with family doctors now the largest single group of OxyContin prescribers.
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Industrywide, pharmaceutical companies spent $4.04 billion in direct marketing to doctors in 2000, up 64 percent from 1996. To get in the doctor’s door, to get past the receptionist and head nurse, the reps came bearing gifts, from Valentine’s Day flowers to coupons for mani-pedis.
The average sales rep’s most basic tool was Dine ’n’ Dash, a play on the juvenile-delinquent prank of leaving a restaurant without paying the bill. For a chance to pitch their wonder drug, reps had long offered free dinners at fancy restaurants. But soon, to-go options abounded, too, for a busy doctor’s convenience. Reps began coming by before holidays to drop off a turkey or beef tenderloin that a doctor could take home to the family—even a Christmas tree. Driving home from the office, doctors were also invited to stop by the nearest gas station to get their tanks topped off—while listening to a drug rep’s pitch at the pump, a variation the reps nicknamed Gas ’n’ Go. In the spring, the takeout menu featured flowers and shrubs, in a version some dubbed—you guessed it—Shrubbery ’n’ Dash.
There seemed to be no end to the perks, or to the cloying wordplay: At a bookstore event titled Look for a Book, an invitation issued by SmithKline Beecham asked doctors to “come pick out the latest book about your favorite hobby or travel destination!” Purdue reps were heavily incentivized, buoyed by $20,000 cash prizes and luxury vacations for top performers and a corporate culture that employed terminology from the Middle Ages to pump up its foot soldiers. Internal documents referred to reps as royal crusaders and knights, and supervisors went by such nicknames as the Wizard of OxyContin, the Supreme Sovereign of Pain Management, and the Empress of Analgesia. Purdue’s head of pain care sales signed his memos simply “King.”
Physicians willing to submit to reps’ pitches were routinely given not just branded pens and Post-it notes but also swing-music recordings labeled “Swing in the Right Direction” and freebie pedometers with the message that OxyContin was “A Step in the Right Direction.”
A chain-smoking doctor in Bland, Virginia, was so blatantly in favor of graft that she posted a signup sheet in her office, soliciting reps to sponsor her daughter’s upcoming birthday party at Carowinds, an amusement park—and one (not a Purdue rep) did. She even accepted cartons of cigarettes emblazoned with a sticker for Celexa, the antidepressant manufactured by Forest Laboratories: another gift from another clever rep.
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Steve Huff was in medical residency training in the mid-1990s when he sampled his first taste of pharmaceutical swag—and not just by way of stickers, golf balls, and pens adorned with drug company names. “We were impressionable young doctors, fresh meat with a lifetime of prescribing ahead, and they flocked to us,” he told me. “They took us golfing. It was standard to have a free lunch most days of the week because the drug companies were always buying, then you’d have a short educational seminar going on [about their drugs] while you ate.”
By the time he progressed to a family practice, Huff decided the free meals were wrong and said so repeatedly, making a show of retrieving his cold leftovers from home from the office fridge, he told me. When he set about trying to coax the other doctors in his practice to ban the lunches, they demurred, saying the staff would be so disappointed if we “took away their free meals,” Huff said.
The reps tended to be outgoing, on the youngish side of middle-aged, and very good-looking. “They were bubbly, they’d flirt a little bit, and it really would make you feel special. And yet intertwined in all those feelings is the name of a drug, which the rep is repeating over and over while you’re eating this delicious, savory meal. And even if you say you’re not swayed by such things, there is no doubt in my mind that you’re more than likely to prescribe it,” Huff added.
Huff didn’t fall for the reps’ pitches; in fact, he stopped accepting pharmaceutical gifts altogether, even Post-it notes and pens. At his first family medicine practice, in Stuart, Virginia, Huff prescribed OxyContin a time or two. But most of the patients returned, as miserable as ever and still complaining about pain, he said, along with new side effects that included sleepiness, confusion, constipation, and unsteadiness on their feet. “A few of them would stay on a stable dose once it was titrated properly, but