As the adage goes, “There’s no such thing as a free lunch.” This phrase dates back to the 19th century when bars would offer their patrons a “free lunch” so long as they bought something to drink. The meals were frequently highly salted. That led to a tremendous thirst, to be quenched with large amounts of beer (for which the drinkers paid). “No free lunch” obviously means that you can’t get something for nothing. Most people understand this principle. We don’t want judges, referees or other impartial experts to have their decisions clouded by favors.
What about physicians? Many doctors have believed for decades that it is OK to accept free dinners for themselves or lunches for them and their staff from the pharmaceutical industry. According to an investigation by The New York Times (Jan. 16, 2012), about two-thirds of doctors in the U.S. have done so. Some physicians (about a quarter of them) regularly accept more significant gifts, such as travel or even cash payments. In some cases, consulting fees or lecture honoraria can reach hundreds of thousands of dollars for a single physician.
Policy experts worry that such financial relationships have altered the practice of medicine in ways that do not put patients’ interests first. Many doctors don’t believe that this is the case, but studies show that financial ties to the industry can influence the practice of medicine as well as research results (Archives of Internal Medicine, May 11, 2009 & April 26, 2010).
The federal government is poised to implement new rules requiring disclosure of payments and even “free lunches.” Drug companies will have to list in a public manner the names of the physicians and clinics receiving such gifts.
It’s not clear exactly how soon these regulations will go into effect. They were originally scheduled to start in October, 2011, but the public now has until mid-February to comment on the concept. Policy makers hope that more transparency will cut over-prescribing and result in more cost-effective care.
Despite disclosure, many doctors may continue to accept payments for speaking to colleagues or supervising research. Perhaps most patients won’t find this objectionable, but they may be prompted to ask why one medicine is being prescribed instead of another.
As pharmacist Allan J. Coukell, Director of Medical Programs at the Pew Health Group, told The New York Times, “Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.”
Patients also have a responsibility to seek out the evidence rather than being swayed by prescription drug ads they see on television. Following the drug companies’ admonitions to “ask your doctor” for the advertised product can result in inappropriate and excessive prescribing.
If we expect objective decisions from judges and umpires, shouldn’t we expect the same from our health care providers? After all, our health may depend on their impartial judgment.
