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Who are the reps? Every one of us knows the friendly face of the local randomprost eye drop representative or the nice man from that eye lubricant company. These company representatives travel up and down the region with a smile, a study, a bag full of Marks and Spencer sandwiches and an invitation to an eye conference somewhere.

But who are they in reality? What do they really want from us? We like to think that they are benign and have only goodness to offer. We like to think that they are keen to help us and that we are far too intelligent to be deceived by their industry spin and results of the RIVAL study with its statistically insignificant p value.

But no. There is danger, great danger and we would do well to take caution. I went to a new consultant meeting a few years ago, sponsored by industry as it happens, where an old cover of the BMJ from 31 May 2003 was displayed which pictured pigs presenting study results to other pigs while snakes looked on from behind the scenes. Snakes handed out food to another group of pigs and a snake and a pig played golf together in the top left corner. In the foreground there was a lonely guinea pig attached to a drip. We were meant to be the pigs. Eating industry food, attending industry meetings, flying abroad to various conferences on the industry ticket, or speaking at an evening event on behalf of industry to a group of our colleagues using industry slides about how wonderful their product is. Why do we attend? Why do we speak? Greed is a factor but there is something far worse under it all that we all know is there but refuse to accept. Ego. Kudos to the pharmaceutical company that arranged that presentation actually. I will forever be grateful to them.

A few drug representatives play on ego like nothing else. “You would obviously have heard of the FRAGMENT Study eight month results?” the eager rep in a sharp suit says to us as we eat a salmon and cream cheese sandwich, arguably the best of the bunch. “Ah, yes,” we say uncertainly, while wondering what that study ever involved. But worry not, the drug rep will usually step in to save us from the embarrassment they very much intended to cause us by revealing a synopsis of that study and helpfully offering to email it to us. Not wishing to appear uneducated cretins we say “Yes, please do email it to me, as I was very interested in that study.” They might say “My, you’re an upcoming young ophthalmologist aren’t you? Really tip top. How would you like to talk at one of our evening meetings? All your colleagues are coming and you would be talking and they would all be listening to you because you really are great. What’s that? No time to prepare slides! Well we know you are way too busy to make your own presentation, obviously you are one of the best so we would expect nothing less, so use our humble slide pack. You would obviously be paid an ‘ahem’ honorarium as a token of our appreciation.” Pseudo-humility might result in a few ‘nah stop it’ moments, but persistence pays and an agreement to present is a common result. Perhaps the aftermath is like that scene at the end of The Devil’s Advocate as the rep then turns to the audience after the ophthalmologist departs, breaking the fourth wall, announcing “Pride, definitely my favourite sin,” before grinning broadly.

Obviously, not all reps are like this. In fact, most are not like that. Very many are genuinely friendly and kind people, who are genuinely interested in the progress of your loft conversion and with whom you would enjoy a quiet pint after work. But they have a job to do and it is very difficult to know where the boundaries are. I know of instances where registrars have set up special teaching sessions and courses funded by a friendly eye drop rep encouraged by the ‘educational commitment’ of their company, who have then been asked to prescribe their medication in a quid pro quo. After a change in departmental drug policy a local drug rep grumbled to the nursing staff about all the sandwiches he had brought in and all the meals he took staff out for over the years, and how now that was all a waste. Never mind the millions of pounds his company had made from us. A glaucoma colleague tells a story of how he was accosted in Boots at the large teaching hospital by a very smartly groomed young glaucoma drop representative who blocked his access to the drinks fridge, looked him straight in the eye and said the immortal words “Glaucoma is a real disease you know. Take it seriously. Pressure control is important.”

On the other hand I have known reps to go out of their way to help me with a project knowing full well that I was working in a subspecialty which had nothing to do with their product. I have known drug reps to be generous decent people who don’t mention their product once. I have met reps that give their own time willingly and who are likeable genuine people. The point is that it is difficult to know for sure. The lines are blurred. There is no such thing as a free lunch. Even departmental sandwiches have a price. Everything has a price. We like to think that we are mature enough to know we are being played, but I have been caught out myself and many people reading this will perhaps admit that they have too. There is a sort of spectrum ranging from eating a cheese sandwich brought in by a drug rep that was just lying there, to flying abroad to a posh foreign city to give a talk to a large audience at an industry sponsored event about the excellence of that product in an advertising campaign poorly designed as a scientific presentation. Where is the point of unacceptability? Know your limits, and be careful. Be wary of those reps with studies and check all the p values. If you don’t trust yourself then best avoid all those situations; if you think any situation is a bridge too far don’t expose yourself for all the tea in China, or all the pre-loaded syringes on earth.

 

The views expressed are those of the author and do not represent those of the editorial team or the publisher.

 

 

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CONTRIBUTOR
Gwyn Samuel Williams

Singleton Hospital, Swansea, UK.

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