Among the many contentious debates embroiling the pharmaceutical industry in recent years is the argument that freebies given to doctors - gifts, meals, dinners and trips - unduly influence the physican mindset. But why do some docs believe accepting such goodies is okay? A new study offers a clue - some docs believe these treats are a reward for the sacrifices made to study medicine.
Two Carnegie Mellon University researchers asked 301 pediatric and family medicine residents about the appropriateness of accepting freebies. But they were divided into three groups. Before completing the survey, one group was asked about sacrifices made in getting their education. Another group was asked the same questions but also whether the sacrifices - poor working conditions and school debt - justified accepting gifts. The last group was asked about accepting gifts but without first being asked about personal sacrifices or justifications that may have allowed them to rationalize.
The upshot? First reminding docs of the effort to obtain their medical education more than doubled their willingness to accept gifts - from 21.7 percent to 47.5 percent - and suggesting the potential rationalization further increased their willingness to take a freebie - to 60.3 percent (here is the abstract).
The finding "suggests that even justifications that people don’t accept at a conscious level can nonetheless help them to rationalize behavior that they otherwise might find unacceptable,” Sunita Sah, the study's lead author and a former practicing doc who consulted for drugmakers, says in a statement. "Given the powerful human capacity to rationalize what benefits us, it is unlikely that we will be able to make a dent in the problem by, for example, educating physicians about the risks posed by conflicts.”
Her co-author, George Loewenstein, was even more succinct: "In other areas of life, bribes are a crime," he tells The Pittsburgh Post-Gazette. "The obvious policy response is eliminating the ability of pharmaceutical companies to pay physicians to prescribe their drugs."
33 Comments
Physician compensation relative to other fields--big business & tech especially--has sharply declined in the last 20 years, even as the educational & ethical demands of the profession have increased. If this continues, it's inevitable that there be some sort of "brain drain" as the generation of doctors who could have entered any field but chose medicine because the economic model was more favorable grows older & retires.
I would like to make a prediction...
If doctors are eventually verboten to take "freebies", you will see the end of the pharma rep. If they cannot bribe/influence the doctor, why are they needed? Any pharma company can ship samples and use other forms of marketing that have a much higher ROI than the avg rep making 120-150K(Total Benefits).
AND they will have much less exposure to False Claims Act litagation.
I'm more worried about my taxes going up next year than the freebies. Unless the GOP comes to my rescue, my taxes will go up by the equivalent cost of a 2011 7-series BMW.
BTW, doctors who really want to soak the drug companies don't bother with the freebie dinners. Foer example, said doctor will befriend an influential manager, who, for example, will supply 50 cases of Dom Perignon Champagne at the doc's kid's wedding in return for promise of the next 100 scripts of a very expensive drug, and said manager will know how to bury the expense. Still happens, trust me.
i can has more drug monies plz?
Canon Communications, which owns pharmalot, is heavily involved with medical devise manufacturers. Just wondering if the doctors involved with these companies discloses what they make, and by the way, is the editor of pharmalot willing to disclose?
I admit I like to make stuff up. Things that happened in the late 80s and early 90s...well honestly it doesn't happen anymore. Everything is automated and the compliance departments have thousands of people combing over rep expense reports. There is simply zero chance of expensing champagne or anything else except maybe hiding a Latte as parking. Everything must be expenses via corporate credit cards so they days I spoke about are over.
Still, I like to bash the commercial side of the industry, particularly reps because I don't like attractive people who seem to have more fun that me in their everyday lives.
Bitter, you bet.
Been a rep for 18 years. All that stuff Pharmavet mentions USED to happen. Not so much anymore.
I know a married couple that are in practice together and they never have to buy food for home except to cover the weekends. They are fed lunch 5 days a week in the office along with their staff and they have reps lined up at night to take them to dinner 5 days a week.
Nobody goes to speaker programs anymore after the ban against spouses kicked in. If you can get 5 out, it is a successful night. I used to have to book rooms for 65 and have waiting lists to See Castelli speak on Framingham. Things have changed. Lucky to get a nurse willing to go out.
Because of all the off-label issues, companies have put strict rules on the reps. Everyone has a Computer Tablet with the step by step detail on it, and varying from the tablet is against the rule. Hours on end of practice detailing each other occurs at meetings. You can't imagine what the executive think is an effective sales technique for doctors is. The companies track which pages they showed you, how long they spent on each page, what order did they present the products, did they get through all pages, how long before the start of the detail and when you signed for samples. The life of a rep is miserable now... It used to be a fun job. Now 50% of the offices limit access and the only offices you can get in see 10 patients a day and aren't real targets for products, but you have to make 10-12 calls a day or you get fired. Some companies even tell the reps how many calls they have to make on a given doctor each quarter to get their bonus. If you are in a clinic that only allows reps once a month and their company says they have to see you 11 times in a quarter, the reps bonus is impacted and they can't do anything about it.
