Confessions of a Drug Lunch Slut

This is by Ninjanurse, aka Nancy Green, RN.

From The New York Times, Drug Makers Pay for Lunch As They Pitch. Well, stop the presses! This has been going on for years.

They say there’s no such thing as a free lunch. I often pondered that as I dug into the Pad Thai and the cute little roll-up sandwiches that the pharmaceutical reps brought to various of my workplaces. Most health care workers spend their lunch breaks, (assuming they get one at all) eating the sad peanut butter sandwiches they brought from home, or the weird offerings from the vending machine company.

But if you have the right kind of job, you might get invited to the drug lunch.

The drug lunch is cool. A sales representative from a pharmaceutical company brings in some really good food from a local restaurant, and invites all the staff to partake. All you have to do is behave decently. In that, it rather resembles a gallery opening, where you can inhale a large quantity of wine and cheese as long as you pose as an art lover.

But there are other attractions for the health care professional. The drug reps are nice looking people with excellent social skills who really seem to believe in their product. They are pharmacists, or have some other science degree and give interesting power point presentations, while handing out nifty office supplies like sticky pads and pens. (Pens evaporate in the health care setting and must constantly be replaced.) These useful work tools keep the manufacturer’s name always close to your heart. Myself, I once coveted a coffee mug with the logo for ‘Haldol’. I didn’t steal it. Anyone know where I can get one?

Anyway, the presentations were a perk in themselves. Keeping in mind that this was the manufacturer putting their best foot forward with their latest drug, it was good to have an inservice on the lunch break. All health care professionals have to stay current with a torrent of new drugs hitting the market.

The problem is that the inservice is also a sales pitch. It’s not a neutral party offering unbiased continuing medical education to professionals. Unless your employer is a good one, you have to find that on your own. It doesn’t come to your workplace with a nice plateful of samosas and pasta salad, with those really good chocolate chip cookies for dessert.

Ah, the memories… anyway, I have to admit that there are several drugs I know better through drug lunches, tough luck to all the ones who never bought me a sandwich. But there is a bigger lure that the drug companies use.

You see them hanging out on the corner, with their baseball caps turned backwards and their baggy jeans, or driving around in Hummers with tinted windows so you can’t see their face, passing packages in dark alleys- they give you a taste, and you’re hooked. They…

Wait a minute, I need to get a grip. I just mean to say that with the high price of prescription drugs, the drug samples that the pharmaceutical reps supply are going to a lot of patients who couldn’t otherwise afford them. Most doctors set aside a good hunk of their closet space in their office to drug samples. Supposedly these samples let the patient try the medication for a few weeks or a month to see if it’s effective. Then they get it by prescription. In a less chaotic, a less F.U.B.A.R. healthcare system it would probably work that way.

As things stand, there are plenty of medications that are long since gone to generic that are still unaffordable to a good number of people. Thank the gods for the sample cabinet. If your patient has a bad infection that needs the latest antibiotic and they can barely manage the rent you may be able to provide a full course of therapy from the samples. But if your patient has a chronic disease, like hypertension, or depression, it gets complicated. The newest drug on the market might work great for them, but when the samples run out, then what? The doctor has to search and the patient has to adjust, to a substitute. It’s a hidden cost, the extra visits, the stress.

These costs fall on the patient, and the taxpayer, through Medicaid, Medicare, state programs like RIPAE, the large local hospitals. While a doctor can easily get samples of the newest drugs, it’s often impossible to get a break on an old reliable drug that has gone to generic. For someone on a very low income even the generics might be out of reach. Amazingly, being sick and having a low income often go together.

The world of free lunch, free samples, medical educational lectures that take place in fancy restaurants is the world of marketing. Marketing costs are added on to the price of the drug, of course, so I guess that sick people and taxpayers bought my lunch. Thanks.

I’m not anti-pharmacy. I’ve spent a lot of time persuading people to take their meds because there are real diseases that kill people when they are not treated. Every time I see someone struggling to walk after a stroke, or blind from diabetes, I wonder if that suffering could have been prevented. Often, with the right treatment it could, and that includes taking medication.

Health care isn’t cheap, it takes a large share of the gross national product of every developed nation. Americans spend a lot, but we get less for our money than other countries because we do it backwards. We don’t invest in preventing disease and promoting health. We let the pharmaceutical industry tailor the medicare drug benefit to their needs and wants, and end up with a patchwork system so confusing that even retired rocket scientists can’t figure it out.

We really need to provide health care to everyone. It won’t be cheap, but the state of Rhode Island already has a high rate of insured people, and good programs like RIte Care. We can be a national model. We can stop pretending there’s a free lunch and count up the real costs. The payoff will be a better future for all Rhode Islanders, especially the children, and we won’t have all that guilt giving us indigestion.