There Is No Such Thing as a Free Pharma Lunch (Anymore)

Initiatives to curb drug-maker influence have endangered medical workers, patients, and the healthcare system.



I am a cancer researcher at the University of Pittsburgh Medical Center (UPMC). A few years ago, UPMC began restricting educational materials and office meals provided by pharmaceutical companies. Since then, numerous other hospitals across the country, including all of the major ones in my hometown of Pittsburgh, have followed suit. Although most bureaucrats paint this as a victory for the bottom-line (studies find that it increases the proportion of cheaper, generic drugs prescribed), I have witnessed (though never received) the many lost benefits of pharmaceutical-sponsored education.

The medical workers are not as jovial as I once remember them. Studies routinely find that medical assistants and emergency medical technicians, people with literal lives in their hands, are among the most underpaid jobs in America. Despite their years of education, their salaries are still below the national average. One of the few push factors to remain at such ungrateful positions used to be a free lunch: representatives from drug companies—known in the industry as "drug reps"—would bring the whole office food in order to educate the physician for a measly few minutes during lunch. The healthcare industry already has some of the worst worker shortages, with costs skyrocketing and the population growing older and sicker. Canceling free lunches has only exacerbated the problem.

Lunch visits constituted a win-win-win: hard workers were fed, physicians learned more about the products they prescribe, and, as of 2016, over 71,000 Americans are employed as drug reps. This number is down from over a 100,000 about two decades ago. The state of New Jersey has enacted severe restrictions on drug reps and 36.5 percent of physicians nationwide no longer take visits. With Allegheny Health Network, the second major healthcare system in Pittsburgh, now closing their doors to drug reps as well, many of the reps with whom I've spoken fear getting laid off. When we lose these necessary American jobs, we also lose the knowledge they impart.

At a recent appointment, I asked my doctor about a new drug, and she responded that she had never heard of it. I have witnessed this time and again in my interactions with physicians. The ban on drug reps means that doctors spend their lunchtime (the only freetime they have) in line rather than learning about new pharmaceuticals. My interactions with physicians in the clinic (and the lunchline) have forced me to wonder: who is better off when doctors are less informed about the pharmaceuticals they prescribe?

The reasoning behind the initiative is simple: advocates are concerned that lunch or compensation from drug companies will sway physicians to prescribe certain pharmaceuticals. Some argue the influence could even be exacerbating the opioid epidemic (though the research shows doctors without drug reps do not prescribe fewer drugs, just cheaper ones).

I understand patient hesitancy about pharmaceutical influence—we expect our doctors to act in our best interest, not their own. But we also expect them to be knowledgeable. The rewards doctors received from pharmaceutical companies were not contingent on them prescribing a certain drug, but they did offer an extra incentive to learn more. Although all doctors are required to pursue certain training and recertify every ten years, that may not be enough to keep up with the rapid development in fields like oncology and neurology. Only 15 percent of primary care physicians could answer basic questions about chemotherapy, while only 18 percent of doctors felt informed about how to treat fatal strokes. Many physicians who used to, in their personal time, attend sponsored events to hear about new research are now banned from doing so by their employers. Anti-drug rep initiatives are replacing a purported form of corporate coercion with a very real one.

Claims of physician bias are even more incredulous considering that transparency regulations have already made unscrupulous physician practices a thing of the past. Thanks to the Physicians Payments Sunshine Act, passed in 2010, all compensation that a physician receives, down to a five-dollar sub for lunch, is published online. There is no need to pass a company-wide ban on pharmaceutical sponsorship if concerned patients can, with the click of a button, identify and avoid doctors they do not trust. Health systems are always advertising patient choice in physicians and procedures. Why not let consumers choose whether they prefer doctors educated by pharmaceutical companies?

The transparency required of doctors is actually already a double-standard not seen by other professionals. Even politicians, whose actions affect millions of lives, do not have to reveal their Super-PAC corporate sponsors until after an election. No other professionals are punished by their employer for trying to learn more and practice better, especially outside of working hours.

Over the years, I have failed to see how ignorant doctors and hungry medical assistants help to improve patient care. But I feel most disgusted when I see underprivileged patients, who were once offered free samples brought by drug reps (which were already tightly regulated by the Food and Drug Administration), are now forced to go without potentially life-saving medication due to these policies.