The only thing I'd like to see is... If reps can't buy doctors dinner because it influences them... let's stop the lobbyist in Washington from doing the same.
Years of Pharma: when you consider that the average American family spends 22% of take home pay on groceries, the free food leftovers that the doctor couple take home to feed dinner to their family are not incidental costs. Also, office staff these days more or less expect free lunches as a standard fringe benefit, and the rep had better get the food order straight, for these people hold the keys to the inner sanctum, otherwise known as the sample closet.
To the rep above...spot on. I would like to add, because physicians' time is so limited, mistakes due to improper prescribing, too high dose, side effects not known, etc. will continue to happen as long as the role of a rep continues to be a sales job driven by sales, not good medicine. Not one physician I call on can name the major side effects of the competitor medicine to the one I rep. The "perception" of safety has trumped efficacy. If the role of a pharma rep goes away entirely, I blame the industry execs who continue to believe representing MEDICINE (not drugs, like say, heroin) is a sales job. A great clinical rep is a needed fixture long-term, a bagel-toting barbie or ken doll sales rep is not (save for Botox sales perhaps).
Absolutely! I've seen employment advertisements for doctors offices that state "free lunch supplied daily".
I know multiple office that you have ZERO access without lunch. I also know offices that require lunch for access but that doesn't guarantee contact with a doctor. You must sit in the lunch room and if they come, they come. If they don't...thanks for feeding our 35 staff members, when would you like to schedule your next lunch. It wasn't uncommon to have 3 out of the 10 doctors come talk to me, yet ALL their nurses came and ate and usually one of them made the doctor a plate and took it back to him.
I know an office that first thing they hand you as a new rep is the pre-printed Starbucks order that must be delivered at 7:30am. You have to sign up for the privilege to bring the coffee to the 18 employees and 4 doctors and NO detailing allowed. You will be allowed to capture a signature only. Any attempt to detail will result in you being banned from the office.
I had a doctor try to SHAKE me down for under the table money. He insisted on a $1500 donation to his boy scout troops golf tournament. If we didn't give it to him, he would switch all patients off of our drugs. We told him if he was 501c3 we could give it to him, no problem. He preceded to tell me that I could CLAIM he did a speaker program for me and pay him an honorarium for doing it. He would tell the company it happened and that is how we could donate. He told me that other companies were doing it and if I didn't he wouldn't use my drugs and I wouldn't be allowed to see the other doctors in his clinic. I didn't do it. Other reps did. He told other people which reps did it and YES, he switched all of his patients to the drugs sold by those companies.
I know doctors that won't see reps unless they need your samples... and not to prescribe them but for his FAMILY. He will call you and call you and when you tell him no, he reports you to your company.
I know doctors that belong to these "round table" clubs... I don't remember what that company calls them, I'd have to go look it up. But they have 4-5 doctors that get together for dinner every 3-4 weeks and rotate "the speaker" for their honorarium, so each doc in attendance gets the max speaker money for the year and the rep gets their required number of speaker program in and everyone gets a free meal with friends every few weeks... (and this one is STILL going on!)
Whitney- That "clinical" rep is few and far between anymore. I'd say they went away around 2006. There are so many Ken and Barbie that the perception that we are all idiots is hard to dispute. I can't sit through a meeting without wishing someone would just shoot me! Reading CafePharma is just embarrassing. I can't believe what the job has come to.
YearsOfPharma, we are kindred spirits! The job is ridiculous and it happened because those in leadership forgot their mission is medicine, not cars, not cell phones, etc. All the sales-driven rep's and DM's from the golf and spa heyday of pharma (80's and 90's) are "leading" our industry into oblivion. They didn't get it then, and they don't get it now. It's a shame. It only took 10-20 years to take this industry from great to junk, and they seem to think the business model still works? Wake up! As for compliance...it is in place because of sales-focused efforts vs. good medicine. Offices wanting lunch every day? Because of sales-focused (read: clinically meaningless) activities, low-value interactions "Did you see gossip girl last night OMG???" Offices pretend to like all reps to get a free meal. Barbie, if you think you are liked more for your banter, grow up and seek employment in a department store. I only hope someday we can get back to being clinical consultants. Pharma companies made money then and had a sustainable and appreciated business model. Teaching institutions WANTED us there. Patients were helped by the education WE gave physicians. Reps were respected.
