their products.
 
And this data conversely allows a drug company to treat other doctors with ‘neglect’, which means the non-supporters of a pharma company will not receive any inducement or remuneration from a particular pharma company.
 
The data, by the way, only reflects numbers linked with particular products, and fortunately is free of patient names- this data that is provided to all drug reps.
 
What has been described is the method typical with all big pharma companies, in my opinion, and I worked for three of them.
 
It appears to be manipulative in a psychological paradigm- a combination of Pavlovian responses combined with positive and negative reinforcement.
 
So such methods create a toxic culture required to be absorbed by those members of such a pharma company.
 
Furthermore, the tactics implemented by pharma companies vacuum the judgment of prescribers, which may prevent patients from receiving objective treatment.
 
Yet on the most basic level, it is the samples left with prescribers that ultimately determine their prescribing habits- with various inducements to some doctors running close in second place.
 
Yet remarkably, prescribers are prescribing more and more generics, which typically are not sampled to prescribers.
 
I find this comforting that the manipulation efforts of the pharma industry are not as effective as they believe they are in a rather delusional way.
 
Yet what is happening now in regards of branded meds vs. generic meds, insurance companies are flat out paying doctors to switch patients to a generic if one is available.
 
I speculate they are paying doctors for this as a response of what pharma has been doing for quite a long time.
 
From a clinical paradigm, if a medication is providing desired treatment and good tolerability for a particular patient, one could argue it would be unethical to switch treatment for financial gain.
 
This is further complicated by the fact that most patients are aware that insurance company payments to doctors for this even occur.
 
It is likely and I believe that most drug reps are good and intelligent people who unfortunately are coerced to do things that may be considered corruptive to others in order to maintain their employment.
 
In other words, the drug reps have compromised their integrity, ultimately.
 
It seems that external regulation is necessary to prevent the drug companies from allowing the autonomy of drug reps that exists presently. 
 
This atonomy and coercion to have big pharma's drug reps. do the wrong things for the medical community often. 
 
Because it is obvious that internal controls, if any, within pharmaceutical companies are ineffective and not enforced.
 
It is possible that these pharma companies falsely believe that being an ethical company would make them a company without excess profit. One can only speculate on their true motives.
 
Yet it appears that overt greed has replaced ethics with this element of the health care system, which is the pharmaceutical industry, as illustrated with what occurs within these companies.
 
However, reversing this misguided focus of drug companies is not impossible if the right action is taken for the benefit of public health.
 
Likely, if there are no drug reps, there is no one to employ such tactics mentioned earlier.
 
Because authentically educating doctors does not appear to be the reason for their vocation.
 
This is far from being the responsibility of a pharmaceutical sales representative.
 
Perhaps most frightening is that most drug reps fail to dig deep enough to realize that what they do at times may damage public health.
 
“Fear ensures loyalty.” --- Author unknown
 
Dan Abshear (what has been written is based upon information and belief)