Wednesday, October 24, 2007

Learning from free lunches in Minnesota

A fascinating news story comes to my attention via the International Baby Food Action Network (IBFAN), which has a working group on industry sponsorship and its impact. By the simple process of limiting the amount of money pharmaceutical companies can spend on food for doctors, the authorities in Minnesota have changed the view doctors have of company representatives and the information they give and changed prescribing habits. The industry is fighting back by tageting nurses and secretaries however.

The story is reported in the New York Times (12 October 2007) and can be seen in its entirety at:

Two years ago a state official interpreted powers introduced in 1993 to forbid drug companies from spending more than US$50 per year on food or gifts for a doctor.

Now every health worker knows, or would claim, that they are not influenced by hospitality or gifts of any value, and, so they might say, only meet with company reps for the important product information they impart.

Except with the spending limits in place, drug companies found they could not get appointments with doctors and in some health facilities the doctors actually asked for a ban on the reps visiting.

The companies have suggested this is because doctors are busy people and only have time to meet at lunch time so providing food was to facilitate this. Yet if such meetings were the only way to obtain information then one would think that the health workers would find the time elsewhere or have the meeting anyway while munching on a sandwich. The fact is the information is available by through official channels where it will have been evaluated with competing drugs compared, not on the basis of how good the lunch was, but on their merits.

The New York Times reports that there is interest from legislators elsewhere to impose spending limits and it has conducted is own research on the impact of sponsorship:

---extract begins

The interest in legislation to register or limit the food, gifts and money that drug and device makers lavish on doctors stems from growing concerns that these benefits lead doctors to prescribe more, and more expensive, drugs and devices, raising the costs of health care and changing care to patients.

Few studies have shown that patients are harmed when their doctors accept gifts or money from drug makers, in part because data comparing the prescribing trends of doctors who accept money and gifts with those who do not have for years been available only to drug makers, not to the public.

In one of the few public analyses of the prescription patterns of doctors, The New York Times found that Minnesota psychiatrists who received money from makers of atypical antipsychotics tended to prescribe the drugs to children the most often despite the profound risks from these drugs.

---extract ends

The industry has tried to get around the restriction on promotion to doctors as the New York Times reports: "Food has not entirely disappeared from the marketing efforts of drug makers in Minnesota. The companies still rent out private dining rooms in restaurants and still hire influential doctors to deliver educational talks about drugs during dinner. But instead of doctors, the companies now invite nurses and secretaries to dine, drink and listen."

Doctors are paid to give the presentations and can earn substantial sums for doing so. As one doctor who has earned US$16,000 from such talks said in the article: "Maybe they’re trying to keep me loyal to those drugs."

We have included references to studies showing the impact of promotion to health workers in the report we produced for the Baby Feeding Law Group on the UK formula law consultation: Protecting breastfeeding - Protecting babies fed on formula, available at:

This also includes monitoring evidence of how the industry targets health workers in the UK.

Let us see if the UK authorities look to the experience of Minnesota and accept that a free lunch comes with strings attached.

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