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Is it cold-turkey time for the free lunch?

May 2009

There is no such thing as a free lunch. Yet, as I was enjoying a free lunch the other day at work, I began to wonder about the truth of that adage. Tasty sandwiches, for sure, and the cookies were even better–but what, just what, could I possibly have to give in return?

Then again, it couldn’t be pure altruism that sent such attractive young people from Airway (named changed) Healthcare to my hospital and made them so determined to give me stickers that read, “Home O2, Airway Healthcare to provide,” to be pasted on discharge orders.

My hosts even encouraged me to help my oxygen-dependent patients who planned to fly in the near future by prescribing one of their oxygen concentrators. One particular airline, I was told, has the gall to charge passengers who need in-flight oxygen an additional $100 fee for each flight segment. Fortunately, with the Airway concentrators, I can help my patients avoid being gouged by the airline industry.

I’m being a tad sarcastic here, of course, and I’m not so naive as to think that the Airway folks have only my and my patients’ best interests in mind. But I’m also making a point: It might behoove us to be more cynical about the free lunches doled out by drug companies.

I was able to find an article that appeared on the front page of the New York Times: “Oxygen Suppliers Fight to Keep a Medicare Boon.” Turns out the airlines aren’t the only ones making a buck off of oxygen.

According to the article, oxygen cost Medicare more than $1.8 billion in 2006. In addition, despite Medicare’s potentially enormous ability to negotiate prices because of their immense buying power, the government currently pays over $8,000 per patient for oxygen equipment.

According to the Times piece, this is twice what the government would pay if it purchased the same equipment at a local drugstore. Not coincidentally, I would surmise, Airway was busy paying for more than my lunch: In 2004, the company spent $1.5 million on federal lobbying.

Will I be able to wean myself off free lunches? If I do so, is it even remotely possible that my decision will affect a multi-billion dollar industry? (“No” is the obvious answer to the second question.) It is interesting to note, however, that starting July 1, Massachusetts will impose a state-wide ban on gifts to physicians from drug and device companies and set a limit as to how much those companies can pay for physician meals. And a number of medical schools have recently banned or limited the activity of pharmaceutical representatives on their campuses. (See one example here.)

Although I have never accepted any money from big pharmaceuticals (at least prior to becoming a “famous blogger”–Pfizer, are you reading this?), I have asked such companies for assistance in sponsoring lectures for local SHM chapter events in the past. More recently, our chapter events have gone “pharma free” and we are now trying to reacquire the taste for PB&Js.

And here’s the rub: It is easy to give up free pens and even free sandwiches, but not so simple to eliminate the deep-pocket support on which certain sectors of our field ultimately depend, like CME. (In fact, the Massachusetts ban is drawing protests from hotels and convention centers there, claiming that the CME business in the state will dry up.)

Obviously, our ability to treat patients will not be compromised if we hold local chapter meetings at a pizzeria instead of a steakhouse. But it is also true that a good deal of important pharmaceutical-sponsored research may not get off the ground without such networking and funding. This is particularly the case, I am told by some academic colleagues, now that the NIH and other government funds are becoming more difficult to secure.

Yet I do have my principles. The same Times article describes how Medicare spent $21 million on pumps to help men get erections at a cost of $450 a pop. Turns out these same pumps are available online–which will not come as no surprise to anyone with an e-mail account and a faulty spam filter–for less than one-fourth what the government pays for them.

I draw the line at accepting a free lunch from the marketers of an erection pump. Then again, as a hospitalist who hopes never to need to treat erectile dysfunction in the hospital, I am hoping I will never have the need to fend them (and their free sandwiches) off.