And how will the Massachusetts economy react to the loss of over $40,000,000 of food sales from local restaurants and delicatessens that are currently the makers of these simple sandwiches and salads for the doctor's “Lunch and Learns”? These doctors are eating sandwiches in the kitchenettes of their office delivered from the corner restaurant, not surf and turf at Morton's. Typical breakfasts and lunches cost $8 to $20 per person with taxes and delivery, not the $60-per-plate meals some must think these companies are buying for doctors in order to get them to see their products. The loss of $20,000 per year in food sales from each of over 2000 pharmaceutical or medical device company sales representatives in Massachusetts alone will hammer the food service industry, resulting in lost jobs, closed restaurants, and lost sales taxes.
As a business owner with unique insight into this issue, I urge you to strike all references to meals as gifts in Senate Bill 2660. I have included reference material below for your review.
Thank you for your consideration of this information and support of an alteration to this bill.
Kevin Abt
Founder & CEO
RestaurantsToYou.com
Now, this is not to pick on Mr. Abt, who certainly does have a business interest here. And there's a long supplementary section to his letter, in which he says that he's merely hoping for an exception for meals between $8-$20 in value “to be purchased and delivered to doctors and their staff for consumption while the representative presents and answers questions.” All fine and well, but of course, we end up paying for that $40 million and more as consumers. That $40 million is just a marketing investment in hopes of a much, much greater return.
And so this is the kind of decision-making one is left with: What set of problems do you want to have? Should PhRMA companies be able to legally bribe docs with gifts large or small — a practice for which all of us end up paying through the nose?
If not, yeah, it might be a pinch on Mr. Abt's business. But it would mean more money in the rest of our pockets.
Just because a drug rep isn’t paying doesn’t mean the doctors won’t be eating lunch. They may not be catered functions, so businesses will have to adapt to fit the new “doctors-buy-their-own-lunch model.”
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p>This isn’t going to be $40 million just disappearing from our economy. It’s going to be shifted around some. I bet non-catering deli counters in the vicinity of hospitals will be thrilled to have the gift ban passed.
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p>I don’t mean to be insensitive to the plight of Mr. Abt and other caterers who have made a business out of catering lunches between doctors and drug reps, but businesses are forced to adjust and adapt all the time for any number of reasons.
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p>I don’t think I’d be opposed to a reasonable spending cap instead of an outright ban, but that complicates the matter a bit. Is food up to $25 allowed or anything up to $25? Food that is only eaten on premises? Bottle of wine?
By his logic Doctors will just go hungry if they don’t get free lunches from PhRMA companies. The doctors I know, including my wife, are getting their lunches from the small local restaurants he is claiming will lose money. Of course, the last thing this guy wants is for health care workers to walk to their local restaurants instead of eating catered lunches.
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p>More and more hospitals are banning such practices in any case, so whining about it to the legislature is probably not going to do all that much good in the long run.
I mean, the pharmacy’s just want to screw the consumer. MD’s have only to look in their PDR if they need any info on drugs.
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p>Same goes for these companies that manufacture new medical appliances , IV equipment etc. Nothing but a profit motive. If medicine wants something new and different. They can find it on the internet.
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p>I have known way too many doctors who have thoughtlessly and needlessly prescribed copius meds for a tuna sandwich.
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p>Unscrupulous bastards!
So, let’s not ban lunch-n-learns. In fact, there’s no request to do so.
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p>Let’s just let the doctors buy their own lunch. After all, at only $8-$20, it wouldn’t be a burden on the doctor. Doctors gotta eat.
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p>So, it’s not about foodz4u.com, it’s about who pays for foodz4u.com. This bill wouldn’t allow the drug companies to buy the food for the doctors.
Why just PharCo to MD gifts? If it’s so costly for drugs, it’s probably equally costly for all other business sectors. Maybe, just to be safe, just ban all gift giving in this state.
the ethical issues are a little different for drugs than, say, cookies? Or socks? Or power drills?
Is your main problem with free lunch spreads for MDs set up by Pharma companies that the 1) costs flow through to the consumers or 2) that the MDs professional opinions will be compromised?
