No Free Lunch

Stanford University Medical Center sent shockwaves through the pharmaceutical industry on Tuesday, declaring all gifts from drug companies off limits in Stanford facilities. I applaud this move to reduce industry influence over physician's prescribing decisions. Unfortunately, Stanford went too far in one important area.

Banning drug rep lunches is a great move. Doctors who claim that free food does not affect their decision-making are either clueless or lying. Way too many times to count in my pharmaceutical career, a doctor gave me time for my sales pitch only because his nurses reminded him that I had brought in sushi. He had no desire to listen to me, but ended up doing so merely to ensure that I'd bring his staff another expensive meal. Over a few months of memorable lunches (most reps bring sandwiches or pizza or Olive Garden), that physician would become a friend eager to hear what I had to say about my products. By eliminating the potential for a sales rep to leverage lunch largesse, Stanford has landed a near knockout blow to industry influence.

Cutting back on product-stamped pens and Post-it notes, etc. sounds great, but will have no everyday impact on hospital business. This ban will, however, negatively affect medical center employees' families. What will the children of nurses do without thousands of free pads to scribble on? With what will husbands write checks, now that millions of free pens are no longer available? I can't even begin to consider the cost of living increase due to employees actually buying their own Kleenex and coffee mugs.

The major flaw in Stanford's groundbreaking plan is its preventing doctors from accepting free drug samples from industry salespeople.

The value of these samples to physicians and patients cannot be overstated. Doctors will not prescribe a product with which they are unfamiliar. Consequently, they use free samples to test out new drugs without risking the wrath of a patient if the desired goal is not met, or side effects prove too much to bear. No patient can complain after receiving a free course of therapy.

More importantly, physicians save samples for the sick with no insurance or the elderly who - surprise, surprise - are shocked to learn their medications cost more under President Bush's new Medicare plan than Grandma and Grandpa were led to believe. In both cases, drug samples allow doctors to provide the best care for their patients without straining their already shaky finances. Unfortunately, Stanford's new policy will not let its physicians continue that helpful practice.

Stanford University Medical Center took a bold step this week, but don't expect to see community physicians jumping on board this anti-industry train. Academic research centers like those at Stanford, Yale and the University of Pennsylvania (the latter two having implemented similar, yet less far-reaching policies than Stanford's) have huge endowments and can afford to turn their backs on pharmaceutical cash. Likewise, these institutions can write off any losses on prescriptions filled but not paid for by poor or elderly patients.

Dr. Doe in Des Moines, however, relies on drug company sponsored medical education programs. He and his patients require those free samples. And, in all seriousness, his staff members expect to eat a free lunch every day. By adhering to Stanford's policy, community doctors across America could risk losing expertise, patients and employees.

Pharmaceutical companies will never stop distributing free samples to physicians, for there is no other way for their customers to gain experience with new drugs. If the American Medical Association can muster the courage to implement a plan just short of Stanford's, i.e. ban gifts of all sizes yet still accept samples, our entire medical system will be better off.