That’s because a two-year-old state, which forbids sales reps from giving docs more than $50 worth of food or gifts each year, is apparently greatly reducing free lunches. One year after the change, the number of visits that Minnesota primary care doctors accepted from sales reps fell at about twice the rate of the decline reported by primary care doctors nationwide, according to a survey by ImpactRx, a market research firm. And a growing number of Minnesota hospitals and clinics have banned routine visits from them, The New York Times reports.

“We have an extended hallway, and the sales reps sit there now without anything except maybe Styrofoam cups filled with M&Ms. The 30 pizzas are gone,” Michael Severson, a pediatrician in Brainerd, Minn., tells the paper. “It’s made the doctors think about whether to ban them.”

A 1997 study found that medical students saw gift-bearing sales reps as helpful while viewing with suspicion those without gifts. This experiment is now being played out statewide in Minnesota, which also requires drugmakers to report all consulting payments made to doctors. Maine, Vermont and West Virginia have passed similar registry requirements, at least a dozen other states are considering them and Congress is considering a national one. But no other state has adopted Minnesota’s limit on free food. And that could change, the Times writes.

New Jersey’s attorney general, Anne Milgram, who last month announced the creation of a task force to examine ways to limit the gifts and money that drug and device makers give docs, is encouraging the force to look at what other states, including Minnesota, are doing. “When you see a doctor, you should have confidence that the advice you get is based on what’s best for you and not on some financial incentives or gifts that the doctor is getting,” she tells the Times. (This is her recent interview with Pharmalot).

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 drugmakers, 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 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.

Drugmakers have long argued that buying modest meals for doctors is simply a courtesy that allows doctors to take a moment out of their busy schedules to learn about medicines. Most doctors dismiss the notion that they can be influenced by food. But the Minnesota experience suggests otherwise.

Sam Carlson, chief medical officer of Park Nicollet Health Services, one of Minnesota’s largest private health systems, says many of his system’s 20 clinics began asking to bar sales representatives after the food limit went into effect. Park Nicollet is considering further systemwide restrictions on sales reps.

SMDC Health System of Duluth, a nonprofit system of 17 clinics and four hospitals, forbids sales reps to make unannounced visits or provide free drug samples, gifts or food. By the end of the year, the system will place strict limits on consulting relationships between its 450 docs and drugmakers. “No matter how you look at it, we’re all influenced by these marketing activities,” Carl Heltne, chief medical officer, tells the paper. “But patients come to us and they trust us to make decisions solely on their behalf. To uphold that trust, we can’t have even a perception that companies influence us.”

Michael Clements, the owner of a food-catering business in St. Paul, says the new rules had been disastrous for him. His business of taking lunches, paid for by drug makers, to doctors’ offices all but disappeared after the rule change, cutting his overall sales by two-thirds, he says.

Food has long been a pillar of drug makers’ marketing efforts. In data collected by the state of Vermont, drug makers spent nearly $778,000 last year buying food for Vermont docs.

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. Sue Bikke, a geriatric nurse in St. Paul, says she was delighted when she and her nursing colleagues suddenly started receiving invitations to free meals - wine and cocktails included - at the area’s best restaurants.

“I don’t go to those places normally because they’re way too expensive for me,” she says. “I’m so grateful that nurses are starting to get all these perks.” She adds that many of her nursing colleagues were puzzled to receive these dinner invitations since they cannot prescribe drugs. But the nurses and secretaries may be ancillary to the companies’ principal target: the speakers at these events.

Those delivering the talks get training that involves learning pharma’s most important marketing messages. And they receive anywhere from $500 to $5,000 for each talk they give, with some doc earning more than $100,000 annually. “This is the companies’ way of thanking high prescribers,” David Rothman, president of the Institute on Medicine as a Profession at Columbia University, tells the paper. “Drug companies don’t really care who’s in the audience.”

When asked whether a drugmaker’s motivation for hiring doc to educate secretaries may be to influence them instead of the secretaries, many docs said they had never thought of that. “That’s a good question,” answers Kent Brockmann, a psychiatrist from the Twin Cities, who earned more than $16,000 from 2003 to 2005 doing educational talks for drug makers. “Maybe they’re trying to keep me loyal to those drugs.”

Still, nearly all said that they were not influenced by the money they earned giving the talks.

Source: The New York Times