A few years ago I received an invitation from a pharmaceutical company for a round table discussion about a certain medicine. The meeting was held in an up- scale restaurant where an out of town physician gave a pep talk promoting that medication. We listened to the exaggerated claims of the medical evangelist, enjoyed the dinner and departed. But not before each of us were handed an envelope with a crisp $100 bill.

This was my first encounter with the pharmaceutical companies that bribe physicians to prescribe their products. The note accompanying the bill thanked me for my valuable time and offered to assist me in my professional needs. I returned the money with not-too-polite a note.

That effectively put an end to any further invitations to me but the practice flourishes.

To their credit the pharmaceutical companies do support a bulk of continuing medical education (CME) programs in America. This support is in the form of unrestricted grants and the institution receiving the grant acknowledges financial support but does not endorse any products.

However when the drug companies do bring in a speaker to a meeting they pay handsome honorarium and liberal travel allowance to these travelling speakers. This has made it difficult for most CME providers to attract quality speakers who are willing to give a talk for a paltry sum of, say, couple of hundred dollars. Some of these so-called experts make a very good living travelling the circuit.

Individually, the physicians are allowed, under the AMA ethical guide lines, to accept minor gifts like pens, penlights, paper pads etc. In real life however a good number of physicians have become willing participants in the shady practice of accepting bribes. Consider the following:

• Free vacations for physicians and their families at expensive resorts.
• Free trips to amusement parks and sporting events for the entire family.
• Free golf outings.
• Dinners at posh restaurants.
• Free screening of ethnic movies with exotic food.
• Take home food from expensive restaurants.
• Delivery of lunches to physicians’ offices.
• Underwriting dinners at ethnic celebrations and ethnic national holidays. (One wonders if wedding anniversaries, graduations and birthday celebrations would be next.)

The latest gimmick is to invite doctors to a nursery (the kind where one buys plants and flowers and not the kind where new born babies are kept) to chat briefly with a visiting expert. After the chat the doctor picks up a few flats of flowering plants for his home.

In 1998 the pharmaceutical industry spent $816 million on advertising their wares, a six-fold increase since 1985. Where as the industry spends 15% of its gross revenues of research and development, it spends a mind boggling 25% on promotion that includes direct advertisement to the consumers and to the physicians through magazine ads, television commercials, ads in scientific journals and entertainment. Some of the ads are so outrageous that prestigious journals like the Annals of internal Medicine and the American medical Journal termed them either misleading or blatantly fraudulent.

Most doctors claim that they accept favors from drug companies without any preconditions. It is hard to believe that after receiving an expensive vacation one would not in any way feel obligated to the host.

Is it possible to accept a corsage but refuse the dance? In a 19996 thought provoking commentary in the prestigious British medical journal Lancet, Sidney Wolfe of the Public Citizen’s Health research Group points out the innovative ways the pharmaceutical industry influences physicians. Their advertisements are now directed towards hippocampus, a small tiny part of the brain that processes information by connecting parts of the brain where gut instincts are formed. Until now we only knew that abnormalities of hippocampus were associated with posttraumatic syndrome and schizophrenia. According to Wolfe, the now innovative ads instead of selling pharmaceutical products to the doctors, now sell doctors to the pharmaceutical companies. No wonder. The cost of medicines is going (has already gone) through the roof. It costs twice as much to buy the same medicine in America than it costs in Canada or Mexico and the cost of hospitalization now ranks second to the cost of buying medicines in this country. While there is a belt tightening in every aspect of health care industry, the cost of medications continues to grow at an alarming rate of 15% a year. All effort to reign in the costs is effectively blocked by the powerful pharmaceutical lobby. Doctors have, unwittingly, become part of the pharmaceutical companies’ scheme to fleece the public.

Next time a pharmaceutical rep brings in a lavish lunch for the entire staff at a doctor’s office, it might be helpful to remember that in this land of plenty we call America, one in eight senior citizens have to choose between food and medicines.

There is no free lunch after all.