Doctor to pharma reps: We'll take your free lunch, but not from Boston Market


I suppose if you're going to take handouts from pharmaceutical reps—a practice that's been proven to influence decisions doctors make, even if they think it doesn't—you may as well get exactly what you want out of the deal.

Carmen Drahl, an editor at Chemical & Engineering News who blogs about the cool science that comes out of pharmaceutical chemistry, sent me this example of the industry's less-awesome side. She says:

Even though it's frowned upon these days for doctors to be getting free lunches from pharmaceutical company sales reps, that doesn't mean it doesn't still happen. And at least one medical practice is acting like a real diva about it- specifying everything from what time the food should be delivered to which local eateries are do's and don'ts. Journalist Ed Silverman's Pharmalot blog has posted a memo from a Baltimore practice that reads "like a rider for a concert tour", as one commenter put it.

To be fair, as far as concert tour riders go, this ain't a J.Lo level of detail. But it is amusing/depressing to see a medical practice specify exactly what it takes to buy their loyalty, potentially at the expense of their patients. Especially when that loyalty can be bought, apparently, with lunch from Macaroni Grill.

Image courtesy Flickr user avlxyz, via CC


  1. Well, she could be doing what Sir Francis Bacon is said to have done to maintain neutrality: take bribes from both sides.

  2. This is not as uncommon as it appears. I have an ex that was in surgical supply sales. She told me that she would actually have to schedule when she was going to bring lunch in so as not to conflict with other vendors and that just about all of them had requirements about where they wanted it from…

  3. I was an office nurse for a bit. This is pretty common. I would have to play traffic coordinator with the drug reps that came to the office. We had free at least once a week from different drug reps. I have seen Prozac branded laptops handed out back when they were $2500 to get a bottom of the barrel laptop. I have overheard hushed conversations about exotic vacation “conferences” that I wasn’t technically supposed to know the drug company was paying the doc to go to.

    Some pharma joints also go out of their way these days to hire attractive young gals. Anything to get a foot in the door, and get that doc prescribing the meds they are pushing.

    My favorite job was with a doc that hated them, and I got to tell them to get out. Sadly, he was the only one. It’s kind of expected for them to bring in drug branded swag, espresso, lunch, and more.

  4. We do the same thing, but just because we don’t like having to eat bad food just to learn about new products.
    In fact, theirs seems very reasonable. Subway? Baja Fresh? These are not going to buy any doctors.

  5. When I dated one surgeon, and was living with another, I was often invited to dinners with pharm reps. Hell, I was on their rolodex when they came through town and called me even when my friends weren’t in town.

    The only problem was, I wasn’t a physician…if they called my Dr. XXXX, I’d simply say I Prefer To Be Called XXXX. Never even asked what my specialty was…these guys were like the ultimate spammers…but with food and perks. They’d ask me if it was against my offices policy to accept ‘gifts’, and I’d state Not If They Don’t Find Out…I once had someone ask for my license number so they could give free samples, and I stated I can’t accept those (which I couldn’t…didn’t have a license!) but I got cash instead, so it meant I didn’t have to sell off psychopharms to friends.

    The worst part is now, I have a grad degree in a health profession and working towards a PhD…and technically…it is unethical for me to deal with these guys (actually, it was never guys…it was always identical looking blondes around 25…maybe the occasional brunette if she was ‘ethnic’)…but I miss the steak dinners. Hell, I’d order two dinners to go, and give them to homeless people on the way home and no one ever complained (I told them what I was going to do…said it made the guilt go away and the reps always told me Whatever It Takes To Sleep Easier At Night).

    Seriously, if you are getting bought by Macaronni Grill…you are a whore…I never settled for less than Ruth’s Chris (to which my friends were thankful for because I was the one that negotiated the arrangements).

    1. You mention that taking a meal from Macaroni Grill would make the person a “whore” in your opinion. However, you are more virtuous by holding out for Ruth’s Chris??? I think your virtue is established…you are only negotiating price.

      Physicians complain about the price of drugs. Yet, they accept lunches from reps. I can understand buying lunch for the provider simply because of their time contraint, but for the entire office? The marketing expense drives up the cost of the medication AND prohibits other companies without the budget from getting the information to the physician. I know of several MDs that have lunch and breakfast delivered by reps every day. They are booked out for months.

      Pfizer has what, 2500 reps in the US? Each will have at least 2 lunches per week at $100 per lunch. That’s $12,500,000 annually in lunches.
      Physicians are helping to drive up the cost for meds.

  6. I dunno about the meals, but all the silly conference-style tchotchkes can be bought pretty cheap in bulk. Maybe set up a fund to give these things to doctors, branded with the logo of “YOUR PATIENTS’ BEST INTERESTS.” I’d want a squeeze ball or two of those, and hey, the marginal value of pens and totes rapidly diminishes as you get more.

