If You Don't Feed Them, They Won't Come--the Minnesota Miracle?

When the "free" food disappears, it is funny how quickly the rationalizations follow.

Gardiner Harris reported in last Friday's New York Times that a minor rules change in Minnesota is having a major impact on pharmaceutical marketing in that state. A state official decided to interpret on old law differently from his predecessor. Suddenly, it was verboten in MN for a drug company to give a physician more than $50 worth of food in any given year.

Reps who used to be lined up handing out pizzas now sport styrofoam cups filled with M&Ms.

Now, if the rationalizations we have told ourselves for years had any validity, this would make no difference. After all, physicians are not influenced by the food or the gifts. They spend time with reps because it's educational. The reps have the most up-to-date information about vital new drugs. Of course, physicians who deeply care about their patients' health would go and see the reps for this information, even if there were no goodies attached. Right?

Wrong. Docs are dropping the reps like the proverbial hot potatoes (that are no longer served). A number of medical facilities are suddenly showing an interest in banning reps from their premises--a level of physician integrity that was singularly not in evidence so long as the food was being passed around.

The drug companies Harris spoke to are keeping mum about this. But there is one group of really unhappy campers and one group of happy ones.

The unhappy campers are some catering firms that relied heavily on the drug rep trade. One St. Paul caterer has seen 2/3 of its business dry up. (I always wondered if the entire US economy would tank if all those dollars stopped flowing to pay for the "free" lunches.)

The happy campers are some groups of nurses and secretaries. The drug firms have taken to inviting them, instead of their physician bosses, the the fancy dinners at the fancy restaurants, to hear the talks given by the paid company speakers.

Harris makes it clear that the purpose of these dinners is not to influence the physicians indirectly by having the nurses and secretaries promote the drug to the docs--though the company would not be disappointed with that outcome. Rather, the companies now have a stable of paid speakers with no audience. If they let go the speakers, they would lose that opportunity to reward their highest-prescribing physicians, which, as Harris notes, sometimes earn a cool $100K annually from giving talks. (Time to jettison another rationalization--that drug company paid speakers are chosen because they are content experts or else are especially good communicators. It turns out that the company really does not care who is in the audience or whether the audience learns anything at all.)

Harris G. Minnesota limit on gifts to doctors may catch on. New York Times, October 12, 2007.