Well I guess SOMEONE has to pay!
Published: July 28, 2006
Anyone who thinks there is no such thing as a free lunch has never visited 3003 New Hyde Park Road, a four-story medical building on Long Island, where they are delivered almost every day.
Articles in this series are examining how money from drug and medical device companies can influence the ways doctors conduct business and practice medicine.

Indictment of Doctor Tests Drug Marketing Rules (July 22, 2006)
On a recent Tuesday, they began arriving around noon. Steaming containers of Chinese food were destined for the 20 or so doctors and employees of Nassau Queens Pulmonary Associates. The drug maker Merck paid the $258 bill.
A deliveryman carrying trays of gourmet sandwiches sashayed past patients at Advanced Internal Medicine. The bill showed that Takeda Pharmaceuticals was picking up the bill. The doctors in the group must have liked the sandwiches. The next day, the exact same delivery came in, paid for by Cephalon.
Free lunches like those at the medical building in New Hyde Park, N.Y., occur regularly at doctors’ offices nationwide, where delivery people arrive with lunch for the whole office, ordered and paid for by drug makers to the tune of hundreds of millions of dollars a year.
Like the “free” vacation that comes with a time-share pitch attached, the lunches go down along with a pitch from pharmaceutical representatives hoping to bolster prescription sales. The cost of the lunches is ultimately factored in to drug company marketing expenses, working its way into the price of prescription drugs.
Doing business over lunch is a common practice in many fields, but drug makers have honed it to perfection, particularly since 2002, when the drug industry adopted a new code banning many other free enticements — golf outings, athletic tickets, trips and lavish dinners for doctors. The code gives approval to modest meals in the course of business. And conventional wisdom in both the pharmaceutical industry and the medical profession is that a lunch is too small to pose an ethical problem. But a growing number of critics say that even those small lunches should be banned.
A former pharmaceutical representative, Kathleen Slattery-Moschkau, called lunch “incredibly effective” in lifting pharmaceutical sales for the companies where she worked, Bristol-Myers Squibb and Johnson & Johnson.
“We got the numbers of what the physicians were prescribing. If I brought in lunch one week, I could see the following week if that lunch had an impact,” Ms. Slattery-Moschkau said.
Dr. John G. Scott, assistant professor of family medicine at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick, N.J., is examining the interaction between medical practices and pharmaceutical representatives.
“We found that some offices get breakfast and lunch every day,” said Dr. Scott, who calls lunch the “currency” that buys access to doctors’ offices for drug representatives. He also noted that some doctors were hard pressed to meet payrolls and that the lunches provided an added benefit for their employees.
“Essentially, we feel that most of what the pharmaceutical reps do works at an unconscious level,” Dr. Scott said. He said most doctors said they were not influenced by the food deliveries and other small gifts. But, he added, “They do influence prescribing.”
The $258 Merck lunch, for example, cost the company only $10.75 a person and fell clearly within industry guidelines allowing modest meals. But it could easily return thousands of dollars for the drug maker in prescriptions for the osteoporosis medication Fosamax and the asthma treatment Singulair, the two drugs discussed during lunch with two Merck representatives.
An official of Merck’s sales and marketing division, Patrick T. Davish, says his company views lunch meetings as appropriate and “a good time to sit around and talk about the clinical properties of your drug and the disease categories you deal with.” Spokesmen for both Takeda and Cephalon emphasize that the lunches they pay for are modest.
Dr. Scott cited several studies that show that the lunches — plus small gifts like pens and sticky notepads, along with drug samples — can lead doctors to prescribe the more expensive brand names when cheaper generic drugs would be as effective.
Such concerns have spurred the effort to ban lunches. The movement is making headway nationwide, as opponents of the practice cite ethics questions. The hospital at the University of Pennsylvania became the latest large institution barring industry-paid lunches, effective July 1, according to its medical director, Dr. Patrick J. Brennan.
“It curries favor and it creates influence, and it introduces influences into decision-making processes that we think ought not to be there,” Dr. Brennan said.
Similar rules have been adopted recently at several other academic medical centers. When the University of Michigan Health System banned industry lunches last year, officials calculated that they had been worth $2.5 million annually.
In Madras, Ore., meanwhile, a group of internists earlier this year banned not only lunch but also visits by drug representatives. Even in Madras, a rural town of about 5,000, the group got visits from more than 30 drug representatives a month, including two or three lunches.
“The complaints that I would get from my patients were, ‘You’re 15 minutes late to see me.’ ” said Dr. David V. Evans, a member of the group. “ ‘O.K., I was back there talking to a drug rep.’ That wasn’t such a good thing.”
Dr. Evans added, “It’s an issue of professionalism and integrity, really.”
The pharmaceutical industry employs about 90,000 representatives. While some patients grumble about their ubiquitous presence in medical office waiting rooms — and many are aware of lunch deliveries — others say the intrusion is worthwhile in exchange for the free drug samples.