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Why should doctors “Say No” to drug reps?

Your doctor’s job is to make sure that you are prescribed the most cost-effective drug. A drug rep’s job is to sell his or her product, whether or not this product is in fact the most cost-effective. Not surprisingly, information provided by reps is likely to biased in favor of their product. Furthermore, reps often provide gifts—food, pens, pads, and more food—in hopes of influencing what your doctor prescribes. Again, not surprisingly, research (as well as common sense) suggests that this works: Doctors who meet with reps and accept gifts from drug companies are more likely to prescribe their drugs – and this may mean a more expensive and possibly even inappropriate drug. There are plenty of sources of information available to doctors—non-promotional, unbiased, independent sources of information, so there is no longer any need for doctors to rely on sales people for this information. Unfortunately, these sources don't come with free lunch!


Many doctors provide samples to patients who lack prescription drug coverage or out of convenience. In fact, many doctors will say that obtaining samples is the primary reason they see reps.  Drug companies spend ½ their promotional dollar (more than 10 billion dollars in 2002) on these samples. And for good reason: Samples are an extremely effective marketing “tool.” Samples get patients, and doctors, “hooked” on the sampled drug. But, not surprisingly, the “Sample Closet” is filled with the newest, most expensive medications, in brightly colored promotional packaging reminiscent of the supermarket cereal aisle.  Though receiving a sample from your doctor may often seem convenient (and may also save you money in the short run), it may also result in you ending up on the wrong medication, and in the end costing you even more money, and maybe even worse. “COX-2 inhibitors” like Vioxx were heavily “sampled,” and given out to patients who didn’t need them, when older, cheaper drugs were available. Vioxx, of course, was later found to have adverse effects on the heart.  Furthermore, many practices do not keep proper track of which samples are given to whom; this could create a problem if a drug (or lot) were recalled.  There are alternative, and preferable, ways to obtain medications--use of patient assistance programs, for example, as well as using generics whenever possible (see below).


New drugs are developed under patent protection, which gives the manufacturer the sole right to market their drug. When the patent expires, companies may introduce generic formulations. According to the FDA “A generic drug is identical, or bioequivalent to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.” However, generics cost less, often substantially less than name brand products. Many insurers require prescriptions for generics when these are available. Though some patients prefer “name brand,” cost is really the only difference between the generic and the name brand product.

Despite the availability of identical, but cheaper, alternatives, patients are often nevertheless prescribed branded drugs. There are several reasons for this:

1) The name brand products are promoted to doctors, generics are not.

2) Name brand products are promoted to patients, generics are not.

3) The samples found in your doctor’s “sample cabinet” are name brand products, not generics (see above). Patients are often started on samples (as a trial, out of convenience, or for financial reasons). When a prescription is ultimately written, it is more likely to be for the sampled drug.

See http://www.fda.gov/cder/ogd/#Introduction for more information about generic drugs

If my doctor meets with drug reps does that mean she’s a bad doctor?

No, but while it is no doubt true that many doctors, despite walls adorned with Claritin clocks and Cozaar calendars, practice very good medicine, studies have shown that doctors who meet with and accept gifts from reps are more likely to prescribe expensive, perhaps inappropriate medications.  While it is true that doctors are very busy, and there’s lots of new information coming out every day, there are also lots of sources of drug information available to doctors that are likely to be less biased then information provided to them by sales people.

How do I know if my doctor is an addict?

It's not too difficult to tell how much time your doctor is spending with sales reps. For one, there will usually be several of them in the office at any given time--often being called before you, especially if it’s around lunchtime. Branded clocks, note pads, facial tissue boxes, and of course pens, are a giveaway. The size of the "sample cabinet" is generally directly proportional to the number of reps that your doctor sees.

What can I do?

As a patient, you have potentially a lot of power. However, given the nature of the patient-physician relationship, it is often difficult for most patients to confront their doctor about this issue. (Asking, for example, “why are you writing me a prescription for Nexium, using a Nexium pen, when omeprazole would do just as well and is much cheaper?”). If you feel able to do this, by all means, just do it! Some additional ideas:

  • Tell your doctor to visit www.nofreelunch.org.
  • Leave behind a No Free Lunch pen on your doctor’s desk (perhaps "exchange" it for that Nexium pen)
  • Leave behind some No Free Lunch “Doctor Information Materials.”

How do I find a non-drug company-addicted doctor?

Several hundred health care providers have taken the No Free Lunch Pledge, pledging to accept no gifts from drug reps and practice medicine on the basis of scientific, rather than promotional, literature. The listing of these doctors will soon be posted on this website, so you will be able to choose a “drug company free M.D. or a "Say No D.O.” We anticipate that in the not so distant future “No Free Lunch Certified” will be as prestigious as “Board Certified” as an indicator of quality.

Sources of drug information for patients:

Consumer Reports Best Buy Drugs

A project of Consumers Union, the publisher of Consumer Reports, its mission is to is to provide consumers and their doctors with information to help guide prescription drug choices.

Public Citizen Health Research Group Worst Pills Best Pills

Public Citizen's Worst Pills, Best Pills News, published since 1995, is a member of the International Society of Drug Bulletins and a web based version is now available at www.worstpills.org. The newsletter is written for patients and focuses on risk, safety and new drug evaluations.

Treatment Notes

Based on articles published in Drug and Therapeutics Bulletin, intended to provide practical, unbiased drug information to patients.

U.S. Food and Drug Administration (FDA) Consumer Drug Information




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