No Free Lunch describes itself as an organization of "health care providers ... who believe that pharmaceutical promotion should not guide clinical practice, and that over-zealous promotional practices can lead to bad patient care. It is our goal to encourage health care practitioners to provide high quality care based on unbiased evidence rather than on biased pharmaceutical promotion."

We aim to achieve our goal by informing health care providers ... about pharmaceutical industry efforts to promote their products and influence prescribing....

We believe that there is ample evidence ...—contrary to the beliefs of most heath care providers—that drug companies, by means of samples, gifts, and food, exert significant influence on provider behavior. There is also ample evidence ... that promotional materials and presentations are often biased and non-informative. We believe that health care professionals ... should not allow themselves to be bought by the pharmaceutical industry: It is time to Just say no to drug reps and their pens, pads, calendars, coffee mugs, and of course, lunch (not to mention dinners, basketball games, and ski vacations).

What a quaint idea! The last time I visited the doctor's office I had to wait for the pharma rep to finish setting up his lunch appointment before I could get a word in with the receptionist. On another occasion and a different doctor, the doctor flew into a rage when I suggested that he prescribe for me a generic alternative to the drug he was promoting. No. I'm not making this up, and needless to say I never saw that doctor again.

In 2002 Vermont passed a law forcing the drug companies to disclose gifts and payments to physicians. But the report goes to the attorney general and names no names. According to Stephen Cha in the Washington Post, the industry gave $3.1 million for 2200 Vermont doctors in 2004, which works out to be a little more than $1400 per year per doctor. If the industry's own estimate is right, the Vermonters are getting the short end of the stick. Based on the industry estimate of $5.7 billion a year on marketing directly to physicians, Cha calculates a figure of $6,000 to $7,000 per doctor.

Anyway, the American Academy of Family Physicians (AAFP) will be holding its annual Scientific Assembly this week and expects a crowd of doctors. Big pharma will be out in force.

Jim Edwards writes in Brand Week,

The AAFP's advertising prospectus promises a truly massive marketing event: 5,000 of the top-prescribing physicians in the country are expected to attend the San Francisco shindig.

A full page in the conference magazine costs $23,300; more if you want it in color. Doctor's gift bags will be given out each day—any company that wants to place a freebie in them must pay $7,500 “per piece per day.”

If a marketer wants to buy doctors breakfast every day and give them gifts as they eat, that opportunity is on sale for $81,500, according to the prospectus.

“And, of course, there's free lunch: $60,500 pays for the food vouchers that physician-attendees will use for lunch each day at the conference,” noted Dr. Bob Goodman, the director of No Free Lunch, in a statement.

No Free Lunch thought this would be an excellent venue for their educational mission and applied to be an exhibitor. But the AAFP thought it would be a bad idea. They described the information that No Free Lunch had to share as "their desire to eliminate information-sharing by exhibitors with our members" and said that it would negate "the purpose of the Exposition Hall," which was to rake in as much moolah and as many freebies as the market would bear.

No Free Lunch got the word out to its members and on Wednesday the organization was able to issue an announcement that the AAFP had reversed its position—

Many members were upset and even outraged that a society which they had supported for many years, and which gives industry almost unlimited access to physicians at its meetings, would not allow a small organization of health professionals to voice an opposing view. Allen Pelletier, for example, a family physician from Memphis, Tennessee, a long time AAFP member and newly elected fellow of the Academy, in an e-mail to AAFP CEO Dr. Douglas Henley, wrote “To my embarrassment, the organization that represents me as a practitioner and teacher of family medicine has shut down the possibility of open (and yes, critical) dialogue about how our practices are influenced by the pharmaceutical industry.”

Now the attending physicians may be able to pick up a pamphlet as they head off to their pharma-sponsored lunch. Are you still wondering why we pay more and get less when it comes to health care than any other industrialized nation?

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