Elliot begins by defining the concept of ‘detailing’ doctors, and acknowledges how the pharmaceutical sales force in America doubled from 1996-2001. Since the first theoretical ‘duty’ of doctors is, according to Elliot, to their patients, the question arises as to whether or not the conventional role of doctors will be maintained in an increasingly market-based medical system.
Detail men attempt to establish relationships with doctors in order to create a sense of indebtedness, so a sense of duty becomes felt in the latter towards the former. After all, studies do indicate that doctors who receive gifts from companies typically either prescribe that company’s drugs or at least add them to their stock. Elliot also mentions the 1992 Prescription Drug User Fee Act that consequently enabled the drug industry to be one of the major funders for the FDA, an agency designed with the purpose of regulating that very industry. Pharmaceutical companies have consequently become focused upon developing blockbuster drugs for chronic illnesses discoverable in large populations.
Two further changes contributing to the marketization of the medical system are the technology of script tracking, whereby hospitals and pharmacies sell prescription related information to pharmaceutical companies, and an increased investment of pharmaceutical companies on continuing education events led by doctors. Elliot suggests that the traditional idealism of medical professionals will perhaps fade away due to the harsh realities of a market-driven health-care bureaucracy, and health care may inevitably not be sought after from medical professionals such as doctors.