A former pharma rep explains how the industry pushes doctors to overprescribe

The pharma industry spends $2 on marketing for every $1 it spends on R&D: Shahram Ahari was a rep for Eli Lilly, so he knows how the money was spent: in a tell-all op-ed in the Washington Post, Ahari describes how he lavished spending over doctors, everything from dinners at "so many fancy Manhattan restaurants that the maitre ds greeted me by name" to free ballgames and Broadway musical tickets to offering hundreds of thousands of dollars in speaking fees to top prescribers.

What's more, Ahari was able to access expensively assembled prescribing data -- purchased from pharmacies across the country -- to both identify doctors with a lot of chronic pain patients (or those who were "freer with their prescription pads") and to give him ammo for "guilt tripping" doctors who had taken freebies from him but hadn't rewarded him by writing a ton of prescriptions for his employers' drugs.

In the years since Ahari left the industry (he's an MD now), it has adopted modest restrictions on how its reps deal with doctors, but as Ahari points out, any amount of freebies (or even plain sales calls) leads to increased prescribing. In part, that's down to the powerful arsenal of manipulation techniques that the salesforce is schooled in, including flat-out lying about the research on their products' efficacy and safety (this was endemic among opioid marketers like the Sackler family's Purdue Pharma, makers of Oxycontin).

An unspoken bedrock principle guided my actions when I was in the pharmaceutical industry: It was not enough to grow our market share we had to grow the market, too.