[Ip-health] Drug Makers Pay for Lunch as They Pitch

[James Love]

*=93We found that some offices get breakfast and lunch every day,=94 said
Dr. Scott, who calls lunch the =93currency=94 that buys access to
doctors=92 offices for drug representatives. He also noted that some
doctors were hard pressed to meet payrolls and that the lunches
provided an added benefit for their employees.  =93Essentially, we feel
that most of what the pharmaceutical reps do works at an unconscious
level,=94 Dr. Scott said. He said most doctors said they were not
influenced by the food deliveries and other small gifts. But, he
added, =93They do influence prescribing.=94  The $258 Merck lunch, for
example, cost the company only $10.75 a person and fell clearly
within industry guidelines allowing modest meals. But it could easily
return thousands of dollars for the drug maker in prescriptions for
the osteoporosis medication Fosamax and the asthma treatment
Singulair, the two drugs discussed during lunch with two Merck
representatives.

http://www.nytimes.com/2006/07/28/business/28lunch.html

Drug Makers Pay for Lunch as They Pitch

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By STEPHANIE SAUL
Published: July 28, 2006

Anyone who thinks there is no such thing as a free lunch has never
visited 3003 New Hyde Park Road, a four-story medical building on
Long Island, where they are delivered almost every day.

On a recent Tuesday, they began arriving around noon. Steaming
containers of Chinese food were destined for the 20 or so doctors and
employees of Nassau Queens Pulmonary Associates. The drug maker Merck
paid the $258 bill.

A deliveryman carrying trays of gourmet sandwiches sashayed past
patients at Advanced Internal Medicine. The bill showed that Takeda
Pharmaceuticals was picking up the bill. The doctors in the group
must have liked the sandwiches. The next day, the exact same delivery
came in, paid for by Cephalon.

Free lunches like those at the medical building in New Hyde Park,
N.Y., occur regularly at doctors=92 offices nationwide, where delivery
people arrive with lunch for the whole office, ordered and paid for
by drug makers to the tune of hundreds of millions of dollars a year.

Like the =93free=94 vacation that comes with a time-share pitch attached,
the lunches go down along with a pitch from pharmaceutical
representatives hoping to bolster prescription sales. The cost of the
lunches is ultimately factored in to drug company marketing expenses,
working its way into the price of prescription drugs.

Doing business over lunch is a common practice in many fields, but
drug makers have honed it to perfection, particularly since 2002,
when the drug industry adopted a new code banning many other free
enticements =97 golf outings, athletic tickets, trips and lavish
dinners for doctors. The code gives approval to modest meals in the
course of business. And conventional wisdom in both the
pharmaceutical industry and the medical profession is that a lunch is
too small to pose an ethical problem. But a growing number of critics
say that even those small lunches should be banned.

A former pharmaceutical representative, Kathleen Slattery-Moschkau,
called lunch =93incredibly effective=94 in lifting pharmaceutical sales
for the companies where she worked, Bristol-Myers Squibb and Johnson
& Johnson.

=93We got the numbers of what the physicians were prescribing. If I
brought in lunch one week, I could see the following week if that
lunch had an impact,=94 Ms. Slattery-Moschkau said.

Dr. John G. Scott, assistant professor of family medicine at the
University of Medicine and Dentistry of New Jersey-Robert Wood
Johnson Medical School in New Brunswick, N.J., is examining the
interaction between medical practices and pharmaceutical
representatives.

=93We found that some offices get breakfast and lunch every day,=94 said
Dr. Scott, who calls lunch the =93currency=94 that buys access to
doctors=92 offices for drug representatives. He also noted that some
doctors were hard pressed to meet payrolls and that the lunches
provided an added benefit for their employees.

=93Essentially, we feel that most of what the pharmaceutical reps do
works at an unconscious level,=94 Dr. Scott said. He said most doctors
said they were not influenced by the food deliveries and other small
gifts. But, he added, =93They do influence prescribing.=94

The $258 Merck lunch, for example, cost the company only $10.75 a
person and fell clearly within industry guidelines allowing modest
meals. But it could easily return thousands of dollars for the drug
maker in prescriptions for the osteoporosis medication Fosamax and
the asthma treatment Singulair, the two drugs discussed during lunch
with two Merck representatives.

An official of Merck=92s sales and marketing division, Patrick T.
Davish, says his company views lunch meetings as appropriate and =93a
good time to sit around and talk about the clinical properties of
your drug and the disease categories you deal with.=94 Spokesmen for
both Takeda and Cephalon emphasize that the lunches they pay for are
modest.

Dr. Scott cited several studies that show that the lunches =97 plus
small gifts like pens and sticky notepads, along with drug samples =97
can lead doctors to prescribe the more expensive brand names when
cheaper generic drugs would be as effective.

Such concerns have spurred the effort to ban lunches. The movement is
making headway nationwide, as opponents of the practice cite ethics
questions. The hospital at the University of Pennsylvania became the
latest large institution barring industry-paid lunches, effective
July 1, according to its medical director, Dr. Patrick J. Brennan.

=93It curries favor and it creates influence, and it introduces
influences into decision-making processes that we think ought not to
be there,=94 Dr. Brennan said.

