Washington ? Weary of their incessant visits often more than 10 a day doctors are starting to give drug salesmen the brush-off.

Doctors, hospitals and state officials are imposing new restrictions on pharmaceutical sales representatives out of concerns about the drug industry’s questionable marketing practices, rising prescription drug costs and the growing army of salesmen knocking at their doors.

The number of drug sales reps has grown from nearly 42,000 in 1996 to almost 88,000 last year.

The pharmaceutical industry last year spent more than $16 billion persuading doctors to prescribe their products. Nearly $10.5 billion went for free samples of many drugs that were widely advertised to consumers. The larger goal is to ward off generic competition and to maximize sales of drugs protected by patents.

Because drug promotions can influence a doctor’s prescribing habits, health-care managers are betting that less contact with marketers will prompt more physicians to prescribe cheaper generic drugs that are therapeutically equivalent to brand-name medications.

This alone could dramatically cut prescription drug spending, which is projected to reach $161 billion this year. Drug spending, which jumped an estimated 16 percent in 2001 and is projected to grow 13.5 percent this year, is one of the major factors behind the nation’s spiraling health-care costs.

Minimizing contact

Among the efforts to reduce drug reps’ contact with doctors:

l Physicians Access, a Cincinnati medical practice, began charging drug companies $65 for a 10-minute meeting with its doctors last year. And Time Concepts, a northern Kentucky firm, has signed up 800 physicians nationwide who’ve agreed to charge drug companies $50 for the same 10-minute meeting. The encounters were previously free.

l The Polyclinic, a medical practice in Seattle, Wash., charges drug reps $30 for one hour’s access to their premises. For $200, the reps get eight hours. But at no price are they guaranteed a meeting with a physician. In October, drug reps will be barred altogether.

l The American Medical Student Assn. approved a new policy in April urging physicians, residents and medical students not to accept promotional gifts from the drug industry. The policy also urges hospitals and residency programs to ban drug company-funded lectures and lunches.

l Massachusetts General Hospital in Boston began barring pharmaceutical reps from its patient and visitor parking garages in July. The reps are also required to have appointments with doctors before they enter the hospital.

l The Providence Medical Group in Portland, Ore., no longer allows visits from drug reps and only accepts samples of medications they’ve deemed cost effective. The practice has also banned gifts from reps such as catered lunches and office supplies branded with drug company logos and product names.

States are also joining in. In June, Vermont passed a law requiring drug reps to report to the state all gifts to physicians worth more than $25. Lawmakers in New York have proposed a $75 limit.

Unfairly targeted?

The activity is a rebuke of an industry that has made enormous strides in treating the world’s maladies.

Dr. Leonard Morse of Worchester, Mass., who chairs the American Medical Assn.’s council on ethical and judicial affairs, said some restrictions, such as charging drug reps to meet with physicians, were “discourteous and disrespectful.”

“If you think those people are coming to doctors’ offices only to make a buck and profit, then the attitude is completely wrong,” Morse said. “They’re coming because they’re bringing learned information that the doctor wouldn’t otherwise get.”

Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, the drug industry trade group, said drug reps were being unfairly targeted.

“Sales representatives are well trained technically and they convey important information to doctors on drugs, their characteristics and side effects. And they answer doctors’ questions,” Trewhitt said.

Those answers aren’t always right, according to a 1995 study by researchers at the University of California at San Diego. They concluded that 12 of 106 statements (11 percent) made by drug reps during 13 presentations with doctors were inaccurate. And all inaccurate statements favored the drug being promoted and contradicted information that was readily available to the reps.

In addition, studies have shown that doctors who depend on information from pharmaceutical reps instead of medical journals tend to prescribe more expensive drugs, said Michie Hunt, a Washington medical consultant and frequent critic of the drug industry.

“As people become aware of the implications of the drug industry’s marketing efforts on rational prescribing practices, they are beginning to look for ways to clamp down,” Hunt said.