Catering trade feeds on rep-doctor meals
By M. William Salganik, Jamie Smith Hopkins, Jonathan D. Rockoff
Sun reporters
Originally published July 29, 2006
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.
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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.
Relations between pharmaceutical companies and doctors have drawn scrutiny for years.
Overall,
the federal government has a limited role regulating those ties. The
Food and Drug Administration bars companies from promoting products for
off-label uses and publishes lengthy guidelines on "industry-supported
scientific and educational activities."
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The American Medical Association, on the other hand, has long had a
voluntary policy governing industry gifts to physicians. It prohibits
cash gifts, consulting fees if little actual work is done and direct
payments to doctors that subsidize the cost of medical conferences. The
policy also says doctors shouldn't accept gifts on the condition they
will prescribe certain medicines.
But
the guidelines allow doctors to accept "modest meals," textbooks and
other gifts serving a "genuine educational function." Doctors who speak
at conferences can accept honoraria and "reasonable reimbursement" for
travel, lodging and meal expenses.
From 1990 to 2002, the
pharmaceutical industry association effectively adopted the AMA
guidelines as its own. In 2002, company chief executives requested more
restrictive measures amid criticism of some marketing practices - for
example, providing doctors tickets to sporting events, subsidizing
attendance at continuing medical education conferences and furnishing
trips.
The 2002 code, which is voluntary and was revised
in 2004, permitted "modest" meals. The trade association considers
lunches acceptable because they represent a rare opportunity to present
information about their products to busy doctors. "It's just a business
courtesy to pay for a lunch," said Scott Lassman, senior assistant
general counsel at Pharmaceutical Researchers and Manufacturers of
America.
Johns Hopkins Hospital allows its doctors to
take "very modest" gifts and meals, though "only in the context of an
education program," said Gary Stephenson, a spokesman. Mercy Medical
Center in Baltimore requires drug reps to register with the hospital's
pharmacy department and permits them to visit doctor's offices but not
patient floors, said spokesman Daniel Collins. LifeBridge Health, which
operates Sinai Hospital in Baltimore and Northwest Hospital Center in
Randallstown, permits "gifts of a nominal value," according to
LifeBridge's policy handbook.
Carolan, of Casa Mia's,
said his drug lunch business "fell into our lap" when a few reps
started requested catering and told others.
He's not
above helping the process along. When he's delivering to a medical
office and sees a drug rep - "They're easy to spot, usually
well-dressed, good-looking people" - he hands them a menu and says, "We
specialize in pharmaceutical catering."
Casa Mia's has
even crafted a frequent-buyer program for drug reps. Each dollar spent
earns points that can be exchanged for movie tickets, gift certificates
to Home Depot or Nordstrom or an "executive spa treatment."
A
normal day's drug lunch business for Casa Mia's is 30 lunches for 12
people each at $8 to $10 a head - more than $3,000 in total sales.
"We're there every day at all the major hospitals and medical arts
buildings," said Nichols. He said he once delivered trays to a cardiac
catheterization lab. Carolan said he had taken lunch to a hospital's
psychiatric floor.
Carolan estimates that five to 10 other caterers in the area do substantial drug lunch business.
Adriene
Deeley, a manager at Pastore's of Rosedale, an Italian grocery, deli
and bakery, said roughly 85 percent of its catering business involves
pharmaceutical representatives.
The key is delivering on
time - "that's very important to the reps," she said. Sandwiches and
subs are popular. Reps pay attention to whether someone on staff is a
vegetarian or has food allergies, and they order accordingly.
Despite
the competition, she said, there is plenty of business to go around:
"Oh, yeah, there's a lot of doctors out there. A lot of reps, too."
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