I work in healthcare and among medical professionals all day. These smoke-and-mirrors initiatives, designed by healthcare administrators—not doctors—are intended to woo customers without the costly investment of actually improving patient care. Consumers are fed a narrative of undue pharmaceutical influence, and then appeased with a show-over-substance gimmick that could have disastrous consequences for workers and patients.

These initiatives were implemented for customers, and it is only as customers that we can undo the damage they've wrought. If you know a medical worker or patient, you can do them a favor by calling or writing your health system to say that you want your doctors informed and nurses fed. Money does speak, just not in the way that drug rep critics think.

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  1. And now how about tackling lobbyist freebies given to politicians, which is a MUCH bigger problem?

    I agree with this article, that drug reps aren’t really a problem, net-net, to begin with…

    Another MUCH bigger problem in medicine is doctors OWNING labs to which they send their patients for testing! Like I knew of a shrink that a relative of mine visits, and this shrink will send new patients for FULL urine and blood work, to “help” the patient by determining if the patient is taking illegal meds!!! For $15 K, at a clinic owned by Dr. Shrink and her husband! If faced by this kind of thing, ask the below… And ask your NEW doctor, WHAT kind of these stunts is he or she going to pull?

    “Do I already know if I am addicted to meth or coke or pot or pain pills? Do I really need someone to test me to get this answer for me? For my own good, supposedly? Knowing that laws about privacy are always subjected to being changed at the whims of lawmakers, AND that supposedly private information gets hacked often, am I willing to have Dr. Shrink have these kinds of test results on file about me? Do I want to pay $5 k, or a co-pay on that?”

    1. “Another MUCH bigger problem in medicine is doctors OWNING labs to which they send their patients for testing!”

      This is a problem insofar as any respectable profession would have, and enforce rules requiring disclosure of such arrangements. You really shouldn’t have to ask.

      But, in the absence of such professional responsibility, you probably should ask. And why would you trust someone who doesn’t freely answer?

  2. Will somebody buy this fucking guy a lunch so he will shut the fuck up?

    1. Which fucking guy and what axe are you grinding? Why do you clutter up the comments with a comment conveying NOTHING other than the fact that you’re angry for some unknown reason? Are you going to go and kick your dog next, or what?

      1. Did you read the fucking article, or do you just start whining for no particular reason? Look above and do you see any mention of a researcher bitter because pharma bros don’t buy his meals anymore? It might be mentioned once or twice in the article. I kick my dog every fucking day – he weighs 200 pounds and keeps jumping on people when they walk in the door. I can’t even count how many times he’s knocked over my 6 year old.

        1. OK, gotcha… And OK, I suspect you were to some extent trying to be funny, sorry to jump your case…

          But a problem I experience in my life, if I bitch about it, I may not be bitching about it ONLY because of myself! But rather, I may be bitching about it on the behalf of who knows how many millions of others, in similar situations, and with apparently ENORMOUS impact on entire societies!

          For example, the ‘lung flute’ case of FDA vast over-regulation is trivial for me personally, but I have bitched up a storm about it, as an example of Government Almighty turning us all into little babies! Letters to editors & Congress-Slimes and put up a web site, all to little apparent avail… See sample page at

    2. Medical students are NOTORIOUS for flocking to free lunches like vultures. Residents too. According to his LinkedIn profile, the author of this article just got accepted into medical school for the upcoming year (and has been working as an undergraduate research assistant), so I can see why he’d be so eager for the “free lunches” to return!

  3. Uh, in a free market economy, how can anyone be “underpaid”? Your pay determines your worth, girlfriend, and vice versa.* Stop whinin’ and work harder!

    *Yes, I am the goddamn Charlie Wilson of the goddamn 21st century! And goddamn proud of it!

    1. The “underpaid” whinge was only thrown in to head off the argument of “why don’t you pay for it yourself.”

      IOW, it’s horseshit.

    2. Because it’s not a free market.

    3. Underpaid can also reflect the problem of people being unwilling to pay what the job’s worth–and it’s not a free market when you cannot (for ethical and/or legal reasons) simply go on strike or refuse to do the job completely.

