Confessions of a drug rep

A forthcoming movie claims to spill the beans on Big Pharma. Jeanne Lenzer reports

Think big. Think money. Think drugs. And then think of all the sly, silly, ethically impaired things that people will do to sell drugs, and you'll have a taste of Kathleen Slattery-Moschkau's film, Side Effects.

Side Effects: only pawns?

Slattery-Moschkau (pronounced Mos-cow, "like the city") sold drugs for a living for Bristol-Myers Squibb and Johnson & Johnson, until she found it increasingly difficult to "look myself in the mirror," and left her job after 10 years in the industry.

An aspiring screenwriter since her college years, Slattery-Moschkau, wrote, directed, and produced Side Effects, a satirical film about the dilemma of Karly Hert (Katherine Heigl), a drug representative torn between her conscience and some really good perks. Hert's company plans to roll out "the biggest drug launch of the 21st century" for its new antidepressant, Vivexx, which they enthusiastically promote as "absolutely the most efficacious drug your patients can use!" while cheerfully predicting that "Vivexx will make Prozac look like penny candy."

Hert, who suffers pangs of conscience about some of the promotional techniques encouraged by her managers, launches a campaign of her own - to tell doctors the truth about drug side effects. She's surprised when her honesty pays off - with increased sales. With increased sales comes a meteoric rise on the corporate ladder, making her even more beholden to her company - a company that is hiding some dirty secrets about Vivexx.

Enter Hert's new boyfriend, Zach Danner (Lucian McAfee), a former drug representative who challenges Hert about her values. When corporate shenanigans turn ugly, the action goes from amusing to savagely funny.

In one scene, likely to resonate with doctors who are frequently presented with wildly conflicting information about drugs, a manager grills one of his drug reps during a group meeting:

"Where is Dr Schmidt in terms of Festril prescriptions?"

"He's at 2%."

"Why isn't he on board yet?"

"He likes to wait at least one year before prescribing any new drugs. It's a safety issue and he likes to reserve quinolones for compromised patients."

"What kind of idiot would reserve the most effective drug on the market? What's his reason?"

"Well, because last year, you know, when we didn't have our own quinolones to sell, we were calling him an idiot for using such a big gun when it wasn't absolutely necessary."

"Oh, it looks like you did your job a little too well last year. Have you invited him out to corporate yet?"

"No, but . . . "

"OK. I want him flown out to corporate. Also make sure he is signed up for the upcoming webcast with Dr Sing. I want you in his office twice a week for the next three. Got it?"

Slattery-Moschkau told the BMJ that when sales reps went into doctors offices, they were "armed and dangerous" with prescribing information on each doctor. "They know what percentage of Prozac or Paxil a doctor prescribes," she said. "The doctor often doesn't know this and it gives [reps] an incredible advantage over the doctor."

When doctors do find out that every single drug they prescribe has been tracked and sold "for millions of dollars" to drug companies, they can "go ballistic," said one drug company insider who asked to remain anonymous. Telling a doctor about the existence of these prescription tracking lists, he said, was "not a good career move."

"This story is actually my story," said Slattery-Moschkau, adding that the tactics employed by the industry in its "dangerous pursuit" of profits sometimes came "at the expense of patients' lives."

One widespread corporate tactic is hiring reps who are undeniably alluring and always charming. And when it comes to experience, sales, rather than science, is the hands-down winner. Slattery-Moschkau, like her alter ego Hert, was stunned when she found that her experience selling cellphones and her political science degree from the University of Wisconsin-Madison were all she needed to get started in an exciting career of "educating doctors." Her science background? A course in geology.

Slattery-Moschkau: industry tactics sometimes came "at the expense of patients' lives"

Jeff Trewhitt, spokesperson for the Pharmaceutical Research and Manufacturers of America, was quoted in USA Today on 15 March saying that Slattery-Moschkau's film "really does sound like fiction considering that all sales representatives undergo extensive technical training and are prepared to answer questions about new medicines and their characteristics." Mr Trewhitt also said that drug companies often hired nurses and pharmacists for their sales force, according to the article.

But Slattery-Moschkau told the BMJ, "Most of the people I worked with majored in history or drama or music." She added, "Drug reps are pawns. They are encouraged to believe they are doing the right thing. But there are clues and when it gets a little dangerous, it's made clear to them that you toe the line."

The rewards for "toeing the line" can be substantial. Slattery-Moschkau was pulling in $100 000 annually when she left her job, her company car, and expense account behind.

Side Effects premiered at the Cinequest Film festival in San Jose, California, in March, and Slattery-Moschkau expects the film to be in cinemas by early summer.

She decided to produce the film herself after a Hollywood agent wanted to "water down" the script to be more appealing to the studios. So she raised $190 000 (£53 000; €77 000) and shot the film over 18 days last summer.

Since the film's debut, the writer has been contacted by other drug representatives whose response, she said, had largely been, "Amen, sister."