US pharma sales reps have

The California Health Care Foundation, a non-profit organization which studies health care and drug-related issues, has reported that pharmaceutical sales representatives are increasingly rejected by physicians. The trend is linked to the adoption by the drug industry of guidelines which limit the distribution of gifts to physicians.

Eric Challgren, a dermatologist based in North Carolina, USA, told the Raleigh News & Observer newspaper that doctors are less likely to receive drug firm salesmen, as they no longer "have that carrot to dangle."