Over the years I’ve written all sorts of blog posts on dishonesty, and because the new book release, I want to repost an updated version of them to accompany. For the next few days I’ll post one every other day. Enjoy!

Janet Schwartz of Tulane University and I once spent an evening with a few former pharmaceutical reps, men who used to be in the business of selling a wide range of drugs to treat all kinds of diseases and conditions, from fibromyalgia to depression to restless leg syndrome. As drug representatives, they would go from doctor to doctor attempting to convince physicians to prescribe their company’s drugs. How? Typically they would start by passing on informative pamphlets and giving out products like pens, clipboards, and notepads advertising their drugs.

But we knew there was more to the story, so we tried the pharmaceutical reps at their own game – we took them to a nice dinner and kept the wine flowing. Once we got them a bit sauced, they were ready to tell all. And what we learned was fairly shocking.

Picture these guys: attractive, charming young men. Not the kind of guys who would have trouble finding a date. One of them told us a story about how he was once trying to persuade a reluctant female physician to attend a seminar about a medication he was promoting. After a bit of persuading, she finally decided to attend – but only after he agreed to escort her to a ballroom dancing class. This, according to our new friends, was a typical kind of quid pro quo where the rep does a personal favor for the doctor and the doctor promotes the rep’s product in return.

Another common practice was to bring meals to the doctor’s office (one of the perks of being a receptionist), and one office even required alternating days of steak or lobster for lunch in exchange for access to the (well-fed) doctors.

Even more shocking was that when the reps were in the physician’s office, they were sometimes called into the examination room (as “experts”) to inform the patients about the drug directly. And the device reps experienced a surprisingly intimate level of involvement in patient care, often selling medical devices in the operating room, while the surgery was going on.

Aside from learning about their profession, we also realized how well these pharmaceutical reps understood classic psychological persuasion strategies, and how they employed them in a sophisticated and intuitive manner. One clever tactic they used was to hire physicians to give a brief lecture to other physicians about a drug. Now, they really didn’t care what the audience took from the lecture, but were actually interested in what the act of giving the lecture did to the speaker himself. They found that after giving a short lecture about the benefits of a drug, the speaker would begin to believe his own words and soon prescribe accordingly. Psychological studies show that people quickly start believing whatever comes out of their own mouths, even when they are paid to say it. This is a clear case of cognitive dissonance at play; doctors reason that if they are touting this drug, they must believe in it themselves — and so their beliefs alter to align with their speech.

The reps employed other tricks like switching on and off various accents, personalities, political affiliations, and basically served as persuasion machines (they may have mentioned the word “chameleon”). They were great at putting doctors at ease, relating to them as similar working people who go deep-sea fishing or play baseball together. They used these shared experiences to develop an understanding that the physicians write prescriptions for their “friends.”  The physicians, of course, did not think that they were compromising their values when they were out shooting the breeze with the drug reps.

I was recently at a conference for the American Medical Association, where I gave a lecture about conflicts of interest.  Interestingly, the lecture just before me was by a representative from a device company that created brain implants.  In his lecture he made the case for selling devices in the operating room because doctors could need help learning how to use the device. And in order to fight conflicts of interest, the company no longer takes physicians to Hawaii for their annual conferences — and instead they have their conference in Wisconsin.

So, what do we do?  First, we must realize that doctors have conflicts of interest.  With this understanding we need to place barriers that prevent this kind of schmoozing, and to keep reps from undue access to physicians or patients. They, of course, have the right to send doctors information, but their interactions should stop there.

I have one more idea: What if we only allow people to be drug reps if they are over 75 and unattractive? Not only would these individuals have more personal experience with the healthcare system, it also could reduce conflicts of interest and open up job opportunities to an undervalued population.