Dr. Drug Rep

Dr. Daniel Carlat – “Dr. Drug Rep”. Just in case you’re wondering the author, Dr. Carlat, is not some indignant crank. Asides from the Carlat Psychiatry Blog, he writes the Carlat Psychiatry Report (a peer-reviewed print publication). The print version is unbiased, the blog version, as he readily states is “very biased.”

He wrote a piece for the New York Times Magazine, in November 2007, entitled “Dr. Drug Rep”. In it he detailed his own experiences as a Continuing Medical Educator and how he found the ethical conflicts too much to bear. I highly recommend reading “Dr. Drug Rep” if you have any doubts about the ethical quandaries involved in any dealings with Big Pharma.

I’ve had it. As of today, I am no longer allowing drug reps into my office.

Yes, until today, I was seeing reps a few times a month for 5 minute visits in order to keep up on trends in drug company marketing techniques. But today, an Astra Zeneca rep and his district manager came in to push Seroquel for bipolar depression. They came armed with the two studies that won Seroquel its FDA approval. The studies have their limitations, but somehow these reps didn’t bring these up.

Instead, what I got was a ridiculous hard sell: “Dr. Carlat, given this data, would you choose Seroquel over the other atypical antipsychotics for bipolar depression?” I asked them if Astra Zeneca had done any head-to-head studies comparing Seroquel with the others. The rep adopted a pseudo-confused look, and said, “I’m not even sure that kind of study would be ethical–would the FDA even allow you to compare an approved drug with an unapproved drug?” I pointed out that the FDA, in fact, requires that drugs be compared with placebo, the ultimate in “unapproved” drugs, and that they deem this ethical enough.

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Kalea Chapman, Psy.D.


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Clinical Psychologist practicing in the Los Feliz neighborhood of Los Angeles, California.

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