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.