Friday, June 3, 2011

A Piece of the Pie


Don't miss that phrase:
"We Specialize in Pharmaceutical Catering."
More about that in a bit.

My office building is a four story modern one that is essentially all medical offices.  A real goldmine for pharmaceutical drug reps.  They can park once and do what they do best--peddle their pharmaceuticals to busy doctors and their staff.  One might ask how, in these times of shortened and harried office visits does a rep expect to get the attention of the ultimate prescriber.

  This was made slightly more difficult by a two year old movement spearheaded by PhRMA, a drug company trade group with an eye to cleaning up their act and not appearing to be bribing doctors.  According to a 12/30/2008 article in the New York Times,  the pharmaceutical industry "agreed to a voluntary moratorium on the kind of branded goodies --Viagra pens, Zoloft soap dispensers, Lipitor mugs — that were meant to foster good will and, some would say, encourage doctors to prescribe more of the drugs." So the pens are gone. In fact there are doctors who proudly display their pen collections as historic mementos of a time gone by.   But there are still plenty of opportunities to influence and cater to doctors.

DR Caren and his Pharmaceutical Pen Collection
And that's where the pizza comes in.  Staff lunches for several hundred dollars, including many different types of pizza, salads and drinks are commonplace in offices, unless they are actively forbidden and stopped.   There are frequent invitations to free dinners at nice local restaurants with compelling speakers on topics that are not even necessarily related to the drugs the company sells.  Some companies make it more subtle than they used to.  After all, it defies one's commitment to science and purity to admit that one might be swayed by a fabulous prix fixe menu (of $0) where the fine print at the bottom says "Merck." 

Fortunately there is another voice out there.  The website NoFreeLunch is dedicated to the principles that I was raised on as a resident at Babies Hospital (part of Columbia Presbyterian) under the often austere chairmanship of Michael Katz, MD who did not allow drug reps in the building.  If we heard "GI Rounds" on the overhead PA, it was not so that we could be regaled with "pharmaceutical catering" but to be invited to bring our own lunch and discuss a case of gastrointestinal disease. (I know, I know, doctors can do really gross things while they eat.)

There is ample evidence to suggest that doctors are indeed influenced by these friendly, apparently collegial overtures.   But doctors can and do make the pledge not to participate in this insidious enterprise.  From No Free Lunch comes this pledge:

"I, __________________, am committed to practicing medicine in the best interest of my patients and on the basis of the best available evidence, rather than on the basis of advertising or promotion.   
I therefore pledge to accept no money, gifts, or hospitality from the pharmaceutical industry; to seek unbiased sources of information and not rely on information disseminated by drug companies; and to avoid conflicts of interest in my practice, teaching, and/or research."

No Free Lunch invites doctors to participate by emailing the pledge to Pledges@nofreelunch.org.  Encourage your doctors to do so.  I did.

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