Do Free Drug Rep Lunches Sway Doctors? See What Physicians Say

Sandra Levy

Disclosures

February 12, 2018

Lunches and gifts from drug reps are still an issue. The Open Payments website, created under the Affordable Care Act, requires physicians to report any transaction that amounts to $10 or more, as well as items that are under $10 if the yearly total exceeds $100. The requirement that free lunches and some free samples must be reported has led half a million physicians and more than 100,000 other healthcare providers to be listed on the site.

Meals from drug reps were reported by a whopping 96% of providers who are listed on the website, according to Thomas Sullivan, who is a leading expert on the Open Payments site.

A Medscape article on this issue sparked emotional responses from many physicians. Many were insulted and adamant that catered lunches and small gifts from drug reps do not influence their prescribing habits. Others said that these freebies can cloud a physician's objectivity. A few said that they like learning about drugs from reps during catered lunches and that the lunch is a well-deserved break for their staff. Still others said that seeing reps is a total waste of time.

'Drug Rep Lunches Are Harmless'

An intensivist who isn't swayed by drug reps' lunches said, "The very idea that I would prescribe a drug I did not think was effective because someone buys me a lunch or dinner is offensive and absurd! I often learn a lot, and I like to get samples for my patients to try before they purchase."

"The fact that the rep brings lunch is not going to sway me to prescribe a drug I don't believe in, but it sometimes helps inform me about the drug, and we are lucky to find time for lunch anyway," said a general surgeon.

A psychiatrist who has received promotional pens said, "I used to use pens that had various drug names on them, and surprisingly these pens never forced my hand into writing the name of the drug that was on the pen I was using at the time."

An internist said, "I practiced medicine for 51 years and was not in any way influenced by the occasional lunch (or God forgive a pen or scratchpad). Those who make these laws had better look in the mirror. They are the ones accepting all kinds of gratuities from the army of lobbyists."

Another healthcare provider said, "I've never been swayed by a free lunch or pen. If grabbing some lunch in my office provided by a rep provides useful info as well as saving my staff a couple of bucks, who cares? I am the boss of my own ethics, not some corporation."

Drug Lunches and Small Gifts Can Be Persuasive

Among physicians who felt that lunches and small gifts indeed can influence a physician's prescribing habits, one public health physician said, "I'm sad to read comments from so many docs who don't believe they are influenced by drug-rep perks, even small gifts like pens. These are not conscious decisions we make. Encounters with drug reps and the perks they offer, even pens (maybe especially pens because we might use them frequently), get their names into our heads subconsciously, and we develop the biases unintentionally. I was pleased when learning more than a decade ago that my residency program had already (based on ample scientific evidence) set policy saying that drug reps were not allowed in clinic. Everyone who is convinced that they are immune to the influences of drug reps should read the literature on bias and then decide whether it's worth continuing the practice (for their patients' and society's sakes—we all bear the financial burden)."

A psychiatrist cautioned, "Virtually every physician says the same thing: 'I'm not influenced by free food or stuff,' yet the studies on this show that this sentiment is wrong. Even worse are the 'thought leaders' designated by the drug companies who give the talks that come with the free food. They influence their peers some, but more importantly they increase their use of the drugs that are sponsoring them by a factor of up to five times or more."

One alternative to drug reps' lunches could be just giving information about the drug, sans lunch, says a neurologist. "If catered lunches for doctors and their staff had no effect on the recipients, you can be certain the drug companies would not do it. There is no reason why a drug rep cannot give you a brief summary and some literature about a new drug in the privacy of your office. The food wasted and the plastic that comes with it are obscene."

A pain management physician has a clear policy when it comes to drug reps. "I feel bad for the reps. They have a job to do, but to me it is just not worth it. We don't see any reps, we don't accept any lunches, no samples."

"The drug companies don't pay $250 million a year on free food (that's in addition to free samples and paying off the "thought leaders" and researchers) out of the goodness of their hearts," noted a psychiatrist. "They are in it for the bottom line. I'm not against that, per se, but you have to be aware that, as a physician, you are the focus of an intense sales program."

A Nice Break for the Staff

Some physicians are pleased with the information they receive from drug reps, and they feel that free lunches are a nice perk for their hard-working staff.

A family physician said, "What is wrong with helping us, the doctors, NPs, CMAs, clerks who work long hours without breaks to help the patients? Having food brought to you, ready to eat, for your 20-minute break is a great service to a very tired body of workers. Helping us helps the patients.... Give me a break, most of us (medical professionals) cannot even remember who brought us lunch, unfortunately. The pharm companies will eventually find out that the meals are not much better than the pens in reminding of us particular drugs. We are just too busy and too tired. The food really helps us continue working without wasting time getting our own."

Eating lunch with a rep even has unexpected benefits, said another healthcare professional. "I have been very pleased with the reps who come to my office. I eat the lunch and get to know them. When there is a problem of obtaining a drug for a patient or a side effect, I call them first. They have been very helpful in solving those problems. If I don't have patients who fit the criteria for their medications, I don't use the medications. Also, the staff enjoys the perk. I'm sure there will be more "research" coming out of institutes of "higher learning" that get tons of money for "research" from big pharma telling me how horrible it is for me to get the lunch because I'm being paid off."

Yet another physician agreed. "I deal with the launch of new drugs all the time. First I read about them, then look at the data sets, then talk to my partners, then the rep comes. I like the samples and sometimes the info or help understanding the new drug. I could skip the lunch if I wanted to, but the office workers like it and the reps like it. Does it make me use the drug? I guess it might push toward the drug if we have a sample but otherwise no."

Finally, a healthcare provider who worked in a hospital described this experience: "I recall receiving pen lights used in direct patient assessments, thus benefiting the patients, and although they had a logo, it was covered by the hand when used and in pocket when not in use so never actually seen.... We were often required to attend the presentations, which cut into our lunch breaks, and if not for the free food we wouldn't have eaten at all, so patients benefited by having nourished staff rather than run-down, low-blood-sugar staff caring for them."

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