“I’m in contact with some drug company to fund my upcoming event so naturally I thought of you,” read the text that popped up on my phone, accompanied by the face palm emoji. It was from my sister, a registered nurse who works on a neonatal intensive care unit.
I instantly called her back and when she picked up, spluttered, “But you read the book!” Having been my faithful clinical editor, she laughed, “It’s just like Chapter 3! I knew you’d be mad.”
When she began explaining the details, her story mirrored so many that nurses had shared during interviews I conducted about their interactions with pharmaceutical and medical device representatives in the hospital. The nurses I interviewed strove to provide the highest quality nursing care to patients and their families. In doing so, they encountered sales representatives who readily offered to help. Appearing as the “perfect friend,” sales reps made highly calculated overtures of support with the aim of securing nurses as allies to promote their products behind the scenes.
My sister’s unit hosts an annual tea to celebrate its “graduates” – children and their families that have been discharged from the NICU. She stepped up and volunteered to organise this year’s event, which meant a chance to demonstrate leadership, but also a big task to accomplish with limited resources, which she would largely accomplish in her own time. Her manager gave her a business card with instructions: “This guy provides the cake and will pay for all the catering, all you have to do is submit the bill to him.” She didn’t give it a second thought until after the cake had been arranged and the ‘guy’ offered to meet for coffee to make sure everything was in order. My sister gave his name a quick Google and found that he was a sales representative for AbbVie, which markets a vaccine for respiratory syncytial virus (RSV), a disease that can be life-threatening in premature babies.
The problem is that this vaccine costs about $7000 per baby in Canada, where my sister practices, and provincial health authorities have had to make tough decisions about who can receive the vaccine. AbbVie actively promotes the drug through patient education campaigns, and providing assistance with administrative paperwork, grants to hospitals for events, and research grants to some physicians also involved in deciding who receives the drug.
With only two weeks until the event, my sister didn’t have time to seek other funding. Besides, as the newcomer to the organising committee she didn’t feel she could criticize the way things had always been done. When I asked if she would accept the coffee invitation, she replied, “Of course! I need to keep him happy so he will fund us next year!”
Her story is just another example of the ways that sales reps are infiltrating healthcare by partnering with nurses. In the name of education or patient support, sales reps provide nurses with personal gifts and resources for patient care, building relationships and becoming indispensable. In return, sales reps are granted a foot in the door and access to clinical spaces where they can deliver their messages to the nurses, physicians, patients and other decision makers that determine the success of their products. They are also granted a seat at the table – in this case, part of the healthcare team that comes to celebrate families’ journey through the NICU.
I wrote Infiltrating Healthcare to bring such stories to the public view. Nurses are so often working overtime and paying out of pocket to deliver the high standard of care for which they are known and trusted. In doing so, they are often turning to sales representatives who offer a helping, and sometimes the only, hand. The problem is that medically-related industry will only do so when it makes business sense, meaning that these kinds of resources are not distributed equitably. Too often it also means that hospitals, payers, and ultimately, the public, is footing the bill and shouldering the consequences for products that may be unsafe, ineffective or unnecessary.
Quinn Grundy is the author of Infiltrating Healthcare: How Marketing Works Underground to Influence Nurses