Similar rules have been adopted recently at several other academic
medical centers. When the University of Michigan Health System banned
industry lunches last year, officials calculated that they had been
worth $2.5 million annually.

In Madras, Ore., meanwhile, a group of internists earlier this year
banned not only lunch but also visits by drug representatives. Even
in Madras, a rural town of about 5,000, the group got visits from
more than 30 drug representatives a month, including two or three
lunches.

=93The complaints that I would get from my patients were, =91You=92re 15
minutes late to see me.=92 =94 said Dr. David V. Evans, a member of the
group. =93 =91O.K., I was back there talking to a drug rep.=92 That wasn=92=
t
such a good thing.=94

Dr. Evans added, =93It=92s an issue of professionalism and integrity,
really.=94

The pharmaceutical industry employs about 90,000 representatives.
While some patients grumble about their ubiquitous presence in
medical office waiting rooms =97 and many are aware of lunch deliveries
=97 others say the intrusion is worthwhile in exchange for the free
drug samples.

=93The doctors I go to only see them at certain times,=94 said Arnold
Dimond of Glen Oaks, N.Y., who was leaving the New Hyde Park building
recently, carrying a plastic bag of drug samples. =93The samples save
you quite a bit of money, too.=94

One of the most vocal opponents of free lunch is Dr. Bob Goodman, a
Manhattan internist who formed an organization called No Free Lunch.

=93I=92d say that lunches are going to be one of the last things to go,=94
Dr. Goodman said. =93The interesting thing is that it=92s generally not
something doctors are ashamed about. That=92s why I find this thing so
fascinating. They don=92t think they=92re doing anything wrong.=94

At 3003 New Hyde Park Road most of the doctors contacted declined to
be interviewed for this article. But one, Dr. Javier Morales, said
the samples that representatives bring to his office are helpful for
low-income patients.

And Scott M. Lassman, senior assistant general counsel for the
Pharmaceutical Research and Manufacturers of America, said: =93It=92s our
feeling that a modest meal is not the type of thing that is going to
interfere with the independence of a health care practitioner. It=92s
really a recognition that these folks are extremely busy. They don=92t
have time to talk. Perhaps the only time they do have time to talk is
over lunch or dinner. So we thought it was appropriate for the sales
rep to pay for that.=94

Not every doctor=92s office gets free lunches at 3003 New Hyde Park
Road, though many do. The deliveries often start even before
lunchtime, with representatives bringing in pastries and large
containers of coffee from Starbucks or Dunkin=92 Donuts.

Ms. Slattery-Moschkau, the former pharmaceutical representative, said
that nurses and staff members in some offices were quite demanding
about lunch.

=93It was almost a game, and it was unbelievable the animosity they
would show if you did not bring the right kind of food, or if it was
the third time they had pizza that week,=94 said Ms. Slattery-Moschkau,
who left the industry in 2002 and recently wrote and directed the
documentary =93Money Talks,=94 in which the practice of lunch is discussed.

Midweek lunches, when all the doctors are sure to be in the office,
are considered prime time.

=93Wednesdays are big,=94 said Larry Plompen of West Islip, N.Y., who
peddles lunch and coffee out of a refrigerated truck at 3003 New Hyde
Park Road. Several years ago, Mr. Plompen said, a drug company
purchased lunch from his truck for the entire staff of a large
practice in the building.

Other entrepreneurs have also capitalized on the business =97 a segment
of the restaurant industry that one national lunch-ordering company,
Lunch and Earn, estimates is worth $4 million a day, or as much as $1
billion a year. A founder of that company, Amy Kristjanson, a former
pharmaceutical representative, said her numbers were based on a
calculation of lunch spending by representatives for the top 10
pharmaceutical companies.

Mr. Lassman said he was not aware of any industrywide figure for the
cost of such lunches. But various sales representatives,
pharmaceutical companies and the lunch delivery industry supplied
estimates of how much is spent for lunch. Judy Kay Moore, spokeswoman
for Eli Lilly, for instance, said that company=92s representatives
spend $500 to $750 a month for lunches. Joseph R. Carolan, an owner
of Casa Mia=92s in Nottingham, Md., which does a large pharmaceutical
lunch delivery business in the Baltimore area, said the average
representative he deals with has a monthly lunch budget of close to
$2,000.

Mr. Carolan said his lunch business =97 about 30 to 40 orders a day =97
exploded after the new industry marketing code was adopted in 2002.

=93I got into this because the feds cracked down on the more
extravagant things they were doing: the dinners, courtside N.B.A.
games, flying them to the islands.=94 Mr. Carolan said.

He is also on the forefront of another marketing trend: rewards
programs for pharmaceutical representatives.

One who spends $5,000 at Casa Mia=92s, for example, can get a $100 gift
certificate to Nordstrom, one month of tanning, or a Swedish massage
with a manicure and pedicure.

Ms. Kristjanson, the former representative who founded Lunch and
Earn, said that lunch represented a fundamental shift in the business.

=93Reps used to have more freedom,=94 Ms. Kristjanson said. =93Lunch is
sort of what it=92s come down to.=94

---------------------------------
James Love, CPTech / www.cptech.org / mailto:james.love@cptech.org /
tel. +1.202.332.2670 / mobile +1.202.361.3040

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