By JOY VICTORY
THE JOURNAL NEWS
(Original publication: May 4, 2004)
Dr. Robert Goodman tackles two jobs a day: seeing his
patients, and running a Web site that urges doctors to
stop taking gifts from the pharmaceutical industry.
Goodman, a general practitioner at Columbia
University Medical Center, started nofreelunch.org five
years ago. He has since built a national following of
300 doctors who have taken the No Free Lunch pledge.
They've promised to refuse "money, gifts, or hospitality
from the pharmaceutical industry ... and to not rely on
information disseminated by drug companies."
Doctors who take the pledge can trade in their
drug-company pens and coffee mugs for white pens, mugs
and other items labeled "No Free Lunch." Goodman has a
large stash of pens sent in by doctors that he keeps in
a file cabinet.
It's well-known that pharmaceutical companies spend
millions of dollars annually on marketing to increase
visibility, and thus profits, for new drugs.
Direct-to-physician marketing is among the most popular
strategies. Companies hope that doctors who meet
face-to-face with a representative will not only learn
about a new drug, but also prescribe it.
To that end, the representatives frequently come
bearing gifts branded with a drug's name, ranging from
notepads and pens to golf clubs and briefcases. In
extreme cases, reps offer exotic "educational" trips to
golf resorts or Caribbean islands, Goodman says.
Goodman sees this as an expected side effect of a
privatized drug industry, and he doesn't criticize the
"I blame the (medical profession)," he says. "The
industry, that's what they're supposed to do. There is
this culture of doctors receiving gifts and feeling
entitled to the gifts from the industry."
Doctors, he says, should not accept any drug-company
gifts, nor rely on the clinical information provided by
a drug company. Accepting gifts creates the appearance
that a doctor may be biased toward certain companies or,
even worse, prescribe inappropriate drugs, he says.
"Medical literature and social-science studies show
that gifts influence behavior," he says. "They create a
relationship. If you accept (a gift), there is a need to
reciprocate. This is why people give gifts or buy drinks
in a bar."
The drug industry has clamped down on some of the
more excessive gift-giving, but providing free meals for
doctors and their staffs remains a popular tactic of the
sales reps. Doing so is considered acceptable by the
Pharmaceutical Research and Manufacturers of America,
which represents all major U.S. drug companies.
During the meal, the sales reps must "provide an
informational presentation to the medical staff,"
according to PhRMA guidelines. The meal may be for one
doctor, or for an entire medical staff in a clinic or
Wanda Moebius, a PhRMA spokesperson, says the meals
are an efficient way to reach physicians, who are often
free only during meal times.
"Doctors are very busy people," Moebius says.
"There's huge changes in the drugs and new drugs that
come on the market. Often sales reps are the best
sources of information."
Fred Perino, pharmacy director at Phelps Memorial
Hospital Center in Sleepy Hollow, says drug reps
occasionally give presentations at the hospital, and
they provide modest meals to the pharmacy staff. But he
listens with a skeptical ear.
"Their job is to promote their employer's product,"
Perino says. "Our job is to analyze it to make sure it
meets our needs and will benefit our patients over what
we have already."
Dr. Christopher Wang, chief medical officer for four
Open Door Medical Centers in Westchester, is even more
wary of sales reps and drug-company data.
"The problem is, even if they fund legitimate
research and conduct it legitimately, they only support
research questions that will potentially say 'You need
to have my drug,' " Wang says. "But they own the
research, and when it comes out and it's not positive,
they bury it because they own it."
Alan Goldhammer, PhRMA associate vice president of
regulatory affairs, says the sales reps can present
facts using only the information on the drug's insert,
which is approved by the Food and Drug Administration.
The FDA, he says, does not require comparative clinical
trials, in which a drug's effect could be studied
against another drug's effect.
PhRMA's guidelines on the matter, "Principles of
Conduct on Clinical Trials and Communication of Clinical
Trial Results," acknowledge that the companies own the
research and therefore are not required to publish all
study results, especially early-phase trials.
Wang was unaware of Dr. Goodman's efforts but praised
the No Free Lunch concept. At Wang's clinics, drug reps
can visit when there are no patient visits, by
appointment only, and only to drop off drug samples, he
says. Since the clinics serve mostly low-income
families, the free samples are useful.
The policy has cut down on the amount of time
patients spend in the waiting room, he says, and forces
his medical staff to obtain new drug information from
"The thing that we found to be debilitating in terms
of getting patients seen is (the reps) would just sort
of hang out — just walk in and start talking to doctors,
and patients are piling up outside," Wang says. "It's
bad enough to wait because a patient is sick; it's
another thing when you're waiting because of a
Wang and Goodman both use The Medical Letter for
information on new drugs. Based in New Rochelle since
1958, the nonprofit semi-monthly publication is
independent and peer-reviewed, and accepts no
advertising. The Letter is supported through its
To further stress its independence, the Letter
doesn't sell back issues in bulk to pharmaceutical
companies, who may try to use a positive Letter review
of a drug for marketing purposes, says publisher Doris
Peter, who holds a doctorate in molecular neurobiology,
microbiology and immunology.
Like Goodman, Peter doesn't blame the industry for
trying to promote drugs to doctors or patients.
"Physicians have a responsibility not to be doing
these things," Peter says. "Patients don't have any idea
why a physician prescribes something, and physicians are
so busy today. I would hope patients ... can be aware of
the tactics, but it's very complex."
Manhattan geriatrician Barrie Raik signed the No Free
Lunch pledge several years ago. She says it has helped
her turn down some of the lucrative offers from the drug
"Within the last two weeks, I got an invitation to a
'training session' for a new drug. They would pay me
$500. It's one thing to turn down a pen, but I knew I
wanted to refuse this," says Raik, who is a clinical
educator for New York Presbyterian Hospital at Cornell
University. "(The pledge) was helpful to me. I kind of
pledged to myself to say 'No, I can't do that. It's
wrong and outrageous.' "
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