In HOOKED, I was able to use testimony from former drug reps to illustrate the various techniques that are used to influence physicians--almost always without the physicians ever having a clue as to how they are being manipulated. A recent paper that takes advantage of another former rep--the second author--is:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040150
The article includes a long table that classifies physicians by type--"friendly and outgoing," "aloof and skeptical," "mercenary," etc.--and explains how the rep would effectively get each type to prescribe more of the company's drugs.
This paper has some of the most direct and unambiguous statements about how the rep system operates. As the former rep, Shahram Ahari, says, "During training, I was told, when you're out to dinner with a doctor, 'The physician is eating with a friend. You are eating with a client.'" The article covers the power of gifts, how the rep scopes out the doc looking for what buttons to push, how the reps use prescribing data to customize their detailing to each physician, and the use of samples.
Anari again: "[To constantly sway the doctors] is a job I'm paid and trained to do. Doctors are neither trained nor paid to negotiate. Most of the time they don't even realize that's what they're doing..."
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All that has been posited by other reps. and others regarding what exactly influences the prescribing habits of doctors is speculative and based on individual interpretation.
Ready for the real truth? Samples and inducements to a prescriber are the two top influencers of thier prescribing habits, and this has been proven repeatedly.
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