Adriane Fugh-Berman - what a woman!

Adriane Fugh-Berman wants to imbue the next generation of doctors with a healthy dose of skepticism toward pharmaceutical companies' marketing tactics. So Fugh-Berman, associate professor of physiology and biophysics at Georgetown University, has spent the last six months lecturing medical students at Georgetown and neighboring schools on the various tools drug salespeople use to get doctors to prescribe their products—from bringing lunch for the office staff to dropping off free samples of new products.

At first, the students are belligerent. "They say: 'I'm too smart to be bought by a slice of pizza,'" Fugh-Berman says.

She counters with a litany of statistics: A doctor who spends just one minute with a drug rep ends up prescribing 16% more of the medicine the rep is selling. A four-minute encounter prompts a 52% jump in prescriptions. At the end of her talk, Fugh-Berman gives the students a quiz, partly to gauge whether their attitudes have changed. "In the margins, they write stuff like 'No more drug reps!'" she reports.

Programs such as Fugh-Berman's are rolling out at medical and nursing schools across the country, funded by $21 million in grants from a consortium of state attorneys general. The money came out of a $430 million settlement that Pfizer (PFE) reached with state and federal legislators in 2004 over allegations that its Warner-Lambert division had improperly marketed the epilepsy drug Neurontin for uses not approved by the Food & Drug Administration.

More than 30 educators won grants to develop for-credit courses, role-playing exercises, and other educational programs designed to arm future prescribers with the ability to counteract drug company sales pitches. To give the students a realistic depiction of the drug industry, many educators incorporate actual drug reps into their programs.

Fugh-Berman's Web site, pharmedout.org, posts seven YouTube videos of former and current salespeople confessing to bad behavior. In one, a rep says that his strategy for using free samples is much the same as what "your typical street dealer employs on the corner when he's selling crack. The first one's free, then you pay, then you're hooked." The rep, who appears in shadow to conceal his identity, goes on to explain how easy it is to coax doctors to write prescriptions for new drugs in return for a handful of free samples.

Grant recipient Elissa Ladd features several former drug reps in four online documentaries she posted on her site, perxinfo.org. The films are part of a larger curriculum designed for advanced-practice nurses, who are licensed to prescribe drugs. When nurses see the confessionals, "they're often surprised," says Ladd, clinical assistant professor at the Massachusetts General Hospital Institute of Health Professions. There are 150,000 nurses licensed to prescribe drugs in this country, she says, but they receive virtually no training on dealing with drug company marketing practices.

Many of the new marketing-focused educational programs are designed as counterweights to the drug industry's strong presence in medical education. Guest speakers who appear in "grand rounds"—lecture series that residents and other medical trainees must attend—are often sponsored by drug companies. And the industry pays for most of the continuing medical education courses that doctors take throughout their careers. Critics say the companies influence the content of those courses to suit their marketing goals. That's why most courses funded via the Neurontin settlement don't allow for pharmaceutical companies to speak up in their own defense or to provide any other type of input. "The drug companies have dominated our culture," Ladd says. "Our goal is to change that."

A handful of grantees are placing future doctors in simulated sales scenarios. Richard Pinckney, assistant professor of medicine at the University of Vermont, runs a workshop in which an actress playing a sales rep makes a pitch to a crowd of med students. At the end, Pinckney deconstructs the pitch, pointing out common pitfalls that doctors can fall into. "Often the rep refers to an expert who she says used the product and liked it," Pinckney says. "I explain how the use of expert opinions can be swayed by the company." At the Mount Sinai School of Medicine in New York, med students spar one-on-one with an actress playing a patient. After complaining of heartburn, the actress whips out an ad for Nexium that she says she found at her hairdresser's salon. "I think this is the drug for me," she declares, reciting the ad's promise that the drug controls acid better than any other branded product. The students, armed with studies showing the drug is no better than cheaper over-the-counter alternatives, try to persuade the faux patient to try something else.

Lauren Peccoralo, a third-year resident at Mount Sinai, found the exercise invaluable. "This happens a lot with patients, where they bring in these ads," she says. "It's important for us to practice how to convince patients that they should trust what the doctor is recommending instead." With such programs now in full swing, it's clear the nation's drug reps will soon find themselves face-to-face with a whole new generation of skeptical doctors.

BusinessWeek