Doctor, Back Slowly Away From That Sandwich!

Written by John Moore MD

In American health care, the era of the free drug-company sponsored lunch is definitely over. Gifts from companies to physicians and hospitals have essentially vanished. Samples have disappeared from our offices. Corporate-sponsored CME budgets have dried up. Next year, as a part of the Affordable Care Act, companies will be forced to disclose any gifts to physicians that cost more that $10. Physicians who accept those small gifts will be listed on a searchable database. No more sandwiches for us!

I am not an apologist for drug companies by any means. The negative impact they have on health care cannot be ignored. There is a lot of scientific data that support the claim that even small items may influence prescribing practices. Our journals are unfortunately full of bogus scientific studies claiming to “prove” one product is better than another with poor scientific support. We have all heard prepared lectures from paid physician spokespeople which provide no educational value beyond brand recognition for the sponsor. Transparency in any industry is good; patients should be able to know whom their physicians are taking money from.

However, we need to bring some balance back into this discussion. First, the headaches of maintaining such a database for small gifts seem far out of proportion to any benefit that patients can receive. Second, we need to remember that pharmaceutical companies can provide useful information to doctors. I know that it is out-of-style to mention anything positive that can come from talking to the local drug rep, but let’s think about it. I learn from my reps what vaccination strategies have worked in other practices in my area. I learn how disease-specific recall notes have worked for the group across town. I am not naïve enough to believe the slick brochures left on my desk (and in fact I throw most of them directly in the trash), but I do use them as a starting point to my own research.

We also should examine the effects of industry sponsorship on organized continuing medical education in America. While the potential biases are real, the positive impact of pharmaceutical industry money on CME is huge! From the most prestigious national conferences all the way down to local community hospitals, budgets for CME have been slashed, in part due to the lack of industry funding. Fees for participants have increased, and not surprisingly attendance has decreased at live CME events around the country.

The bottom line is that pharmaceutical companies and physicians have a complicated relationship, one that is not inherently good or bad. Like any business relationship, the association between pharmaceutical companies and physicians relies on real people on both sides doing what is right. No amount of oversight can force someone with questionable ethics to follow the rules. No amount of bribery can sway an honest doctor to prescribe a medication not in the best interests of their patients. The vast majority of pediatricians are caring advocates for their patients whose loyalty cannot be purchased by a pen or a sandwich.


Dr Moore is a pediatrician in Roanoke, VA. He schedules drug rep visits only one time per week and always ignores lunches, preferring to meet his family instead!