Tuesday, November 20, 2012

Doctors Miss Their Free Lunches Says Survey

Medscape's 2012 Ethics Report survey revealed that 72% of 23,710 physician respondents answered "Yes" to the question "Do you feel that you could be unbiased with prescribing habits if you accept lunches from pharmaceutical representatives?"

First, it's interesting that this question was included in a survey that purports to investigate "Physicians' Top Ethical Dilemmas" along with questions involving insurance fraud, physician-assisted suicide, and abortion. But it certainly has generated buzz and blog posts such as this one and this one.

Limiting free lunches to physicians is part of PhRMA's Code of Interaction with Physicians. According to my own survey of pharmaceutical marketers, however, the code has had little impact on "Lunch and Learn" activities in which sales reps offer free lunch in physicians' offices while making a presentation (see "Impact of PhRMA Code of Interaction with Physicians").

Some states, however, have enacted laws that are more prohibitive than PhRMA's code. But these laws have had an impact on local businesses (i.e., restaurants that serve the meals). In response to pressure from pharma, physicians such as the 72% above, and local businesses, Massachusetts recently decided to "scale back" it's anti-free-lunch-for-physicians law. Instead of outright banning of gifts like free lunches, Massachusetts now allows physicians to receive "modest meals," which is more in line with PhRMA's code.

The physician payment sunshine provision of the Affordable Care Act, however, will eventually reveal just how much pharma companies spend on feeding physicians. "Food" is one of the 15 or so "categories of payment" that pharma must report.

Some of the comments from physicians in the Medscape survey include:
  • Voted Yes: "A dedicated lunch offers a chance to ask questions and actually ruminate on how the product might work for your patients. The alternative is doing what we do -- a bit of reading and trying it out patient after patient." Why, however, do physicians need a free lunch to ask reps these questions?

  • Voted Yes: "I am outraged at the notion that a lunch or a pen or a book could be felt to be inducement for me to prescribe certain drugs." There are studies that show what doctors think and what they do are two different things (see, for example, the study attached to this post: Pharmaguy's Picks for 20 November 2012).

  • Voted Yes: "If you accept lunches from ALL reps, that levels the playing field and you make your own choices." Ha ha! This guy/gal just loves to eat, IMHO.

  • Voted No: "I want to believe I can be, but the evidence says I'm kidding myself." An evidence-based physician! How refreshing!

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