Drug sales representatives have been around ever since the Food and Drug Act first created prescription drugs in the twenties. They are known in the industry as drug reps or detailers. (To pitch a drug to a doctor is to "detail" him, in the salesmen's argot.) The ranks of drug reps have swollen in recent years, from 36,000 in 1994 to 68,000 today, according to Scott-Levin. Although some drug reps hold degrees in pharmacy, medical experience is hardly a prerequisite. Dr. Jon Mohrer, an internist practicing in Forest Hills, Queens, recalls a salesman who walked into his office not long ago and said, "I know you!" Mohrer assumed it was just another play for his attention. But it turned out the salesman had previously served his family as a waiter at a neighborhood pizza parlor. Pfizer, a marketing powerhouse, has earned the industry nickname Semper Pfizer for its policy of recruiting former military personnel and teaching a hard-sell mentality.

Selling drugs to physicians takes quite a bit more training than most sales positions, of course. Forest, for example, runs a three-month training program out of a special campus on Long Island. After "graduating," sales reps receive monthly packets of information to digest. They are tested over the phone by a computerized quiz system. But it is well worth it. "Pharmaceuticals is a very hard sales job to get," says René Backer, a star Forest rep and now a regional director who works out of her home in Philadelphia. "It tends to be among the higher-paying sales jobs I can imagine." She declines to comment on her own paycheck, but other drug reps say that with a good incentive bonus, a successful rep can make $140,000 a year.

The typical drug rep is female, about 30 years old, well dressed, and attractive -- picture a Jil Sander suit and a giant suitcase on wheels. Doctors make the acquaintance of their first drug reps within their first month of residency. Reps flood training programs with pens, coffee mugs, stethoscopes, and bags, and are delighted to pick up the tab for all of a student's textbooks. (The reps stick their companies' logos inside the covers, of course.) At most hospitals, drug companies also cover the cost of an important part of resident training by sponsoring talks by medical experts, inevitably on subjects related to their products. A rep touting an antibiotic, for example, will pay an infectious-disease specialist a small sum to address surgical residents about transplants, where antibiotics are essential. The rep may even say a few words about her product after the talk.

More often, though, food is the reps' weapon of choice. They arrange with head residents to cater buffet lunches in clinics. As hungry residents load up their plates, reps buttonhole them to repeat short plugs for their pills' best attributes, like "lower side-effect profile" or "more digestible." They beep residents on their pagers to invite them to meals and happy hours. Some hospitals have bulletin boards full of reps' business cards, so residents can call for a meal whenever they feel like it. "They always try to take you to the fanciest restaurant possible, so they can really lure you in," says Laura Goetz, a surgical resident at Northwestern Medical Center in Chicago. "It's viewed as a prostitute-pimp relationship." The residents make up nicknames for their favorite reps, she says, like "Diflucan Dave," who hocks an anti-fungal pill, or "Trovan Tom," who touted an antibiotic that was heavily marketed until it killed six patients by poisoning their livers.

Emerging from an organ-transplant operation into the hallway of her hospital, Goetz recently ran into a familiar drug rep. He quizzed her about what drugs were used in the surgery, and she happily rattled them off. "Thanks so much -- you really made my day," he said, then handed her a $3 Starbucks coupon. "It just makes you feel kind of cheesy," she says.

If not for a chance meeting, Celexa might never have been introduced in the U.S. The active chemical in Celexa, citalopram, was first concocted by researchers working for the small Danish company H. Lundbeck in 1972, about the time Lilly first synthesized Prozac. But Lundbeck ran into problems in early tests -- its antidepressant proved toxic to beagles, because of what turned out to be a problem specific to the canine metabolism. But by the time the mystery was solved, three other antidepressants were heading into the U.S. market. Citalopram went on to become the best-selling antidepressant in some European countries, but Lundbeck missed out on the U.S., which is the biggest market and the only one free of price restrictions. The few compounds that make it to market as viable drugs bring in profits as high as 90 percent of their prices.

In 1995, an investment banker from London happened to visit the office of Howard Solomon, chief executive of Forest Laboratories, a tiny New York drug company. Seventy-two years old, tall, slender, and reserved, Solomon began his career as a lawyer and entrepreneur. He founded a small chain of bowling alleys and invested in Manhattan office properties before taking over in 1977 at Forest, which had been a legal client.

Solomon's ears perked up when the visiting banker happened to mention Lundbeck, noting in passing that its main product was an antidepressant popular in Europe but unavailable here. Forest doesn't discover its own drugs, relying instead on licensing compounds from others, and Solomon knew that grabbing even a small piece of the fast-growing antidepressant market could be a windfall.

To Solomon's chagrin, however, Lundbeck's executives wouldn't agree to meet -- they'd already been through the mill with U.S. drug companies (both Pfizer and Warner-Lambert had signed licensing deals before backing out). So Solomon resorted to a white lie. He sent a message to Lundbeck's chief executive, Erik Sprunk-Jansen, that he was going to be in Copenhagen anyway -- could he just stop by? Sprunk-Jansen, a polite man, assented.

After a brief presentation at Lundbeck headquarters a few days later, Sprunk-Jansen took Solomon to lunch in the company's elegant dining room, where Solomon scrambled to build a rapport. He had read every work by the great Danish author Isak Dinesen, he told them. And did he mention that he was the president of the New York City Ballet? Sprunk-Jansen was impressed. Peter Martins, the ballet-master-in-chief of the New York City Ballet, grew up in Denmark. Solomon said Martins was a good friend, and offered to introduce him.