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p>1) I’m not sure that having the MDs pay for their lunches will actually result in a savings for consumers. You are assuming that the Pharma companies won’t simply pocket the savings and you are assuming that the MDs won’t get slightly higher salaries because they have to pay for additional lunches. Perhaps some of the savings might be passed through, but to assume all seems a bit foolish.
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p>2) You are also assuming that MDs will compromise their professional opinions because they are given a relatively inexpensive lunch. Maybe I’m just not as cynical as you, but I don’t see that happening. I think there is a potential upside too, perhaps some MDs will attend sales pitches that they otherwise would not attend for the free food and they will learn about new ways to treat their patients. It might happen, I know I am at least a little more likely to go to a sales pitch if I’m getting a de minimis meal in return.
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p>As long as we’re talking about relatively inexpensive meals I don’t have a problem with it. I think your concerns over costs being passed through to consumers and medical opinions being compromised is considerably lessened if we’re talking about a ham sandwich and a coke rather than lobster bisque and fillet mignon at Capital Grille.
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p>And if you are truly worried about reducing Pharma costs then maybe you should come out strongly against Gov. Patrick’s Life Sciences Bill that takes taxpayer money to give government subsidies to unprofitable Pharma companies.
I really don’t think that doctors will get higher salaries because they won’t get free lunches from drug reps. I don’t think that you will be able to find that hospitals that forbid drug lunches pay higher than those that do not.
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p>I agree that most doctors will not be especially influenced by such tactics, but some are. Let me put it this way: the pharmaceutical companies would not be doing it if it didn’t pay off for them, and hospitals would not be banning the practice if they did not feel that this was indeed presenting an undue influence.
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p>I also wonder how much doctors actually learn from meetings conducted by drug reps with no medical background.
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p>
but if they had “no medical background,” i.e. didn’t know their product and couldn’t talk intelligently with their customers, they wouldn’t be making any commissions.
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p>A drug company rep who is revealed to be an ignoramus about his/her product soon finds that no one will listen to him/her or even give him/her the time of day.
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p>And BTW, most of these “perks” involve getting sandwiches from Subway and soda from the hospital beverage machine. It’s more a convenience than a bribe.
They might know their product to some degree, or at least how to sell it, but they don’t know medicine. And indeed most doctors I know won’t give them the time of day. This might be a generational thing. My dad was a doctor and we always had pens and pads with drug names at home, but my wife won’t even take a pencil with a drug name on it.
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has been very theoretical, that because Pharma companies won’t have to pay for the meals they serve at their sales pitches, the costs will necessarily be passed through to the customers. I’m making the point that the assumption is flawed. Perhaps Pharma companies will have to spend the money for better sales training for their reps. Perhaps the Pharma companies will just pocket the saved money. Perhaps the savings won’t be passed through to the customers because hospitals will start picking up the tab for the doctor’s lunches, or will reimburse the doctors for the money they spend on their lunches at such meetings. You can pick any one of my possible endpoints for the savings to dispute, but to argue in theory that the $40 million will necessarily be passed through to the customers is silly.
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p>You also make several post hoc ergo propter hoc arguments. Pharma companies are doing it, so they must be influencing the MDs. Hospitals are banning it, so their doctors must be being influenced. Perhaps Pharma companies are doing it because thats standard operating procedure for any sales pitch. They wear professional business clothing, show up on time, have a nice power point prepared, have a nice spread of sandwiches out, set the room at the proper temperature, etc. Of course the point of the presentation is to sell their products, but to argue that the single act of having some food makes the difference between a simple sales meeting and imposing undue influence on doctors also seems silly.
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p>And I would also hope that the doctors do not simply take the sales rep at their word. But maybe, just maybe, a doctor could learn about a new product at one of those meetings and after they do their due diligence, they could conclude that the product is beneficial to their patients. Perhaps the marginal amount of time saved by having the spread out instead of requiring the doctors to go down to the Au Bon Pain to pick up their sandwiches before the meeting might cause a few extra doctors to show up and learn about the new products.
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p>Again, I’m not talking about steaks and lobster tails at upscale restaurants. I’m just talking about a statutory carve out that allows for a de minimis amounts of food.
You assume that doctor’s pay is somehow linked to whether they get free drug lunches, when there is absolutely no evidence that this happens. I don’t know what you are talking about regarding passing $40 million onto customers. I never said any such thing. Perhaps you should read more carefully before attributing that to me.
