Healthy Skepticism Library item: 1018

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Koerner B.
Dr. No Free Lunch: Hellraiser: Bob Goodman
Mother Jones 2003 Mar 3
http://motherjones.com/politics/2003/03/dr-no-free-lunch

Full text:

Five clumps of pens, rubber-banded together, spill from an overstuffed
envelope to the floor of Dr. Bob Goodman’s office. Each ball point bears
the name of a different blockbuster drug — Lipitor, Paxil, Zocor. They
have been sent in by a doctor who’d learned about Goodman’s one-man
organization, No Free Lunch, and its “Pen Amnesty” program: Turn in your
collection of industry-supplied freebies, and Goodman will send back a few
replacement pens bearing the No Free Lunch insignia. “It’s a money loser,”
Goodman says, “but it’s a fun way to spread the word.”
According to the Journal of the American Medical Association (JAMA),
the pharmaceutical industry spends $8,000 to $13,000 per physician each
year to promote its wares, which are hawked by a sales force of roughly
80,000 representatives. “If you randomly look at a doctor’s white coat,
you’ll see a stethoscope tag with one drug company’s name on it,” says
Goodman, an internist who also teaches at Columbia University’s medical
school. “Then there are several pens in their pockets, and calipers, each
with a drug company’s name. We’re walking advertisements.”
The ubiquity of perks has bothered Goodman since his med-school days
in the late 1980s, when he felt uneasy eating pizzas supplied by drug
salesmen. In 1999, Goodman was opening a new clinic for low-income patients
in the Washington Heights neighborhood of upper Manhattan. He decided to
keep the clinic off-limits to drug sales representatives, but that meant
cutting off access to the free drug samples doctors often give to patients
who don’t have medical coverage. “So I decided I was going to make up some
pens and mugs in order to raise money to buy meds for patients,” says
Goodman. He created a website to sell the items, called it NoFreeLunch.org,
and included some salient figures on the industry’s marketing excesses. The
site now attracts roughly 300 visitors a day, and well over 1,000 pens have
been turned in.
Maryann Napoli, associate director of the Center for Medical
Consumers, a nonprofit dedicated to drug-marketing reform, says it’s
crucial for doctors and patients to see that not all health care providers
are comfortable with corporate gifts. “I find [No Free Lunch] to be one of
the few hopeful things in this area,” she says. “So many doctors are now
bought and paid for.”
Though bad press has forced drug companies to scale back some of their
more extravagant gifts, like the Caribbean getaways of yore, Goodman says
expensive dinners, and tickets to Broadway shows and big-league games
remain commonplace. One popular sales technique involves trailing a doctor
to a gas station, then offering to pay for a lube job — during the wait at
the shop, the sales representative has ample time to talk up his product.
Then there are the more lavish perks, like dinner and complimentary rooms
at New York’s Plaza Hotel; as the Washington Post reported last year,
doctors who attended one such gala were also handed $500 checks from the
event’s sponsor, Forest Laboratories.
“Doctors take such umbrage when you suggest that [the perks] influence
what they prescribe,” says Goodman. “But of course they do — otherwise,
they wouldn’t be given out.” Indeed, numerous studies have shown that perks
and meals nudge physicians toward prescribing certain drugs, even when
better and less expensive options are available. By way of example, Goodman
cites the calcium-channel blockers, like Pfizer’s Norvasc, which treat high
blood pressure and can cost more than $2 per pill. Last December, a study
published in JAMA confirmed that those pills don’t work nearly as well as
thiazide diuretics, or water pills, which cost just pennies per dose; yet
the more expensive drugs, which are heavily marketed to doctors, are far
more frequently prescribed.
To alert physicians to such troubling data, Goodman has begun setting
up informational booths at medical conferences, prowling the hallways in a
T-shirt sporting the No Free Lunch logo. He has also started “The Pledge,”
an online oath that asks doctors to swear off pharmaceutical gifts; so far,
more than 200 visitors to his site have signed the pledge.
Goodman’s next step is to convince med schools to educate their
students about the ethical perils of accepting corporate gifts. Campus
chapters of No Free Lunch regularly hold “pen exchange days” to get the
message out, and Goodman works the lecture circuit. “But that’s going to do
very little if med students look around and see their role models doing
this,” he notes. “I’ll give a lecture to first-year students who that
afternoon are going to spend their day with a [doctor] in the clinic. And
those rounds will start with lunch with a drug rep.”