(A) A few months ago Kim Schaefer, sales representative of a major global pharmaceutical company, walked into a medical center in New York to bring information and free samples of her company’s latest products. That day she was lucky— a doctor was available to see her. ‘The last rep offered me a trip to Florida. What do you have?’ the physician asked. He was only half joking.

(B) What was on offer that day was a pair of tickets for a New York musical. But on any given day what Schaefer can offer is typical for today’s drugs rep -a car trunk full of promotional gifts and gadgets, a budget that could buy lunches and dinners for a small county, hundreds of free drug samples and the freedom to give a physician $200 to prescribe her new product to the next six patients who fit the drug’s profile. And she also has a few $ 1,000 honoraria to offer in exchange for doctors’ attendance at her company’s next educational lecture.

(C) Selling Pharmaceuticals is a daily exercise in ethical judgment. Salespeople like Schaefer walk the line between the common practice of buying a prospect’s time with a free meal, and bribing doctors to prescribe their drugs. They work in an industry highly criticized for its sales and marketing practices, but find themselves in the middle of the age-old chicken-or-egg question – businesses won’t use strategies that don’t work, so are doctors to blame for the escalating extravagance of pharmaceutical marketing? Or is it the industry’s responsibility to decide the boundaries?

(D) The explosion in the sheer number of salespeople in the field- and the amount of funding used to promote their causes- forces close examination of the pressures, influences and relationships between drug reps and doctors. Salespeople provide much-needed information and education to physicians. In many cases, the glossy brochures, article reprints, and prescriptions they deliver are primary sources of drug education for healthcare givers. With the huge investment the industry has placed in face-to-face selling, salespeople have essentially become specialists in one drug or group of drugs – a tremendous advantage in getting the attention of busy doctors in need of quick information.

(E) But the sales push rarely stops in the office. The flashy brochures and pamphlets left by the sales reps are often followed up with meals at expensive restaurants, meetings in warm and sunny places, and an inundation of promotional gadgets. Rarely do patients watch a doctor write with a pen that isn’t emblazoned with a drug’s name, or see a nurse use a tablet not bearing a pharmaceutical company’s logo. Millions of dollars are spent by pharmaceutical companies on promotional products like coffee mugs, shirts, umbrellas, and golf balls. Money well spent? It’s hard to tell. ‘I’ve been the recipient of golf balls from one company and I use them, but it doesn’t make me prescribe their medicine,’ says one doctor. ‘I tend to think I’m not influenced by what they give me.’

(F) Free samples of new and expensive drugs might be the single most effective way of getting doctors and patients to become loyal to a product. Salespeople hand out hundreds of dollars’ worth of samples each week- $7.2 billion worth of them in one year. Though few comprehensive studies have been conducted, one by the University of Washington investigated how drug sample availability affected what physicians prescribe. A total of 131 doctors self-reported their prescribing patterns – the conclusion was that the availability of samples led them to dispense and prescribe drugs that differed from their preferred drug choice.

(G) The bottom line is that pharmaceutical companies as a whole invest more in marketing than they do in research and development. And patients are the ones who pay – in the form of sky-rocketing prescription prices – for every pen that’s handed out, every free theatre ticket, and every steak dinner eaten. In the end, the fact remains that pharmaceutical companies have every right to make a profit and will continue to find new ways to increase sales. But as the medical world continues to grapple with what’s acceptable and what’s not, it is clear that companies must continue to be heavily scrutinized for their sales and marketing strategies.