I don't care. I just want it on the record that reps have zero value. ZERO! I mean when I rode with them, they paid me no attention and little did they know I controlled the feedback ZS got. Not their DM or the RM, ME!
See who is paying now.
Yeah, ZS Associates did such a "clever" job; 4-7 reps per territory but only if managed care coverage dicates a rep(s) is needed. Their business model is as innovative as a cupcake pan. ZS in effect took us back to the Pfizer model, with the exception of zero coverage in poor markets (read: generics only). I don't seem to recall any physicians begging for more reps, do you? And ZS...docs have already figured out each rep carrying a "unique" portfolio is a smoke-screen...docs are actually smart enough to figure out we all work for the same company. I have to admit, ZS did one heck of a sales job on our industry to convince it to use their model, either that, or my theory of sales-driven 80's-90's former reps/dm's driving our industry into oblivion is coming to fruition, one signed contract with ZS at a time.
Hey, To all of the old-timers that are taking pot-shots at the reps that haven't done this for 20 years....this job is whatever you make it. Of course it has changed...you need to evolve with it or leave. There is honestly no reason you should like this job as much as you used to. It has eroded massively. However, if you haven't noticed, the doctors have allowed themselves to be dominated by managed care companies so they have effectively stopped caring about medicine as well. They don't want to hear about drugs that they can't prescribe to most of their patients anyways because of cost. It is like selling all the features of a BMW to people that can't afford a Toyota. It all sounds great but who cares if you can't buy one. They will sit and listen for the free stuff but really don't care much. They are beaten down by the system.
I was in that Pfizer model for 7 years. We actually had 11 (yes, ELEVEN)Pfizer PRIMARY CARE REPS in each territory. PLUS, there were the specialty reps, the hospital reps...What a freaking nightmare! There were EASILY 200 Primary care reps in my city and 12 different district managers.
They saw Pfizer more frequently than they saw their wife and kids.
i can has meet more drug reps plz?
My FAVORITE take advantage office was one that takes FOREVER to be trust enough to get on the "lunch list" as they only allow a very limited number of reps to bring them lunch and they give those reps the next years calendar in Oct. to fill in all their appointments for next year, so the opportunities to belong to the "in-crowd" are limited.
He is a HUGE doctor in almost every catagory! He sees 40-45 patients a day and everybody gets prescriptions, he is a MACHINE! So lunch is valuable because you usually have to wait 4 hours to see him. You have to be one of the first 3 reps to show up in the morning and wait until he is free.
The morning of the lunch the office will call you to get your credit card number. An hour later, they call you back and tell you where they are ordering lunch from and ask what you want to order. When you get there at 11:45 the table is covered in food and someone hands you a receipt. The receipt for 1 doctor and 11 staff is $450. You are dumbfounded... but quickly learn... they ordered appetizers (some even ordered 2!), lunch, dessert, extra meals to take home for the kids or dinner.
If you complain, you get kicked off the lunch calendar. If you try to bring your own order, they cancel all future lunches.
The doctor finally finishes his morning at 2-2:30. gives you 5 minutes and goes into his office and shuts the door to eat his lunch.
My favorite situation...similar as the one you described. Curveball? Your budget is cut, etc. (take your pick) and you can't provide as elaborate a lunch. What happens? The doctor who was prescribing your medicine 80% of the time now prescribes your competitor - who can still provide an elaborate lunch - 80% of the time. And reps are the problem here??? Ha ha ha...ugh.
In the early 90s when I was a big pharma contractor - we worked on things like the dash and dine, the gas and go, and the spa and go.
Nothing has changed since then. The industry does the same thing. The reps are just as hot as 1994 and just as dumb.
I can sell more in my cube than any gel head ever will. Don't you get it. We rule the world now - not you dumb jocks and hot blondes.
They needed to do a study to find out why doctors are so amenable to accepting pharmas' gifts? What a waste of time an money. OF COURSE, they feel it's a reward for their sacrifices. WHAT SACRIFICES? For having to study to hone their craft like other people with PhD's and other degrees (and non-degrees) do? THAT'S A SACRIFICE?
I knew they felt this way, because I know doctors well. Knowing them well is what I do to help patients find some who will treat them as humans. ROFLMAO
Doctors think they ought to just graduate college and become big money earners as MD's. But no. They have to study.
Awful. Just awful.