      CNAs are also chronically underpaid, in significant part because the people who set their pay have no actual interest in both the quality of care provided and staff turnover. The only thing they care about is how cheaply they can run the place before they get into trouble for it–and that usually takes a certain degree of open, malicious incompetence…over years.

  4. Sounds like Barsouk is already missing the free grub (either the bags of mediocre Boston Market fat and salt the rep brought for the whole office staff, or the pricey steak house dinner just for the MDs). Any maybe missing the pseudo flirting with the reps, a job role for the pretty people who have few other skills.

    Professionals have to stay informed? Geez, I thought that was what the serious scientific and medical literature was for (not the one page glossy promo sheet and the sales pitch by the rep who flunked freshman biology).

    1. See my post below for comparison to the same reps-bring-lunch practice. I considered it a fantastic way to learn about new products without having to interrupt work, and don’t believe it would be any different for medical professionals.

    2. “I thought that was what the serious scientific and medical literature was for ”

      Nope, the relevant scientific and medical literature is written for an audience of other researchers, NOT for practicing physicians.

      Drug trials for FDA approval of new drugs do not get published in the literature like that.

      1. And if those rep lunches are anything at all like the electronic ones, they give you the 5 minute overview which is impossible to get from literature. You know it’s biased to only tell you the good, but you have a starting point on new products and new features. From there you dig in where necessary, compare to other vendors, and figure it out. No one came away from those meetings sold on using new chips. No rep expected that. I don;t see how pharma lunches would be any different. No doctor is going to start prescribing new pills based on 5 minutes talk and free pizza.

        1. ” No doctor is going to start prescribing new pills based on 5 minutes talk and free pizza.”

          I can see how a lay person might want to believe that.

          I’d suggest you don’t.

          There is a fine line between really busy and too fucking lazy.

          Case in point. Yesterday an MD approached me about a problem patient – high potassium from combined renal/hepatic failure who was balking at taking more kayexalate (a potassium binder) due to taste issues. I said there was one newer agent available – Veltassa, and without any further question she was clearly willing to order it right then and there.

          Happens all the time.

          1. Are you a drug rep with an obvious financial interest in her using Veltassa or are you a peer whose opinion she sought out for your expertise?

            1. Not a rep, not exactly a peer either. I’m a pharmacist. I’m paid by long term care facilities to manage their medication usage for efficacy, cost and regulatory compliance.

              1. Not to disagree since you were there. Sure the doc should at least look up the basics of the drug before actually prescribing for the first time.

                But no problem with the informal consult. She gave you a summary of the patient and you could have asked questions as well. Say there is a potential issue with liver or renal toxicity with the new drug. You could mention those. Or if you had just heard about it and had no experience with it you could just say that and she would know you cannot say one way or the other.

                You are expert in pharmacy. She may have also stopped by radiology to ask a radiologist what is best diagnostic exam for my patient with suspected lymphoma and whatever else is going on. The radiologist might ask for more information, and recommend a CT vs MRI. That sort of thing happens every day and it should. The literature can lead you astray. (Yes that article from that group in Pittsburgh says MRI is more sensitive for this but they have 3.0T scanners and a dozen attendings and fellows doing this all day.)

                1. I get all those things too. And in this specific case she may have been relying on me to be her safety net, which had she order the drug, I would have done. But I’ve been around long enough, and in enough practice settings to know that the behavior is common, while the safety net is not.

                  Many practitioners will indeed order something with minimal consideration of risks and benefits.

                  1. I would suggest that you are the safety net.

      2. “the relevant scientific and medical literature is written for an audience of other researchers, NOT for practicing physicians.”

        No, it is not. NEJM, JAMA, etc. are all suitable for the practicing physician. And there are journals specific to most every specialty.

        the drug trials you speak of do not get published because the owners of the research do not seek publication anywhere.

        1. Not only that, but I assign my UNDERGRADUATES review papers all the time. If a medical professional can’t understand general papers written on a subject in a review paper format, then there are bigger issues than what’s presented here.

          1. From what I’ve heard, it’s more an issue with attempting to drink from a firehose–there’s a lot of research, the review papers are always a bit behind simply as a function of how they’re written, and most practicing doctors are expected to be spending their time treating patients.

