There are no free lunches

Monday, September 1, 2008

Our youngest daughter had an unpaid summer internship at a doctor’s office. After her first few days, she came home and told us how she scored a free lunch every day, even though she only worked until 1:00 in the afternoon.

“How nice that the doctor buys you lunch,” I said.

“Oh no,” she replied. “HE doesn’t buy me lunch; the pharmaceutical reps do. They buy lunch for the whole office. And it costs them over $100 every day!” She was clearly impressed.

Everyone she told this story to thought this was the greatest thing ever. What a deal, right? And let’s not forget the two cruises the doctor and his wife went on last year and the tickets to concerts and sporting events. And that, I’m sure, is just the tip of the iceberg. All of which makes joining the medical profession even more glamorous to a 20-year-old, poverty-stricken, college student.

I tried to make her understand that her lunches weren’t free. That they were being paid for by her very own grandmother every time she used the bulk of her income each and every month to fill her seven prescriptions. Her lunches were a gift from tens of thousands of elderly people on fixed incomes who, after filling their prescriptions, can barely afford to eat themselves, but often have no alternative. They must pay the pharmaceutical companies’ inflated prices or risk possible death.

And, boy, do doctors ever love to issue prescriptions. You don’t expect them to dip into their own bank account for their next vacation, do you? Our pediatrician once sent us on our way with twelve prescriptions for our then 13-year old daughter, who was concerned about an acne problem. The feverish pace at which he was writing the prescriptions caused me to wonder if he had some kind of quota to meet. Twelve prescriptions for one generally healthy adolescent. That’s lunacy. We filled three of them.

I personally know two people who were diagnosed with diabetes and never given one word of advice on ways to change their diet to keep their condition under control. Or possibly completely eradicate it. Instead they were sent home with a fistful of prescriptions for drugs they didn’t understand and couldn’t afford, but were afraid not to take.

Many people don’t look any further than their doctor for information. They aren’t comfortable questioning his or her judgment and naively believe that every doctor has only the patient’s best interest at heart. I’m sure there are some doctors who sincerely care about their patients’ health and well-being. I just haven’t met them yet.

I hope my daughter gave these things at least a little bit of thought while she was eating her “free” sushi.


midlife mommy said...

Hoo, boy. I know I'm in the minority here with this viewpoint, but here goes . . . I used to work for a pharmaceutical company. During that time, I learned that they spend millions and millions and millions on R & D, and almost all of the potential drugs don't pan out. I hope I have these numbers right, but as I recall, the companies can apply for patent protection at the point the research looks like it might be promising, and that protection is good for 17 years. Unforunately, most of that time is eaten up for completion of the research, the animal trials, and then the human trials. By the time a drug gets to market, it may have only a couple of years of protection left. If the drug company can find another use for the drug, then I think they get another 2 years on the patent (and they can renew this for each new use). After that, then they have to compete with all the of the companies who make generic drugs, and the profits go way down. (OTOH, believe it or not, drug companies can make an awful lot of money by having their drugs go OTC. But, there will be copy cats out there, so hope that people will buy based on their brand name.)

So, what do they do? They market the hell out of the newly approved drug -- hence, the freebies for the doctors. And they charge for the new drug. A lot. They need to make up for all the research that didn't work out, and they need to make a profit for their stockholders and to continue to fund new research.

Not the best way of doing things perhaps, but the alternative (the government chooses what research is done, or it limits profits) might not be so good either, because we probably wouldn't have as many drugs come to market. And, believe it or not, the pharmaceutical companies do work on drugs that treat very small numbers of people for not a whole lot of profit -- I think they are called orphan drugs? (It's been awhile since I worked in this industry, so forgive me.) In addition, often the last stages of clinical trials are very broad, allowing many people to participate and get the helpful drugs that they otherwise might not be able to afford. I know that was the case with the first Alzheimer's drug that came on the market shortly before it received FDA approval.

I don't see a problem with pharmeceutical sales reps buying an occasional lunch (trips are way over the top, IMHO). There is nothing wrong with familiarizing the doctor with new drugs and building a good rapport. But the doctor has to keep his/her head -- just because something is new doesn't mean it's better. It might be, but it will also be more costly. It is the doctor's responsibility to be the patient advocate.

Mrs. Jelly Belly said...

Hey there! Welcome back!

It doesn't bother me if a rep buys an occasional lunch...but we're talking every day, five days a week and this is just one small office. Multiply that out and those freebies add up to some very large numbers.

This is just a real sore spot with me (and you know my general hatred of doctors) because I think it all just boils down to greed. I have been to too many doctors who just don't give two shits about their patient. I'm not going to start on my long rant on my personal history (you should thank me for that), but all they've done for me is make me refuse to go to doctors. Period. And that's really not a good idea.

I missed you. Hope you had a great time on your vacation. :)

midlife mommy said...

Thanks, it was as much fun as a person could have with a four year old. You know, after she discovered miniature golf and we had to play kind of fun.

Sorry about all the typos in that very long comment; it was much longer than your original post, and that was in seriously bad form.

It's nice to be missed! I so do not want to go back to work on Monday. Sigh.

Cyndi said...

Excellent post. Midlife Mommy makes many good points in her comment, but it is sad that the doctors and their staffs dine out while their patients eat cat food or go without the medications they need.

Mrs. Jelly Belly said...

Thank you, Cyndi.

I know pharmaceutical companies are the same as any other company in corporate America. I just can't view it the same as I would when Dunder-Mifflin schmoozes ABC Construction company to get their paper order away from Staples. In that case they are dealing with other corporations who can choose whether or not to use a product - and can go somewhere else to get a better deal. The end user for a pharmaceutical company doesn't usually get that option.

MLM - Hope your daughter doesn't figure out there are miniature golf courses close to home...