  7. Free lunch will come whether you award them any loyalty or not. These guidelines are mainly to keep from wasting food and/or disrupting the office schedule.

  8. I worked at a clinic that had 16 doctors. We’d get free lunch about once a week. If the reps were lucky they’d get to see two of the doctors for fifteen minutes. This group of doctors at least were certainly not influenced by the Hawaiian BBQ meatballs, they only allowed it as a staff perk. And as a member of that staff I can definitely understand this memo. If you’re going to be getting lunch it might as well be an edible one and not the same one you’ve had the last three weeks, and it’s also really nice when it doesn’t show up two hours late.

  9. It wasn’t just the drug reps; back before the Joint Commission (the agency that accredits hospitals) reformed its practices, you’d have some reviewers faxing ahead their own version of the “tour rider”, including how they liked their steak cooked and what sort of dressing to have for their salads.

  10. I’m sure there are docs who are not influenced by this kind of marketing, at least not positively. I seriously doubt that billion dollar companies would do this so pervasively without research showing that is was effective. It’d be pretty easy to saturate an area with lunches, then see if a product takes off in that district.

    Full disclosure:
    an MRI place used to send me donuts. I recommended the place before they sent me donuts (clear results, radiologist was very available for consult, good patient care, schedule ran on time). Afterwards, whenever I sent people there, I told them it was a nice place, but in the interest of full disclosure, I need to tell you they send me donuts, but that I sent patients there before they sent me donuts.

  11. Could someone please explain to me why there is mistrust about a doctor’s loyalties when given a box lunch but nobody seems to care about corporate campaign contributions to politicians?

    1. Really? Because we still trust most doctors to do the right thing based on patient’s interests. That ship has long since sailed for politicians.

  12. The only time pharma reps can typically get in to talk with physicians is over the (typically very short!) lunch break. It seems reasonable to me to let the docs eat, and why shouldn’t they decide what they get to eat for lunch, just like the rest of us presumably do? If the docs had to eat Boston Market every time, they’d soon need to take statins themselves. And if the rep wants the doc’s time, they should pay for the damn subway sandwich, say I.

    Even so, many places have put an end to drug rep lunches because they sound bad to the public.

    Personally I found the memo perfectly reasonable, most of it is telling the drug reps what they *can’t* do. And given the list of restaurants, it seems designed to 1) be fairly cheap, and 2) keep the completely disgusting crap out.

  13. @#17
    I think you misunderstand just what this entails, this is not a case of the drug rep taking the the doctor out to lunch once a month so they can discuss new drugs.

    Drug reps will cater lunch for the doctors entire staff 2-3 times a week.

    I worked for a restaurant in a small town with a small hospital. We weren’t a takeout place, but we would deliver food if you were buying for groups of 20 or more. Once the drug reps realized this, we were delivering food to different offices 3-4 times a week and we weren’t the only ones delivering. I found out from the staff at an oncologists office that they got lunch free everyday and most days got a breakfast basket of muffins and croissants.

    It wasn’t constant, some months we’d only deliver once or twice, others would be several a week.

    It really is a hell of a lot of unregulated, undeclared money.

  14. I am from Ireland & i lived in the US five years ago, albeit illegally. Once I needed to see a doctor when i had a really bad flu, he just looked at me and my symptoms, opened a drawer and took out some sample blister packs of antibiotics (2 per pack) given to him by sales reps, put 10 of them in a brown bag & asked me for $300, cash. The sales reps knew of & encouraged this lucrative revenue stream for doctors.

  15. It is really astonishing to see the self-deception involved amongst those who accept pharmaceutical bribes. “I take them, but it doesn’t influence me at all….” This is just a joke. There is no doubt that free lunches and the like sway doctors. The results of studies into this are unequivocal. The size of the bribe–the quality of the lunch, in this case–is almost irrelevant. Macaroni works as well as veal in influencing physicians’ prescribing habits. The sick joke here is that legislation to limit the bribery does not significantly reduce its effectiveness; it just saves the pharmaceutical bribemeisters some money, so they can exert even more influence without increasing their budget.

    Maggie K-B said it in the original post: giving free lunches is “a practice that’s been proven to influence decisions doctors make, even if they think it doesn’t…”. Of course, it’s not just health-care workers who are susceptible to these practices. We all are, it’s just more obvious with physicians because they are the crucial intermediary between seller (pharma) and buyer (patient) in a market worth a billion dollars a day. Anybody who thinks they, or their doctor, is immune to this particular primate game is deluded.

    (Some references: on persuasion techniques in general, check out Robert B. Cialdini, among others. On pharmaceutical industry practices in particular, there’s a free hour-long documentary at Big Bucks, Big Pharma).

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