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Do you know who your doctor's 'friends' are?

They remember spouses' birthdays, scan offices for personal details and gather information about a doctor's hobbies. And they may be influencing the way doctors choose to prescribe drugs.

Pharmaceutical salespeople use carefully honed psychological techniques in their efforts to sell more pills by wooing doctors, according to a paper co-authored by an ex-U.S. drug representative and a physician.

The paper, Following the Script: How Drug Reps Make Friends and Influence Doctors, was released today by the Public Library of Science's online journal PLoS Medicine. It exposes such strategies as scouring the doctor's office for novels, sports equipment and even religious symbols. The reps use these cues to "establish a personal connection."

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"Most doctors think themselves immune to such influences. This is an illusion," writes Shahram Ahari.Mr. Ahari was a U.S. drug representative for international pharmaceutical giant Eli Lilly and Co. "It's my job to figure out what a physician's price is."

In Canada, while wooing strategies may be similar, a self-regulating arm of the pharmaceutical industry has taken steps to curtail freebies and is planning to strengthen regulations further. Still, pharmaceutical salespeople continue to knock on Canadian doctors' doors: a 2005 survey showed that 20 per cent of family doctors had seen a pharmaceutical representative within the last week.

In their study, Mr. Ahari and Adriane Fugh-Berman, an associate professor at Georgetown University who researches the pharmaceutical industry, outline six doctor types - ranging from friendly to aloof - and the specific strategies that drug representatives use to attempt to woo each.

Humility, for example, can work in the offices of skeptical doctors who demand evidence-based medicine. "I play dumb and have the doc explain the significance of my article," Mr. Ahari says.

Other techniques include "just being friends with most of my docs," Mr. Ahari said. "When the time is ripe, I lean on my 'friendship' to leverage more patients to my drug.' "

Representatives woo doctors because they know they can "create a subconscious obligation to reciprocate," Mr. Ahari wrote. "The highest prescribers are every rep's sugar mommies and daddies."

Experts say the risk for consumers is that physicians will be influenced to prescribe medicines too often. They may also choose newer, more expensive drugs over older drugs with track records.

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"The drugs that are promoted the most heavily are the newest ones," says Joel Lexchin, a professor of health policy at York University who has studied pharmaceutical policy for 25 years.

While new drugs tend to be the most profitable for their makers, they are often less well-studied than older ones. Some blockbuster and highly promoted medicines, such as the pain-reliever Vioxx, are only found to have dangerous side effects years after they go to market. "One of the things we know about new drugs is we really don't know an awful lot about their safety," Dr. Lexchin says.

Canada's pharmaceutical industry generated $17.8-billion in sales last year and spent an estimated $2.67-billion - 15 per cent - on promotions, Dr. Lexchin says.

The Canadian Medical Association has 38 guidelines specifying what doctors may or may not accept from drug companies. The code is not binding, however, and the CMA has no way to enforce the rules.

Canada's pharmaceutical industry tries to police itself using guidelines introduced in 2005. These curtailed the freebies that drug companies doled out in the past, such as lavish dinners, computers and exotic excursions. Goodies such as free bags and rounds of golf were all banned, according to Canada's Research-based Pharmaceutical Companies, a national Rx & D association that represents 54 drug manufacturers.

"No gifts, period," says Greg Fergus, director of industry practices.

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Next month, the association plans to make the rules even stricter by revising the guidelines to enforce a ban on drug representatives and doctors showing up at a golf course together - even if the doctor pays his or her own green fee.

"We don't even want to see you playing golf," Mr. Fergus says. "It's the perception."

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