For years, physicians at Madras Medical Group, a family practice in rural Oregon, were split on whether to 
continue seeing drug representatives, who had begun to visit the office several times per day. Although office members enjoyed the free meals and gifts provided by the companies, two of the group's five providers were leery that being "buttered up" by pharmaceutical companies influenced their prescribing decisions.
The practice finally reached a tipping point in 2004 when not only did the addition of a sixth anti-rep physician shift the group's internal politics, but the Vioxx scandal also made skeptics out of the doctors who enjoyed working with reps.
The pharmaceutical companies didn't accept the practice's new policy easily, the Bend Bulletin reported, but physicians and staff used the following strategies to fill the gaps left with the drug reps' absence:
Recognize the 'hidden cost' of the sample closet. When Madras staff analyzed the sample closet, they realized that it included very few first-line drugs.The samples that they had been giving to patients, however, were for drugs that cost patients an average of $90 a month. For 38 of the 46 sample drugs, there were less expensive generics available, cutting the patients' average cost to $22 a month.
Removal of the sample closet, the doctors said, forced them to prescribe more based on cost and efficacy, eliminating their irrational prescribing patterns.
Seek unbiased education. Prior to shutting out drug reps, Madras doctors regularly attended company-sponsored educational seminars, which they felt were more like sales pitches. To replace the pharma-led sessions, the practice began holding monthly meetings with other community physicians to go over reviews published in unbiased journals such as the Medical Letter and the Prescriber's Letter.
Recreate social interactions. Finally, while not as lavish as the industry-sponsored meals the office had once enjoyed, the group continued to hold monthly luncheons to give doctors and staff a chance to take a mid-day break and socialize sans the sales pitch.
"Really, it was the social interaction the staff was concerned about," David Evans, M.D., told the newspaper. "It was easy for us as a practice to spend $50 to $80 a month to have a little luncheon that served the social purpose and didn't want us to take a shower afterward."
To learn more:
- read the article from the Bend Bulletin