Medical salesmen prescribe lunches

Catering trade feeds on rep-doctor meals


At Casa Mia's restaurant near White Marsh, 10 cooks begin constructing sandwiches, forming crab cakes and layering lasagna in foil trays each weekday morning at 6.

Working on folding buffet tables, the crew pours condiments into little plastic containers, packs sodas and ice into coolers and swathes trays of hot foods in thermal wraps. At 10:30, eight to 10 drivers start loading the catering orders into their cars.

Their destination: medical offices and hospitals from Elkton to Annapolis.

There are all kinds of specialties in medicine. Casa Mia's specializes in pharmaceutical lunches.

New pharmaceutical industry guidelines in 2002 barred sales representatives from offering physicians sports tickets or trips to resorts. But buying lunch was still OK, and with so many other practices banned, it became an increasingly important way for drug companies to get the attention of doctors.

For Casa Mia's, serving that demand has created a growth business. Casa Mia's keeps a file of hundreds of drug reps with credit card and cell phone numbers, and it fields dozens of orders daily by phone, fax and e-mail. Half of Casa Mia's business is catering, and about 70 percent of that is drug lunches, according to Joe Carolan and Mark Nichols, partners in the business. Casa Mia's has 60 employees, about double the number five years ago.

For policymakers and ethicists, the proliferation of drug lunches has touched off more debate on whether drug companies are, in effect, still buying the loyalty of doctors. Doctors, for the most part, defend the lunches as a harmless way of getting information during a busy day to help them sort through a variety of similar medicines.

"It's obvious that drug companies provide these free lunches so their sales reps can get the doctor's ear and influence the prescribing practices. That's not the way it should be done," said U.S. Rep. Henry A. Waxman of California, the ranking Democrat on the House Committee on Government Reform. "Physicians should get their information from peer-reviewed evidence and objective sources."

Dr. Bob Goodman, an internist at Columbia University Medical Center in New York, founded the group No Free Lunch seven years ago because he had long been bothered by the gifts - food and otherwise - that doctors accept from the pharmaceutical industry.

"It just seemed to me kind of obvious what was going on, why the drug companies were buying lunch for doctors, and that it was working," he said. "The industry spends so many billions of dollars doing this. You have a sense they're not throwing away their money."

But Francis P. Palumbo, associate director of the Center on Drugs and Public Policy at the University of Maryland School of Pharmacy, said he's a lot less troubled about lunches than about other permitted industry practices, such as consulting fees and research grants to doctors. "The risk of influencing is much greater when there's a cash payment than when there's a sandwich for the staff," Palumbo said.

In fact, he said, it's often the staff, not the doctor, that's the target of the culinary largess. Drug reps "need face time. Their big issue is access to the doctor," he said. Office managers and receptionists control access.

"I don't write a drug because they bought me lunch, but it might put a drug at the top of my mind," said Dr. Stephen H. Pollock, a Towson cardiologist. He said his office might have two drug lunches in a typical week, and he considers the practice "very benign."

Drug reps, he said, will present studies favorable to their products, but he tries to maintain academic detachment and read other studies as well.

Dr. Jos. Zebley, a solo family physician at Greenspring Medical Associates, said doctors are increasingly pressed for time, needing to see more patients because reimbursements are declining. Lunch hour is the only chance a representative would have to talk to them. "They bring lunch for the staff, they'll be in the office from 12:30 `til 1, and they might get me for five minutes at the end of that," he said. It's "a nice perk for office staff."

Zebley, who said his office accepts lunches three times a week, added. "But everybody knows: The same way you don't buy a congressman with a dinner, you don't change a doctor's perspective with a lunch."

There are about 90,000 pharmaceutical reps nationwide, and the only limiting factor on the number of lunches they buy is the number of doctors willing to let them in the door, said Amy Kristjanson, co-founder of Lunch and Earn, a marketing and order-taking company in the Tampa, Fla., area.

"A fair amount of offices have lunch every single day," said Kristjanson, who was a rep for eight years before she started the business with her husband, John.

She estimates that pharmaceutical companies spend $3 million to $4 million per workday on meals for doctors and their staff - an unscientific number that she gleaned from talking to reps.

Relations between pharmaceutical companies and doctors have drawn scrutiny for years.

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