            The time constraints mean that something that does short one-line abstracts with major papers getting highlighted, with links to the actual papers and kept within a reasonably-short period of time from publication of the papers, would be good for anybody trying to keep up, including researchers who are in a tangentially-related field. (It might also be interesting to see if there’s an inverse relationship between dubiousness of the science and the ability to describe what you found in a minute.)

            1. Yeah, I think you’re right. Thing is — I deal with practicing physicians who are on service full-time who still manage to be experts in the latest and greatest in their fields. So it’s clearly doable. The question is: do they WANT to do it?

  5. Government get out of the medical and pharm industry.

    1. Yeah, no. No politician is going to campaign on killing Medicare. Even the ones that want to are very careful to not admit their intentions while running for office.

  6. While I oppose government restrictions of pharma (or any other) marketing efforts, this sort of behavior falls more under free association and rights of employers.

    Someone bitching about a lack of access to “free” marketing information doesn’t impress me much. You are either a professional, who recognizes that things of actual value (like true educational materials) will have associated costs, costs that you are ultimately responsible for bearing; or you think that you are special.

    But maybe I’m a tad jaded. Having been in the biz for over 30 years I also think there is a sort of combined Dunning Krueger/Gell-Mann Amnesia effect going on.

    Firstly, marketing is only ‘education’ in the sense that it encompasses exactly what the marketer wants you to know, and tends to omit or minimize everything else. As a medical professional you have lots of responsibilities. They only have one, and it is not always in your, or your patients best interest.

    Secondly, we all tend to forget (or maybe some never notice) just how badly we’ve been jobbed in the past by these guys – we perpetually give them our time and credence though they often do not deserve it.

    1. Don’t forget to add in some sexually-driven delusions inspired by the pretty, flirtatious reps.

      1. That’s the obvious stuff. what is less obvious is that most all of the drug rep’s patter has been scripted by a team of psychologists, and marketing magicians, working along with some members of whatever profession is to be detailed (usually a mix of MDs, pharmDs, and RNs.) They know exactly which buttons to press.

    2. “Secondly, we all tend to forget (or maybe some never notice) just how badly we’ve been jobbed in the past by these guys – we perpetually give them our time and credence though they often do not deserve it.”

      Yeah, we should just outlaw marketing in toto.

      1. Count me out.

        What we should do is improve the professions by teaching them how detailing actually works.

      2. I’d be less inclined to listen to arguments about limiting or regulating marketing if more folk weren’t delusional about the efficacy of marketing.

        1. Marketing tends to be the most delusional about the efficacy of marketing, amusingly enough. They’ll insist that there’s no such thing as bad publicity, even when there are definite examples of marketing causing significant backlash to companies.

          But no, no such thing as bad PR. Just ignore the brands that have been damaged–if not destroyed–but really ill-advised marketing campaigns.

  7. Most industries banned the 3 martini lunch years ago. Same deal.

    1. Nobody banned the (non-existent) 3 martini lunch. The IRS just said you can’t deduct it any more.

  8. I used to work in an electronics design/manufacture company. We always looked forward to reps bringing pizza or sandwiches for lunch while we listened to propaganda about new chips and equipment. Just like the author says, it was a great way to eat and learn at the same time, and while we did only learn about that rep’s products, all the reps came by; there was plenty of competition for best lunches and best speakers. We also researched things on our own.

    To ban doctors from doing this is sure short-sighted, throwing out the baby with the bathwater. It doesn’t surprise me that petty bureaucrats would want to control it. Just as we got lots of lunches and knowledge, I can’t see how the medical industry would be any worse. If generics pharma companies don’t send around reps and the bureaucrats want to remedy that, send out political hacks with sandwiches and pizza. It would be a much simpler cheaper solution than just banning something.

    1. You gotta remember that this is a health system/hospital dictating what happens on their own property. And they are already dictating what tools their providers have via drug formularies.

      Nobody is stopping anyone from anything on their own time, or their own dime.

      1. I understood this to be new federal regulations.

        1. Not that I am aware of. I oppose anything that attempts to block the free flow of information.

          Laws like those in NJ – which don’t block information, but do place limits on associated perks are stupid (and harmful because they tend to give the false impression that what is still permitted is somehow safer or better) so I oppose them as well.

