What Would Happen If It All Just Stopped Today?

Interesting question. I think the answer ten years ago would have been very different. In the last decade, the presence, positive or negative, of the pharmaceutical industry has diminished in many areas in the practice of medicine - day to day drop-ins, samples, gifts, meals, CME support, etc. There is still a presence, of course, but not the omnipresence of yesterday. A sudden disappearance of detailing and all that goes with it in 2000 would have seemed very dramatic; today, much less so.

In my office, there are several reps I would miss just because I like them on a personal level; but are there any whose disappearance would (at least subjectively) negatively affect my professional practice of medicine? Maybe five to ten. I'm thinking mainly of reps who carry products that are truly uniquely valuable to me AND have proven to be excellent resources in obtaining meds for indigent/underinsured patients. There are also reps who over time (years, not months) have been committed to bringing the type of patient oriented outcome information I seek. (I also suspect that these reps I value the most would be told by management/corporate that they are not doing their job correctly since they respect my time, speak off script, don't use viz-aids, etc.)

I am extrapolating from your general question, but you could speculate that there would be a more insidious detrimental effect over time in some types of of practices. Specifically, doctors who practice independently, outside of hospitals, and/or in remote areas often work in a functional vacuum and are rarely challenged to re-think what they do or learn about new interventions. The constant circulation of reps potentially provides a service to these doctors and their patients. I don't know how to prove that, but it's possible.

However, in a nutshell:
-The doctors who were hooked on expensive gifts and extravagant meals already had to give those up for the most part;

-The doctors who depended on Big Pharma to support CME at lavish resorts are now out of luck;

-A significant number of offices (including mine) do not routinely stock samples, and hospitals and academic centers across the country have institutionalized "no sample" policies, thus reflecting the decreasing value of samples to us;

-Residents are being trained that information from the pharmaceutical industry carries a high risk of being tainted by fallacies of logic and invalid data;

-Most importantly, as discussed recently in other threads, rather than revolutionize the paradigm of how reps are utilized in response to these changes, the companies continue to ask reps to try to do the same old thing in an environment that has become more and more restrictive for them. On the whole, samples, meals, and the information provided in a detail are not valued by doctors the way they once were.

Therefore, my summation would be that we can still cite specific examples of how pharmaceutical reps can be helpful and/or would be missed in the daily practice of medicine, but they are becoming the exception, not the rule, in 2010.