By Chris Stookey
During my medical residency in the 1990s, the hospital where I worked put on, like most hospitals, a monthly “drug luncheon.” A drug luncheon is something akin to a fair where drug companies operate booths pitching their various wares, in this case, drugs. The drug companies, themselves, pay for the event. I remember how my fellow residents would get excited on drug luncheon day. There would be free food, flashy slide-show presentations, and free gifts. All the doctors, residents, and medical students at the hospital were invited to attend.
We would walk into the large conference room where the luncheon was held, and we would immediately be assaulted by the smell of simmering casseroles and by blue-suited drug salesmen, the so-called “drug reps.” We would pile our plates with free food, then the drug reps would invite us to visit their booths where we were promised a variety of gifts. The gifts would range to include free drug samples, free stethoscopes, and free trips to tropical places. Nearly every drug rep offered you a complimentary pen with the company logo on it. There were also free penlights, free centimeter rulers, free tee-shirts, and free coffee mugs—all with the company logo, of course.
In addition to the free food and gifts, we also earned free “CMEs,” continuing medical education units, at these lectures. All doctors must stay up-to-date by attending lectures and taking medical courses, and all must earn a certain number of CME credits every year to keep their licenses current. As it turns out, the pharmaceutical industry funds about half of all CME courses offered in the United States, and CME credit was an important part of the drug luncheon experience during my residency days. Simply by signing our names on an attendance sheet at the luncheon, we earned valuable CME credit.
All we had to do in exchange for the free food, gifts, and CMEs was listen to a four- or five-minute sales pitch by this or that drug rep regarding his company’s newest and greatest wonder drug just brought to market. In addition, there were lectures and videos promoting featured drugs.
I always came away from these luncheons feeling a little “unclean.” Had we all just been pawns in a big brain-washing scheme, a scheme to get us to prescribe the drugs pitched at the luncheon? My fellow residents all answered this question with a resounding, “No!” They all said their prescribing habits were not in any way influenced by these luncheons. They were just there for the free food and gifts.
But, I wondered: if no one’s drug-prescribing habits were influenced by the free food and gifts, then why were the drug companies spending so much money to put these luncheons on in the first place? Was it simply because they liked us? I suspected the truth was the marketing departments at the drug companies had thoroughly researched the answer to the question, and the answer was a resounding, “Yes! Drug luncheons do influence prescribing behavior.”
Yet, if the luncheons influenced prescribing, was this ethical? Shouldn’t doctors be prescribing medications based what’s best for their patients—rather than on a free lunch and a fountain pen?
I’m certainly not the only one who feels uncomfortable about drug-company-sponsored free food and CMEs. Dr. Marcia Angell, a former editor-in-chief of The New England Journal of Medicine, has been outspoken in her criticism of this practice. Dr. Bernard Lo, a leading medical ethicist at the University of California, has called for an end to drug-company-funded CME conferences. In June of this year, the University of Michigan Medical School announced it would no longer accept drug company money for CME coursework (the first medical school to do so).
According to an article appearing in The New York Times (June 23, 2010), drug companies and medical device manufacturers spend around $1 billion a year to sponsor CME events. The drug companies maintain they offer lectures, information, and courses that are free from bias. Dr. Michael Steinman, a professor of medicine at the San Francisco V.A. Medical Center, disagrees. As quoted in the Times article, Steinman believes: “The course providers have a subtle and probably unconscious incentive to put on courses that are favorable to industry because they know where their bread is buttered.”
Meanwhile, as I wander around the hospital where I work today, I still see the signs of drug company marketing. There’s the doctor who just walked by with a drug company pen in her white coat. There’s another doctor drinking coffee from a mug with the name of a popular antidepressant written on it. Another doctor gleefully tells me he’ll be going to a medical conference in Hawaii—meals and CME credits paid for by the drug company sponsoring the event.
I tell my colleague to have a good time in Hawaii. Rather than mention my discomfort with drug-industry-sponsored CME, I simply shrug my shoulders and say: “Be sure to wear sunscreen.”