          1. Yeah man, agreed, thanks much for your valued input as a pharma-Dude!

            Then there’s the associated issue of free speech and “off-label uses” as well, see…..-the-fda-t …

            1. Thank you.

              Yes, that is phenomenally obnoxious. You can have exactly the sort of ‘ideal’ data available in a non-industry funded, peer reviewed, and published study and the manufacturer/distributor cannot even hand out free copies of the study because it is not considered part of the “FDA approved marketing data.”

              Truly cutting off your nose to spite your face.

              Part of the blame lies with the FDA, but Congress could ultimately fix this (although like with much of the regulatory state, they like not being held responsible, so don’t fix anything.

    2. I invited a med device company coming in to my department on Tuesday to give a demonstration. I’ve arranged to have Panera cater a lunch to feed the residents and attendings who will attend this demo. And we don’t have UPMC money. In fact, very few academic medical centers have UPMC money.

      If the author is correct, then UPMC is fucking their employees, bottom line. I hadn’t heard that, and I personally know several members of the faculty at UPMC (and just coauthored a paper with one) so I’d be surprised if that were true. So I have to somewhat cast doubt on what the author has to say.

      Just to put things in perspective btw — I googled the author because I had never heard of him, and he’s listed as a medical student. Not to be too flippant or disrespectful here, but… certain things should be taken with a grain of salt.

  9. OK, I can see the regulation as being so much PR for the regulators, but:
    “The medical workers are not as jovial as I once remember them.”
    Thin gruel, folks. Put on a funny hat and you can solve that problem.
    And, anecdotally, I have yet to ask my MD about any of the meds publicly advertised without getting a knowledgeable reply as to the benefits and dangers. If you find otherwise, maybe you ought to locate doc who keeps current.

  10. If you want to be informed on new developments in your field, you shouldn’t rely on marketing reps wining-and-dining you, you should get professional journals, go to conferences, keep in the loop in your professional network and so-on.

    And that’s something employers can and should sponsor, to keep their work force current.

    All of which is to say… what’s so special about the medical field that it needs that level of directed marketing that is missing in most other fields?

    1. Bingo!

    2. Because while it is something employers can and should sponsor, to keep their work force current, they’re not and there’s not really any pressure on employers in the healthcare system to do so–continuing education is a cost, and as a rule, the priorities of a service are determined by those paying for it. If the people paying for it want it as cheap as possible and don’t care about the quality…don’t expect quality.

      1. continuing education is a cost

        …and also a requirement in the United States.

        1. While I suppose it possible that drug product marketing could be considered continuing education my personal and professional opinion is that it is not.

          The distinction being whose needs are primary to the presentation.

  11. Among those of us in academic medicine and cancer research in particular, UPMC is widely considered one of the top institutions in the world. They also happen to be THE most funded academic medical center in the country (don’t be deceived by the fact that they’re ranked only #3 on most lists… you have to also include Magee in the figures if we’re being honest).

    So it’s amazing to me that (if the author of this article is correct) they do not invest in educators coming to campus to give talks. And that they don’t incentivize their clinical faculty or their partner practitioners to attend these talks beyond their CME. Why do they seemingly rely so heavily on biased drug reps? To me, this either screams that UPMC has low standards for their medical professionals, or that the author might be wrong.

    1. You are correct. UPMC is an academic medical center not well known among the general public yet a pro like yourself knows.

      The sandwiches from Panera are nothing. The staff appreciates having food to take your maybe 30 minute lunch to hear something.

      A medical student wrote an article. Since when do medical students have time to write…whatever.

      1. From the looks of his LinkedIn he’s not starting med school until September. So he better get his articles out now!

        1. Describes himself as a cancer researcher. Hmph.

    2. “So it’s amazing to me that (if the author of this article is correct) they do not invest in educators coming to campus to give talks. And that they don’t incentivize their clinical faculty or their partner practitioners to attend these talks beyond their CME.”

      I find it hard to believe that such an organization does not have a clinical/research staff culture that positively demands participation in such activities.

