The practice of pharmaceutical sales reps taking doctors and other decision-makers to business lunches is nothing new. For years, these so-called “free lunches” have helped sales reps influence people. Buying someone a meal has always been about gaining business and generating sales for a pharmaceutical rep, and, even though doctors are supposedly well-aware of what “lunch” really means, they still take sales reps up on their offer.
Last year, the Journal of the American Association (JAMA) released a report that published study results that showed a correlation between drug company-sponsored meals and physician prescribing practices, which isn’t all that surprising. However, similar studies have indicated that despite lunches being complimentary, they’re anything but free.
Freebies – Past and Present
Stemming from years of shady practices and various complaints, in 2008, the pharmaceutical industry decided to do something finally. They voluntarily gave up a lot of the freebies offered to doctors, from pens carrying a drug’s name to pricey equipment (NBC News). Before self-regulating itself, the industry was rather well-known for essentially buying loyalty by showering doctors with gifts, promotional items, the aforementioned free lunches, and perhaps most notoriously, paid vacations to luxury resorts under the guise of “advanced medical education.”
The current voluntary guidelines from the American Medical Association and Pharmaceutical Research and Manufacturers of America allow meals and gifts to physicians of up to $100 in value. One would assume that perks of that value wouldn’t go very far in influencing doctors. As NBC News reported, recent findings by JAMA indicate that even meals of less than $20 are often associated with prescribing patterns.
Furthermore, relationships between doctors and pharmaceutical sales reps are seemingly dose-dependent, meaning that additional and costlier meals are associated with greater increases in doctors prescribing the promoted drug to their patients. The reality is that freebies, including free lunches, aren’t necessarily a thing of the past and are still quite valuable perks that are used by the pharmaceutical industry to influence doctors.
Free Lunches Can Be Expensive
Many industry experts are beginning to see the unfortunate consequences of pharmaceutical reps buying meals – consequences that are starting to affect patients. The Washington Post highlighted this growing belief in an article published last year, describing that costlier prescriptions may result from drug firms treating doctors to free lunches.
Dr. Ravi Parikh referred to the JAMA report in the Post’s September 2016 article noting that physicians who received industry payments (typically company-sponsored meals valued at less than $200) were slightly more likely to prescribe more-expensive brand-name cholesterol medications over generics. Additionally, Parikh brought up data from another study within the report showing that physicians who had received one company-sponsored meal promoting a brand-name drug were twice as likely as other doctors to prescribe the more expensive (and not-so-coincidentally) brand-name drug over the generic option.
It’s unknown if this trend will continue, but, if it does, there is concern that untold numbers of patients will be unable to afford their prescriptions – including medications that would keep them healthy and might keep them alive.
Who’s at Fault?
The assumption is that a doctor would be willing to do more for a sales rep who spends more money on them. However, the JAMA report suggests that contact with an industry representative (and not the actual value of the lunch) is what influences physician behavior. So, in a sense, the monetary worth of a gift has nothing to do with how a doctor responds or reciprocates the gesture.
Jason Poquette, Pharmacist and contributor to Pharmacy Times argues that reciprocity is human nature, occurring in virtually every professional field and that the pharmaceutical industry isn’t necessarily to blame. He says: “social scientists have long spoken about the psychology of reciprocity, basically the instinctive human desire to give back once a gift has been given or a favor has been done.” Maybe our biology is what drives us – not simply the value of something.
Buying a lunch for a physician may influence their prescribing habits. Some say it’s a subtle and socially acceptable form of brand-name bribery while others point fingers and press for punishment upon offenders. Still, free lunches have been and will most likely always be a part of the pharmaceutical sales rep – doctor relationship, with each person gaining something. Whether you’re a pharmaceutical rep or doctor, one thing is for sure – lunch is never free.
