My first boss in community mental health had a favorite saying: “There’s no such thing as a free lunch.” But is that really true?
For many years pharmacy company representatives have been providing physicians and nurses in our organization catered lunches. I believe our organization has tried to informally ban this practice a few times in the past, but it seems to keep returning as new pharmaceutical company representatives are hired and new medications are promoted.
First of all I think we can all agree that the selection of medications for prescribing should be based entirely upon clinical evidence, not promotional gifts. What, however, is the effect of such gifts and how should they be dealt with by behavioral healthcare organizations.
Staff members may see free food as a minor benefit that does no harm and believe that management is “machine-gunning butterflies” in trying to ban or regulate this practice. They may see it as a deserved reward for their hard work and argue that it can help keep them on the job since they don’t have time to go out for lunch, anyway.
Staff members in other departments, however, who do not get the food, may see it as an unfair benefit bestowed upon a select few. The food (including its delivery, setup, aromas, and disposal) may be disruptive and place a burden on other staff members who must clean up after it.
Of course the biggest objection is based on the ethics of the matter. Does a free lunch create a conflict of interest and can it actually bias prescribing practices.
David Grande from the University of Pennsylvania has written. “Gifts associated with pharmaceutical detailing are motivated by a single goal - to increase the sales of a company’s products. Given the evidence that gifts of any value influence the recipient, states should follow the leadership of Massachusetts and avoid setting financial thresholds that would define the permissibility of gifts. However, they should go further by banning all gifts rather than exempting some such as office-based meals.”
Ken Johnson, former member of the U.S. House of Representatives and spokesman for the Pharmaceutical Research and Manufacturers of America (PhRMA) has said, “U.S. physicians are committed to quality health care. It’s part of the oath they take. So, despite what critics say, it’s insulting to suggest that doctors would prescribe treatments based on who gave them a slice of pizza, a pen, or a medical dictionary.”
In response to this, a commenter named Nishkant wrote:“It may be insulting, but the truth is often unkind. …If I do something nice for you, you will want to do something nice for me in return. … So we can angrily demand to know how dare someone accuse doctors of being influenced by promotional freebies?! But that doesn't negate the fact that doctors are human and the rules of evolution and social interaction apply to them too."
According to Jason Dana and George Loewenstein from Carnegie Mellon University, surveys show that many doctors consider small gifts as “ethically more acceptable” than large ones and seems to believe that they don’t affect judgments regarding products. This assumes that physicians are making deliberate conscious choices, which is inconsistent with research regarding self-serving biases.