      1. Exactly.

  12. Agree with hospital property issue, etc. However, rules extend to sponsored dinners offsite as well. My beef (sorry, I’m so hungry!) is the sheer hypocrisy of regulating pens and mugs with company logos (as if doctors’ prescribing can be influenced by such! Seriously?) while state and federal legislators enjoy nonstop wining, dining, golf trips, tropical junkets, contributions to their campaigns, etc. on Big Pharma’s and Big Hospitals’ dime. These big players are eating filet and swilling Screaming Eagle and Opus while doctors have PB&J and milk cartons at the little kids’ table.

    1. If you think it’s just mugs and pens, then you have no clue what really goes on.. How about $450 Bose stereos systems and $200 diners with the spouse? Studies show that ‘yes.. Gifts and sales reps do affect the choice of drugs doctors prescribe.’

    2. “…rules extend to sponsored dinners offsite as well…”

      Yeah, that’s problematic, to say the least. There is a real benefit to attending those things, if only to know what you colleagues are being told.

  13. As a nation, we spend about $600 Billion each year on prescription medicines… That could be cut down to 20% of that total if we just forced Congress to allow us citizens the right to participate in the supposed capitalist society we are told we live in, and buy the same drugs from the same manufacturers at 20% of the cost.. from Canada, Germany, Britain, etc…. Do we really need drug-rep lunches? I remember my neighbor, a doctor telling me that he really loved the Bose AMFM CD Player he was given by a drug company after one of those lunches…. At the time a $450 system…You have to ask.. ‘Did that gift affect his prescriptions’? of course it did.

    – Study: Generic Prescribing Increased When Sales Rep Influence Was Limited | Drug Topics

    – Doctors Choose Cheaper Meds When Drug Reps Are Kept Away : Shots – Health News : NPR

    Sorry to hear that doctors don’t get free lunches… I’m OK with generics.

    1. While I agree that drug prices could be cut considerably by removing regulations, it isn’t going to be because we are buying from other countries who’s drug prices are being subsidized by their taxpayers (or by the USA being charged more to make up for other countries lower cost).

      If buying from other countries became a thing, their prices would go up or the countries would put regulations in place to protect their taxpayers.

      Get rid of the FDA and let private for profit certification agencies do medical device, drug, and treatment certification, and the whole problem goes away as medical tech follows the same cost/performance curve that all other unregulated tech does.

      1. This.

        But also recognize that the manufacturer pipelines are extremely well controlled. A significant change in demand caused by people ‘going abroad’ would be met with diminished surplus supply to the affected countries. Locals would, by and large, still get their doses at the usual cost, but there wouldn’t be much left over to sell abroad.

        This is why most every internet seller of ED drugs is either counterfeit or some other scam.

  14. I’ll bite: how exactly does one “treat a fatal stroke”?…

    1. Rifle through their pockets quickly?

  15. I am always bothered when somebody omits a key fact: yes, contact with drug reps provides valuable education, but it is one-sided. The drug rep will tell you about the advantages of the drugs he is selling. He won’t tell you about the advantages of the competitors’ drugs, or when you should use those instead of his drugs.

    Aside from that, I agree with the thrust of this column.

    1. I believe that the average board certified Oncologist knows.

  16. “Claims of physician bias are even more incredulous…”

    How can a claim be “incredulous”?

    1. If by incredulous he means that Physician Bias is extremely prevalent… I agree.

      I worked for a prescription benefit management company in the early 2000’s when Prilosec went over the counter and every person with effing heartburn was suddenly switched to Nexium… which every doctor thought was the best thing ever…. except it was the same thing … and it cost 10 times as much.

      I’m not one for government interfering (other than maybe mandating that who talks to who about what drug be publicly accessible) but bravo to UPMC for throwing this in their code of ethics.

  17. “Only 15 percent of primary care physicians could answer basic questions about chemotherapy.” – I wouldn’t expect my primary care physician to be conversant with the latest in chemotherapy; that would be a job for my oncologist.
    “[O]nly 18 percent of doctors felt informed about how to treat fatal strokes.” – The referenced article doesn’t say this at all. It says, “[D]epending on their specialty, 18 percent to 49 percent of physicians are unsure about the best approaches to diagnose and treat cryptogenic stroke [which comprises 30% of ischemic strokes, according to the American Stroke Association].”
    This lack of attention to detail and misrepresentation of a source would tend to make me skeptical of the author’s conclusions.

    1. Gee, the fact that this is the web makes me skeptical of the author’s facts.

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