Erin Marie Daly-26Researching and writing about drug addiction and personal loss sounds not only challenging, but very depressing. What kept you going as you were developing the book?

Guilt. When my brother died, I was shell-shocked. I felt a strong sense that I had failed him. Pat was 10 years younger than me, and our dad was sick with cancer for most of Pat’s life (he died when I was 19 and Pat was nine), so I spent a lot of time babysitting Pat when we were younger, and there was a maternal aspect to our relationship. But I also tried to foster openness and honesty between us, which is why I didn’t understand the secrecy of his addiction. Hiding is a part of addiction; no one wants those who love them to know the depths of their darkness. I didn’t know that at the time, so I felt that Pat was either making stupid choices or actively trying to hurt me—sometimes both. And because of that misperception, I was angry with him. I had no experience with addiction and I certainly didn’t know about the link between painkillers and heroin. I ended up saying things to him like “just stop doing drugs,” as if it were something he was doing for fun. He wasn’t. His downfall was hard and fast, and shocking in the context of our family. Of course we’d had tragedy with the loss of our dad, we weren’t perfect, but we loved each other and lived in a great community where this type of thing didn’t happen.

Generation RX_FINALJust Let Me Forget

 Luke tells me it is the rush that draws you in. It makes you forget the darkness.

He flicks a lighter under a spoonful of syrupy brown liquid and says he is ready to die. Fumes rise from the potion, filling the room with the scent of vinegar. It is sickly and sweet at the same time.

We are sitting side by side, Luke and I, on his unmade bed in a sober living house in San Juan Capistrano, a seaside town in southern California where I am reporting a story on the epidemic of pill and heroin abuse. We have just met, but he lets me in, lets me close to the poison that has taken over his life since he became hooked on prescription painkillers eleven years ago, at age fourteen. And he’s right: there is a rush. There is something exhilarating about the poison in his hands, just in its presence, the way that it swirls and bubbles in the spoon. I wonder about the strange seduction of these little bits of crystallized black tar swimming around in circles. I wonder what my brother felt like as he stared down at them three years ago.

How do pharmaceutical reps make their money and what exactly do physicians/quasi-physician-psychiatrists get out of it? The answer is both exactly what you think and something entirely different, something bordering on perversion.

First, I’ll show you the money. Here’s how pharmaceutical reps earn their livings: “Every company determines their own method of how to assess growth and this can change every 6 months -– so don’t get too comfortable! For example, some pharmaceutical sales companies track the # of new scripts coming in and your goal will be set in reference to that measure. Other companies may determine bonus by measuring the total # of scripts.” That’s from a pharmaceutical rep “education” company inventively called Pharmaceutical-Rep.com.

But how to do reps make the sell? Logos…lots and lots of logos. According to the Markkula Center for Applied Ethics (apparently no one informed Santa Clara University that applied ethics long ago died in the business world, if they ever existed), “Many prescribers receive pens, notepads, and coffee mugs, all items kept close at hand, ensuring that a targeted drug’s name stays uppermost in a physician’s subconscious mind. High prescribers receive higher-end presents, for example, silk ties or golf bags… This kind of advertising is crucial to sales. A doctor is not going to prescribe something he or she has never heard of, and it’s the drug representative’s job to get the products’ names in front of the physicians… It’s a way to get in the door so that your information rather than somebody else’s reaches the doctor’s brain.”

If that’s not insidious enough, here’s more from PLoS Medicine’s Following the Script: How Drug Reps Make Friends and Influence Doctors, which begins with a quote from one of its authors, Shahram Ahari, an ex-drug rep: “It’s my job to figure out what a physician’s price is. For some it’s dinner at the finest restaurants, for others it’s enough convincing data to let them prescribe confidently and for others it’s my attention and friendship…but at the most basic level, everything is for sale and everything is an exchange.”

Ahari and co-author Adriane Fugh-Berman expand upon this process: “Reps may be genuinely friendly, but they are not genuine friends. Drug reps are selected for their presentability and outgoing natures, and are trained to be observant, personable, and helpful. They are also trained to assess physicians’ personalities, practice styles, and preferences, and to relay this information back to the company. Personal information may be more important than prescribing preferences. Reps ask for and remember details about a physician’s family life, professional interests, and recreational pursuits. A photo on a desk presents an opportunity to inquire about family members and memorize whatever tidbits are offered (including names, birthdays, and interests); these are usually typed into a database after the encounter. Reps scour a doctor’s office for objects — a tennis racquet, Russian novels, seventies rock music, fashion magazines, travel mementos, or cultural or religious symbols — that can be used to establish a personal connection with the doctor” [my italics].

From all of this, I can only conclude that physicians/quasi-physician-psychiatrists are amongst the loneliest people on earth. I’ve often entered a quasi-physician-psychiatrist’s office just as a drug rep leaves. Couldn’t the “doctor” have spent that time calling his wife? Alternatively, couldn’t she have read a monthly journal describing immediately-available new psychotropic drugs and their uses and side effects? Wouldn’t that take less time and at least approach professionalism? As it stands, the wise patient will reference prescribing information online, since it’s almost never provided prior to The Writing of the Scripts. Why a psychiatrist is paid at all remains a mystery. A better job title and one deserving minimum wage: “Treadmill Technician.”

I suppose if I asked physicians/quasi-physician-psychiatrists why they spend so much time with pharmaceutical reps, they might respond, “Thanks to insurance costs, I can’t afford pens, Post-It notes and coffee cups; I need those things, goddamn it.” Next, they’d stalk out of the office and weep upon the steering wheels of their BMWs, then call the kinds of prostitutes who don’t visit offices with suitcases full of samples and logoized potpourri.