Betsy, with all due respect, most PhD's get to see their families and sleep in their own beds every night. When I was an Internal Medicine Resident we were required to be on call every other night and in the hospital until 8 PM on off-call nights. This meant 100+ hour weeks that included only 3-4 nights/week where we slept in our own beds. On those nights we were barely conscious enough to greet our families before making a bee line to the bedroom.
There is no comparison with any other profession with respect to work schedule.
tell that to students and postdocs in major research groups
Ha! I just read of impersonators on another thread and come back here and find one of me!!
Where do you all get off saying 'freebies' influence drs? I would hate to 'dumb down' any dr that takes a lunch/dinner or god forbid the all mighty pen/pad give away-thinking that they were going to write a RX the minute I left. Let me say this-this industry is over regulated and has heavy misleading things printed about it every day. No other industry is as heavily regulated as ours. With all the fall out over the housing market and what took place on wall street recently-maybe if someone had been watching them as closely our economy wouldn't be in the tank. If you take someone away from their private time, have a set limit on what you can spend, what you can say-I see no reason why a spouse can't attend. The first time I see a dr write a script because of a lunch/dinner, pen/pad I left and not because it will benefit the pt-I am done with healthcare all together.
Cut to the REAL debate: Doctors need to regain their authority to make the call for what treatment (not just medicines) each of their individual patient needs.....because this is what they were trained for, not to do face remakes and fat cell suction jobs (get on with that diet). So what will it take......?
It is (was) all a matter of degree. Reveiving a free lunch or being taken out to dinner at a local place is one thing it is an entirely different animal when it's Golf Outings, Major League Games (great seats of course), Broadway Shows and Dinner at the latest 5-star restaurant with $200 bottles of wine. I know a rep who ended up with a $20,000 dinner bill in Manhattan... yes $20,000! And this was not dinner for 200 people, more like 20. Yes Virginia there are places that charge that kind of money. Hey, "you HAD to use up your entertainment budget otherwise you'd receive less the following year." Wow. But a burger at Billy's? Why not?
And by the way there have been numerous studies showinf that docs are influenced by pharmas' gifts... in a big way. And by the way do you think pharma is giving away the store to interns and residents, the guys and dolls, with the big debts? Heck no! The ones that get the really big and juicy gifts and freebes and trips to the islands are the established guys who then turn around and influence the interns and residents training in hospitals. The office based guys just write more and more prescriptions. You write more you go from the Kings to the Lakers, you go from row 100 to row 10, you go from 3-stars to 5-stars, get the picture. Docs (not all) are pigs, they believe they deserve everything because of their sacrifice. Yes it is a difficult road to go down and we are grateful for the smart, caring ones that did, but they made the decision. Hey professional licenses are a good thing, you can always be your own boss.
A lot of the stories you all speak of where years ago!! The blame game has to stop. Does anyone every think of personal responsibility and consequences of their actions?
Everyone is to blame, doctors, reps, companies, insurances. We all benefited and now when things start to change everyone points the finger at someone else.
Pharmavet: I would have welcomed you in my territory anytime. I know we haven't agreed in the past, but I respect your knowledge and your stories.
take care...
There's lots to criticize about the past, but let's direct our gaze away from the rear-view mirror and look at the road ahead: - Freebies from pharma, other than meals, have (almost) all been eliminated. - Samples in Europe have been eliminated and the US may be next. And mail shipment of samples is starting to take over. - Meals are on the way out, thanks to the Physician Payment Sunshine Act, which kicks in Jan 1 2012 - 15 months away. The dollar value of meals to physician offices will be posted for all to see - it'll be a complete embarassment for offices that squeeze phamra reps for free meals.
The pharma industry is slow to change, but will have no choice. It may be that the only reps who will get access are those armed with "value" in the form of science and services. That might sound idealistic, but I think it's safe to say that reps will no longer be Kens and Barbies who "drop off stuff," because the "stuff" is going away.
Thanks, Best. However, I would pose a somewhat rhetorical question. If a physician is shameless enough to regularly order a $450 luncheon spread for his office staff of 12, how could he possibly be worried about seeing his name literally buried among thousands of other physicians in 6-point type on an Excel spreadsheet that you know the company will make so unwieldy that it will be all but impossible to manage or be too large a file to open in the first place?
You have to bride them I thought. My dad would hire doctors to test out his products (stents). They wanted the whole family to come (4 people) - 1st class. While they were here my stepmom went to rent them a car and they "wanted the big car cause in Sweden they drove a small one". We went to 4-5 dinners and they never picked up the bill. This was what they were always like accoring to my dad.