Physicians, Pharma, and the Ethics of the Free Lunch
The latest in the NY Times series on conflict of interest in the world of pharma: Drug Makers Pay for Lunch as They Pitch, by Stephanie Saul.
Anyone who thinks there is no such thing as a free lunch has never visited 3003 New Hyde Park Road, a four-story medical building on Long Island, where they are delivered almost every day.
On a recent Tuesday, they began arriving around noon. Steaming containers of Chinese food were destined for the 20 or so doctors and employees of Nassau Queens Pulmonary Associates. The drug maker Merck paid the $258 bill.
Free lunches like those at the medical building in New Hyde Park, N.Y., occur regularly at doctors’ offices nationwide, where delivery people arrive with lunch for the whole office, ordered and paid for by drug makers to the tune of hundreds of millions of dollars a year.
Like the “free” vacation that comes with a time-share pitch attached, the lunches go down along with a pitch from pharmaceutical representatives hoping to bolster prescription sales. The cost of the lunches is ultimately factored in to drug company marketing expenses, working its way into the price of prescription drugs.
OK, so drug companies are buying doctors lunch, and taking the opportunity to inform doctors about their wares. But that can’t possibly actually affect doctor’s prescribing behaviour, can it?
A former pharmaceutical representative, Kathleen Slattery-Moschkau, called lunch “incredibly effective” in lifting pharmaceutical sales for the companies where she worked, Bristol-Myers Squibb and Johnson & Johnson.
“We got the numbers of what the physicians were prescribing. If I brought in lunch one week, I could see the following week if that lunch had an impact,” Ms. Slattery-Moschkau said.
Is this lunch stuff as bad as the old trip-to-Tahoe or courtside-tickets schtick? Certainly not. But ask yourselves these 2 questions:
1) Do drug companies expect lunches to affect prescribing behaviour? (Answer: Of course, else they’d be stupid to spend so much money on lunches.)
2) What factor(s) ought to influence physicians’ prescribing behaviour? (I’ll leave that one to readers…)
(p.s. It’s interesting to note that there’s no need to ascribe any serious moral culpability to physicians in such cases. They may actually believe that these lunches don’t affect their decision-making. But people in general are very bad at understanding what factors do and do not influence their decisions. Physicians are no different than anyone else in this regard.)
(p.p.s. Neither do we need to ascribe any malevolent intentions to pharmaceutical companies. From their point of view, these lunches are “just part of doing business.” And in a competitive environment, it’s likely the case that if one company does it, the others have to, too. But that doesn’t mean that the practice is OK.)