by   Dr. S. Brown

As a physician in private practice familiar with highly skilled pharmaceutical representatives pitching the latest (and most expensive) medications, I am fairly good at separating truth from salesmanship. These clear cut interactions with the drug reps visiting my office are relatively harmless. Drug maker’s are now changing up the game however, with a new, more subversive tactic to influence doctors’ prescribing habits.

I have been compiling a “medical propaganda” file, consisting of emails directed to my work and personal address offering cash for my time. In less than a year, I count over 500 of these emails. Here are twenty from the past week. Some details are blacked out for legal reasons.

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Most days I receive 3 to 5 but occasionally I have received upward of 10 in a day. These are not the spammy offers you immediately move to the Junk Folder. They come from a broad array of non-pharmaceutical companies, some well known brands in the medical information field and others appear to have sprung up to serve this particular purpose. I have not found any pharmaceutical company names directly attached to these invitations but based on the products being spotlighted it is not hard to guess who is financing the activity. These emails are invitations to participate in all sorts of internet activities for generous rewards. Incentives for the doctor’s participation include cash honorariums, consumer technology, or gift certificates, among others. The “honorarium” for participation range from $30 to $250. My colleagues all receive them. Some regard the email invitations as a harmless way to make easy money but few are concerned about their potentially subversive nature.

Looking over my “propaganda” file I can identify several operative strategies. The most common approach is to invite the doctor to participate in a survey or to give their opinion about a particular medical issue. Other approaches include offers to share your experience, receive late breaking news, learn about top advances, improve patient care, test your expertise against others or receive CME (continuing medical education) credits needed to renew medical licenses. More complex and lucrative approaches are offers to join an on-going panel of experts, provide information on actual cases in treatment, or to become part of a clinical study. This last group of strategies often provides the participant an iPad or similar electronic device to facilitate data sharing.
Once the invitation’s link is activated the first objective is to collect vital information including the doctor’s age, gender, number of years in practice, number of patients seen by day with breakdown by disease, insurance classes accepted, attitudes about using various drugs, whether you are an “early adopter” of new medications etc. . Sometimes the doctor is rejected based on the goals of the recruiter but not before providing a hefty data base about the doctor and the medical practice. Have no fear of missing out on the incentives because once categorized based on the information provided, a flood of new offers probably better suited for your professional profile, begins to hit your inbox.

Upon acceptance to the activity, a true genius for manipulation is observed. In order to get into medical school most doctors have become expert test takers and love to be rewarded for correct answers. Targeting these characteristics the internet exercise leads the doctor to choose answers which reinforce the benefits of using the sponsor’s products. In addition, the correct answer often highlights disadvantages of using a competitor product. Although the email’s stated purpose is to seek the doctor’s opinion, input, experience, etc., it is the shaping of knowledge and attitudes directed toward prescribing a certain medication or treatment which I think, is the underlying purpose. Reinforcing the whole experience is a substantial monetary reward, making an unbeatable combination.

For several decades major pharmaceutical companies have paid doctors to act as expert pitchmen among their medical peers, employing them to give carefully scripted speeches in restaurants or luxury locations in support of the company’s drug products. The fee for these speeches generally runs in the thousands of dollars while the speaker also receives a public relations boost in the medical community for appearing as an expert. For a specialist physician this exposure can result in a significant increase in referrals. All this provides a powerful incentive to the doctor to stay in the good graces of their sponsors. I should know since I participated in this system for a number of years. At the end of 2013, a major drug maker, Glaxo-SmithKline, made news by announcing it would no longer pay doctors to promote its products. Since pharmaceutical companies tend to ape each others policies in regard to their relationships with doctors, this decision seemed to be a step toward ending what seemed like subversive tactics by the pharma industry. Skepticism is appropriate since money now appears to be flowing into these internet based approaches which may prove far more influential.

Our nation’s doctors may be surreptitiously influenced into prescribing treatments by sponsors with corporate interests at heart. These treatments are not necessarily the best and most are far more expensive than older established drugs. My patients on fixed incomes or Medicare are often unable to afford these medications when they truly are appropriate for them. My goal is to bring this form of medical indoctrination into the spotlight and help restore balance to the information doctors are exposed to.
Due to concern about having to defend my views against large corporate interests I have adopted a pseudonym, but the truth of my observations is easy to verify. Just ask any doctor with an email address and an active medical practice.

If you want to do something that could help control this manipulative form of drug advertising, send an email to which directs complaints to the American Medical Association. You can cut and paste the following,  ” I want the AMA to look into the use of internet activities sponsored by pharmaceutical companies, that pay doctor’s for their participation, and which promote the use of the sponsors’ medical products.”

I thank for providing a platform to express my views.

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