Tuesday, May 13, 2008

Free pens and pizza for doctors

A couple of years ago, my hospital banned any sort of pharmaceutical advertising, including free pens, lunches, dinners, prescription pads, drug samples, anything. This was a huge deal. Half the resident lunches were paid for by pharma, and they always coincided with mandatory meetings and conferences, so residents could eat while the attended and knock out two birds with one stone. I certainly understand. For one, without the free lunches at these meetings, residents often don't have time to get lunch! They don't even take the time to go the cafeteria and grab something to go. Even from an outsider's perspective, I think this is understandable - why feed yourself when you could work more on your patients and provide better care? Perhaps even save a life? Secondly, residents do not make a lot of money. They make about $40-45K a year ($30K after taxes), and many of them have $200K in debt after medical school. They haven't saved anything for retirement yet, and some of them have kids and families to support, so the loans are often just gathering interest during residency. So actually, these free meals were a source of income for the residents! Sure you can bring food and eat cheaply (and be much more healthy too) but the average resident does not have time to do this. The alternative is eating at the cafeteria or elsewhere, where an average meal probably costs $5-7. However, if you eat a free lunch off of the drug company (which usually is just pizza or ordered in chinese food or sandwiches), you save that money. You may even have enough left over for dinner if you're working late, which you usually are. Taken over a week, that's $20-$30 you save. Taken over a year, that's $1000-1500 you save, which for a resident, is a lot of money.

Despite these reasons, I've always been hugely for this. I've always thought these free pens and everything else could easily influence (hopefully subconsciously) doctors' prescriptions of these drugs. For example, say you want to prescribe a proton pump inhibitor to a patient, and in your line of sight is your clipboard, with "Protonix" all over it. You might not even realize that you saw it, but the next thing that happens is that you prescribe Protonix for your patient, and they're on that for life... not a bad way for the company to get a patient for 30 or 40 years, huh? And it's even worse with the free samples. I completely understand that free samples are how a lot of poorer people get their medications, and I think that's certainly a benefit. However, if you have a sample of drug X, and it works for a certain patient, even after they stop giving out free samples, that patient is probably going to stick with it, even though it might be 10 times as expensive as drug Y. It's also a huge source of medication confusion - so many patients I've seen have switched from medication to medication, for, say, their hypertension. And it's basically because they switch to whatever is being given out for free for that particular month. That is bad medicine, and bad for the patient.

Of course, we never knew if this was true or not. These are just theories. But why would pharma keep doing this if it didn't work, right? I'm sure they've done their research, and I've actually heard statistics from some ex-drug reps about it. So it's real. And hospitals and practices should ban pharma from advertising in their space. Of course, that's just my opinion, and there are plenty of differing views on this.

Here's an interesting recent article by Art Caplan, a pretty well known medical ethicist.

No comments: