In response to the Massachusetts Code of Conduct which bans restaurant meals at FDA regulated events, Dr. Carlat recently debated Steve DiFillippo, owner of Davio’s and Avila’s restaurants, on the effect the law is having on area restaurants. The debate was aired on the WGBH program Greater Boston, and was hosted by Emily Rooney (daughter of 60 minutes fame Andy Rooney).
Prior to the debate, the segment noted how in addition to the hurting economy, restaurants and their employees have been suffering tremendously due to the loss of business from the gift ban law. One restaurant owner estimated his losses $65,000, and a waitress estimated that she was losing $400 a week.
Although these consequences may have been unintended by the law, many critics of the gift ban are particularly upset because states that closely border Massachusetts do not have similar laws, so business is being shifted there. Critics also point to the fact that these bans on food and restaurants have not been applied to hospitals, where food can be catered, causing even worse losses for employees and owners.
Debate
Steve argued that drug companies should be allowed to hold educational events at restaurants, while Dr. Carlat believed that such events were ways to “wine and dine doctors in order to sell them on their newest drugs.”
The common sense approach used by the restaurant owner emphasized the fact that doctors, with their “years of training,” are smart enough to separate the hype from the truth. Steve emphasized the fact that these are not just social events for doctors, and that sometimes there can be images of “severed foots” on the screen. In other words, these meetings are not to “wine and dine.” They are actually events where important discussions take place, information is conveyed, and questions are answered.
While critics believe that these sorts of “gifts” may influence doctors and create a “subconscious” need for them to ‘return the favor’ by prescribing the drug representatives product, the evidence proving this is weak.
As we previously mentioned, an overwhelming majority of doctors who attend or speak at these kinds of meetings are already familiar with the drugs, and are usually attending to compare their clinical experience with their colleagues. Therefore, the level of bias doctors receive from a free meal is limited.
On the other hand, Dr. Carlat, who used to speak for companies and who did these very same talks, asserted that the extensive training doctors go through “does nothing to immunize them from the effects of marketing.” He further suggested that doctors who attend these meetings are prescribing brand name drugs when generics are available, but such a claim was recently disputed by a study, which showed that 75% of drugs being prescribed in the U.S. are generics.
Although Dr. Carlat seemed to have missed this recent study, he suggested that there are better ways for doctors to receive information about drugs that do not involve dinner and company representatives. The problem with such “better ways” is that often, journal articles, research data, and presentations can take up valuable time away from a physicians schedule, and these meetings help condense that information at a time when that’s convenient for physicians, dinner. The fact that the information is coming from a drug representative should not be problematic since the data and research being conveyed is controlled by FDA regulations.
Despite his confusion, Dr. Carlat asserted that Steve, “like thousands of other business owners, was a victim of “trickle-down deception.” He explained that drug companies use “advertising companies, medical education communication companies, publishers, lunch caterers, and celebrity spokespeople,” to “dress up advertising in the guise of education.”
While the evidence regarding industry influence on prescribing habits is debatable, doctors use their clinical experience and information from these meetings to make the most informed decisions for their patients. In fact, many like Steve truly trust their physicians to go to these meetings that are doctor and doctor to learn about ways to help patients.
As a result, if doctors continue to have fewer places to be educated about new medicine and treatments, the concern from patients may grow.
When that happens, patients might begin cooking dinner for drug companies so that their doctors can stay up to date on the newest drugs and treatments.