"Where is Dr Schmidt in terms of Festril prescribing?"

"He's at 2 per cent."

"Why isn't he on board yet?"

"He likes to wait at least one year before prescribing any new drugs. It's a safety issue and he likes to reserve quinolones for compromised patients."

"What kind of idiot would reserve the most effective drug on the market?"

This exchange between a pharmaceutical rep and his manager is fiction, as is the drug Festril. It comes in the first part of a low-budget, independent US film Side Effects, of which I recently watched a preview copy. Its screenwriter, Kathleen Slattery-Moschkau, worked as a pharmaceutical representative before quitting for the film industry; as she says, she used to "be a drug dealer- but legal ones".

And it's all fiction, right? Actually, no. This is the drill. You sit, the rep sits. Reps look good: the women are glossy and lovely, the men smart and charming. The rep brings out a dozen leaflets, unclicks a pen, smiles winningly and offers me a bar of chocolate they have just "found" in their bag. How is life, have I been on holiday, don't I have a baby? Oh, but you look great on it! So slim! (a clear lie) and oooh! Are those Jimmy Choos?

I'm not flattered often. But believe me, this is sunshine: someone is sitting in my office, someone who wants to be nice to me, someone who is giving me chocolate. This isn't what one expects as a doctor. Since graduation I have been told by my searingly honest patients that: 1) I look "washed out" and 2) if I continue to dye my hair, I would "definitely end up divorced".

The leaflet or clipboard is casually revealed, I am told why this latest drug is fantastic, with fewer side effects or more compliance or whatever; and they ask - seeing as how I am either asking picky questions or visibly bored - whether I would like anything from the briefcase: a Biro perhaps, or some Post-it notes?

I gave up seeing reps several years ago and signed the 'No Free Lunch' pledge, which says that pharmaceutical promotion should not lead clinical practice. Besides other things, seeing reps just got too nauseatingly embarrassing. But it wasn't just the blushingly awful exchange of boxes of tissues for my time (common gifts, come hay fever season.) It was also that I binned the bits of shiny paper containing the select statistics as soon as the rep exited.

The president of the Association of the British Pharmaceutical Industry was quoted in The Times in June this year:

"At times, the conservatism of British doctors borders on Luddism," Vincent Lawton said. He added that rules were needed to force doctors to prescribe new treatments at the earliest opportunity. "There should be an obligation for GPs to take up new drugs as soon as they are approved. Doctors' rewards should be linked to their prescription record."

The pharmaceutical industry is a valuable one - the third most profitable UK industry. But do we really need reps to tell us about the latest and best - after all, most doctors read journals and newspapers? Doctors, and patients, are not just there to hold the pharmaceutical industry up. If we need drugs, we need them because they are good - not because they are new.

If I write a prescription for a "new" drug, my patients need confidence that I'm doing it with good evidence to back it up, and not because a charming man raised a groomed eyebrow at the vision of my new shoes.

And I can see that reps dealing with technical equipment - such as an anaesthetic machine - where the staff may want a chance to handle it, might be useful. But reps to promote one anti-depressant or anti-inflammatory over another? Give me a break.

The NHS is, in the end, paying for my dose of flattery, and it can't afford to. In the US, there is a rep for every five doctors. Either doctors are spending too much time seeing reps rather than patients, or reps are hanging around with nothing much to do. Doctors don't want to admit that they are influenced by reps: it's called denial. Meantime, as Slattery-Moschkau depicts, drug reps remain charming and highly qualified and, in the UK, are often highly qualified, with a science degree or nursing experience behind them. In the nicest sense, they are wasted in the job for there are far more useful things they could be doing.

Imagine. If there were no reps, drugs would be used for reasons other than sales pressure. Patients could have confidence in the prescriptions they were given and pharmaceutical companies could use the skills of their reps in properly research-driven, pioneering ways. Where I get my flattery from, though, is something I'll have to work on.

Margaret McCartney is a GP in Glasgow. margaret.mccartney@ftnetwork.com

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