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p>But the fact is that Pharma companies have been doing this for a very long time. They are not dumb. They would not be doing it if they didn’t at least think that it worked. Hospitals are banning it because they feel that it does unduly influence physicians, especially the young inexperienced residents that the companies would like to target. Hospitals are run by people who actually know something about this issue. They aren’t acting randomly when they ban the practice.
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p>BTW, these companies also do pay for much fancier dinners and lunches aimed at more senior doctors.
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p>
There are 2 arguments for banning Pharma companies from paying lunches for doctors at their sales pitch meetings that I have discerned from this post and the comments that follow.
#1 – It reduces the costs for consumers
#2 – It decreases improper influence
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p>I am responding to #1 by pointing out the many different ways that reducing the cost of a sales pitch will not result in lower prices for consumers. I am not making assumptions. There is an assumption made that the costs will flow right through to the customer in the original post. I pointed out several other places that the cost savings could end up. You seem to be very sure that hospitals have never, and will never reimburse doctors for the money they pay for lunches at Pharma sales pitches or take over providing lunches to their doctors at such meetings. I think thats a silly thing to be so sure about. Regardless, if that is the case then that eliminates one of the possible endpoints for the savings that I pointed out. However, it still does not mean that the savings will end up in the pockets of consumers.
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p>Again, the assumption in the post is that savings are passed through to customers. I am not assuming anything, but pointing out flaws in that original assumption.
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p>In response to #2, I don’t know why hospitals are banning Pharma companies from providing inexpensive food at their sales pitches. Perhaps the hospitals are responding to the mere appearance of impropriety, or they are responding to past egregiousness with a zero tolerance approach. (Note – a careful reading of the last sentence reveals it does not make assumptions). I just find it hard to believe that an individual who made it through medical school would have their judgment based on their extensive education subverted by a free sandwich one afternoon.
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p>So maybe this is a better approach to continue our debate. 3 questions for you.
1. Do you support the bill banning Pharma companies from providing inexpensive food at their sales meetings?
2. Do you support it because you think costs will be passed through to customers?
3. Do you support it because you think that inexpensive food improperly influences doctors to make poor medical decisions?
You continue to assume without any basis in experience or fact that it just can’t be possible that these lunches could be influencing any doctors. In fact, I know from talking to doctors that these practices do influence doctors, especially young residents. You seem to be under the delusion that doctors walk out of medical school fully trained and with fully formed medical judgements. That is simply not the case. I have heard at least one doctor relate how the felt that this practice did indeed influence him when he was a resident.
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p>As to my view on this bill. I do support the bill because I believe this practice does unduly influence at least some physicians, not for its economic impact, whatever that would be.
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p>
we’re only talking about the lunches, not the sales pitches themselves. If the main difference between a routine sales pitch and a sales pitch that exerts undue influence is a table in the corner of the room with some sandwiches and cookies then medical service in this country is in much more trouble than I could have ever imagined.
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p>I have several close friends who are recent medical school graduates and are about to start their residences. I’ll be sure to warn them that once you become a resident, the extreme power of a ham sandwich will completely cloud your judgment and you will be unable to resist the power of any ensuing sales pitch.
The potential cost savings wouldn’t come from the reduced cost of marketing to pharma. The major efficiency would come from doctors prescribing the drug that is the best value rather than the one marketed to them. The same bill that includes the gift ban also includes a provision that would establish ‘academic detailing’ – essentially sending out medical professionals to educate doctors with a balanced view of prescribing options to counter the drug detailers. The state of PA saved millions just to its medicare program just by doing academic detailing one a couple classes of drugs. Imagine the savings – and the health benefits – that would result from doctors having the information they need and being free from industry-bred bias.
So the real argument here is not that the costs of the gifts are passed on to the consumers. The argument is that the undue influence of the Pharma companies causes doctors to make inefficient choices in which drugs to prescribe. So that gets back to the issue, are the free lunches provided by the Pharma companies what causes the doctors to make the inefficient choices? Are these de minimis amounts of free food really the problem? Shouldn’t we be focusing more on the gifts that are actually of value rather than having a zero tolerance policy for inexpensive gifts just to have one?
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p>Having more information is great, so this ‘academic detailing’ is certainly commendable. It seems like insurance companies that have to cover the costs for the more expensive drugs or consumer/lobbying groups that represent drug using consumers should have an incentive to provide this education. But if the government is going to be in the business of covering costs of drugs for certain individuals, then the government should take a role in decreasing the costs that they have to cover.
The bill does not just ban the lunches. The unintentionally hilarious letter by the caterer just makes the lunches a great symbol. The bill bans ALL gifts, and here is the definition from S2660:
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p>”Gift,” a payment, entertainment, meals, travel, honorarium, subscription, advance, services or anything of value, unless consideration of equal or greater value is received and for which there is a contract with specific deliverables which are not related to marketing and are restricted to medical or scientific issues; provided, however, that a gift shall not include anything of value received by inheritance, a gift received from a member of the health care practitioner’s immediate family or from a relative within the third degree of consanguinity of the health care practitioner or of the health care practitioner’s spouse or from the spouse of any such relative, or prescription drugs provided to a health care practitioner solely and exclusively for use by the health care practitioner’s patients.
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p>There are also some exceptions in the bill to protect medical education and free drug samples.
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p>We are talking about much more than sandwiches here. We are talking about the kinds of expensive trips, honororia and such that have allowed such egregious practices as doctors signing on to drug studies ghost written by industry all the way down to more subtle and maybe even subconscious influence.
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p>I certainly agree that expensive gifts that could actually exert undue influence should be banned. I would hope that the AMA or the certification boards would take a leading role in promulgating ethics rules for its member doctors. I’m just not sure I see a lot of benefit in having a zero tolerance approach merely because the absence of prohibitions were abused in the past.
Zero tolerance is important to reduce the advertising influence. Exempting gifts under say $15 (about the lunch threshold) would keep all those viagara pens, cialis hats, and prozac clipboards coming. The ubiquitousness of those ads in medical settings is another part of the prescribing inefficiency problem here.
just to garner some free bees from a pharmaceutical company. Granted there are some physicians who will no doubt engage in unethical behavior. But what a physician may or may not do pales in comaparison do the “deals” that get pulled off in law offices and court houses.
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p>The arguement proffered is that all or most doctors will prescribe X medication rather than Y medication because he received a free lunch, pens, notepads or whatever gratuity. Really?
….my cousin does scheduling in a doctor’s office with several physicians, and a majority of the time, the drug reps drop off the food, along with some information about whatever drugs they are pushing, and go onto the next office without actually speaking to the doctor. The doctors read (or discard) the material at their leisure; my cousin and her fellow hourly-wage co-workers get the free meals. I’m not saying every office operates like this, but she knows a lot of other folks at other offices and they’ve mentioned there’s a lot of the same thing going on there – the staff’s eating the food, not the doctors. I don’t necessarily think the practice of pharmaceutical sales reps bringing food to doctor’s offices is a good thing, but I like to think that most doctors are somewhat sensitive to the fact that it is an attempt at bribery and it is ultimately the doctor’s decision on each individual patient’s care as to what medication is most appropriate. I don’t think they’re prescribing medication because bagels were involved.
The drug companies do it because it works. And only because it works. That’s why they’re fighting this so hard.
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p>The psychology is that a large, fancy gift feels like a bribe, and doctors resist giving in to bribery. But small, regular kindnesses, like lunch and so on, send a message of friendship that results in reciprocity by the doctor. This article (http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html?scp=3&sq=Carlat&st=nyt) in the NYTimes by a former drug rep lays it out. The drugs reps know exactly how many prescriptions are written each month by the doctors they are assigned to, and target them for their marketing.
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p>The harm is that these gifts, even small ones, distort the judgment of prescribers. Nobody is pushing the cost-effective generics, just the high-profit brand names. The proposal wouldn’t prohibit sales calls, just the lunches and mugs and dinners that go on every day.
is to enforce at all costs the advancement of fascist concepts in America. Like Sarbanes-Oxley and it’s blatantly Orwellian doublespeak terms complicance enforces only the illusion of reform. When has government in the last 25 years enforced any anti-trust laws. They are now even bailing out criminal corporate behavior. Sarbanes-Oxley compliance crap reads like a Soviet re-education gulag. The only difference is that the masters are corporate in nature and not the Communist party. Big difference, rather no difference at all. The illusion of “freedom”.
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p>Did you know you can’t sue big pharma if one of their crappily tested drugs kills one of your loved ones?
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p>Did you know your medical records can be used against you because they are available to financial institutions. Your loved ones can’t know but the rest of the internet connected world does have your last colonoscopy.
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p>Big pharma is number two in it’s Satanic uglyness, number one of course being the military-industrial complex Eisenhower warned us about years upon years ago.
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p>I won’t get into codex alimentarius or mandatory vaccines with mercury and the autism link.
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p>If legislators want to make an issue out of salesmen taking doc to lunch I’d like to make an issue out of that insult to my intelligence by taking a baseball bat to said legislator’s kneecaps. With zero industry left here big pharma is protected. Dumbed down was not enough, dumbed down and medicated just might be.
http://www.deliberatedumbingdo…
http://www.naturalnews.com/019…
http://www.patientprivacyright…
http://www.geneticalliance.org…
And finally we have RICO lawsuits against health care insurance company who did bail out it’s CEO to the tune of 1.78 billion dollars tied up in court for years upon years.
http://www.zwire.com/site/news…
http://www.necn.com/Boston/Hea…
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p>I wonder who’s paying Stossel’s “honorarium”?
it is always a small catered affair for the doctors and staff. I’ve only seen Boston Market or a similar outfit feed some home style cooking. Never seen Ruth’s Chris Steak House or any other fancy meals at these things.
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p>I don’t see the problem.
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p>What about the Beacon Hill crowd’s meals? What of those guys that grab the meal tabs? You know, the ones in the fancy suits? Oh yeah, they’re just making laws…
I have to say I find this debate at the Statehouse and on the blog to be a tempest in a teapot that is sapping valuable energy and time from more important issues.
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p>1. Undue influence by pharma companies on health care professionals is wrong, and there are existing laws, rules and (believe it or not industry compliance practices designed to control them). There are also whistleblower statutes that provide for sharing much of what is recovered with the whistleblower (some have earned up to $25MM or more this way)and if this is such a problem, the folks have the ability to complain. Under the Federal laws, the giving of anything of value for the purpose of influencing or inducing prescribing behavior is a crime and subject to prosecution. The penalties are huge resulting in half billion dollar fines and criminal sentences.
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p>2. The Office of Inspector General and our State Attorney General have enforcement guidelines that seek to delineate wrongful behavior from legitimate promtional activity. They are agressive in enforcing the law.
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p>3. Several states have passed laws like that proposed in MA, except none has set the bar at banning all gifts. Rather they tie it to the AMA code or to a $25 limit to recognize that legitimate, informative education may be provided with a meal or that a trinket might help remind a customer of the educational conversation. One problem from having state by state regulation is that it becomes a nightmare for a company to establish an effective compliance program when the rules differ in the 50 states. Consequently, Senator Grassley has proposed federal legislation that would set a standard and then pre-empt the states’ rights to legislate in this area. Perhaps this is a better solution if the federal law is appropriately balanced.
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p>4. The MA bill as proposed is somewhat unclear as to its scope. Does it apply to all biotech companies as well as pharma companies? Does it mean that a biotech company that is seeking to discover the next cancer breakthrough cannot engage a consultant at a boston hospital to educate it on the limitations of current therapies and how to best focus its research? Does it mean that when a company discovers a new breakthrough that could save substantial hospitalization costs, that when it launches the product it cannot have lunch and learns with important doctors to help them understand the clinical trial results? As in any business, existing marketed products will continue to be used due to inertia unless and until a new product is visible and understood.
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p>From my perspective, I think this proposal is an example of a well intentioned idea that if implemented may lead to a bad result. Given the significant laws already on the books, the substantial efforts underway at most companies to comply with these law, and the likelihood of federal legislation that will pre-empt the law if passed, that our legislators should use their scarce time to focus on more pressing matters.
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p>Bruce
Thanks for this terrific post. The Massachusetts Prescription Reform Coalition has been reaching out to our state leaders in support of the gift ban. To learn more about the coalition and to join in our efforts please visit http://www.hcfama.org/mprc or email me at lkaplanhowe@hcfama.org.
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p>Also, please consider contacting your state representative and senator to urge them to support the gift ban. You can easily send them an email here – http://capwiz.com/hcfama/issue…