There truly is no such thing as a free lunch, or at least that's what Arnett Health-System told drug company sales representatives last fall.
The Lafayette-based system banned meals for doctors that were paid for by the salespeople, but it allowed them to continue to meet with physicians through appointments.
Then that stopped Jan. 1. Now, Arnett also prohibits reps from making sales calls at its roughly 20 locations in Tippecanoe County and the surrounding area. No more free samples or educational materials. No more face-to-face time with physicians.
The ban eliminates a distraction for the system's approximately 140 doctors and it stops a powerful marketing influence, according to Dr. Jim Bien, Arnett's chief medical officer.
"We're trying to remove one of the ways physicians are advertised to," he said. "We still are exposed to lots of other ads in our journals and at clinical conferences, but we wanted to remove the influence of advertising within offices."
Arnett joined several providers around the country that have decided in recent years to restrict or quiet the powerful voice of big pharmaceutical companies in their offices.
Proponents of drug-rep bans say they can learn about new medicines through objective journals and that even the pens a salesman passes out can influence prescribing patterns.
But their opinion is by no means the majority. Other doctors say drug representatives still provide valuable insight and free samples that help poorer patients.
Dr. Charles James thinks that if he polled St. Vincent Physician Network doctors, 90 percent would want to continue to see drug reps. He noted that salespeople leave behind thousands of dollars in samples, and they've also toned down their aggressiveness over the past 30 years or so.
"I go back to when they were giving you airplane trips and weekends in Florida," said James, the Indianapolis-based network's medical director. "Now those are perks."
250 a week
Before Arnett's ban, as many as 250 sales reps would walk through Arnett clinics in an average week. Bien believes they brought with them a powerful influence on prescribing patterns, one that could be seen even in the token gifts they left behind.
"If I'm seeing a patient, and the pen I'm using has the name of a high-blood-pressure medication on it, I may be more inclined to prescribe it," he said.
He acknowledged that sales reps do provide information about new drugs, but the overall effect of their visits "is to change and influence the prescribing patterns of physicians and not always in the best interest of patient care and cost."
He noted, for instance, the heavy marketing campaigns that accompany new drug launches. Doctors receive reams of promotional material for that new cholesterol drug that patients see advertised every 20 minutes during a football telecast.
"That's not an issue if those are clearly the better choices, but in most cases those are just the newest choices and not yet proven to be the best choices," he said.
Bien noted that doctors order drugs through prescriptions, so they don't need a sales rep to supply them. The free samples, though, are a different story. He said a committee of Arnett doctors is studying that issue.
Many doctors get valuable feedback about medications by giving free samples to patients.
"Some feel [free samples] should be maintained, and the question is, how do you do that in a way that's in the best interest of care?" he asked.
The Lafayette system's ban applies only to drug company reps. Medical-equipment salespeople still meet with doctors. Bien said physicians must test new equipment and practice with it before using it on a patient, so the interaction with manufacturer representatives is more important.
Dr. Ed Langston has seen the number of pharmaceutical representatives increase dramatically over the last decade or so. His employer, American Health Network, limits the number that can visit each day and the times of day they can make a call.
Langston, who also works in Lafayette, believes the medical community is split down the middle on the issue. Half impose no restrictions and the other half impose some.
"I think a lot of us are very sensitive to the marketing aspect of the representative," said Langston, who's also an American Medical Association board member. "They're here for a reason, and that's to market their medication."
For instance, the Minnesota-based Mayo Clinic, which works with well over 1,000 doctors, bans most free drug samples and asks representatives to contact its physicians through their secretaries.
"We don't want the physician sort of stopped in the elevator or approached in any way that would make it uncomfortable or take away from their time with the patients," said Marianne Hockema, the clinic's administrator for the Office of Medical Industry Relations.
Bans are rare
Complete bans like Arnett's are rare, according to Eli Lilly and Co.'s Beth Sexton. She's aware of only four doctor groups in the entire country who have taken such a measure over the past seven or eight years.
If the Indianapolis drugmaker encounters one, its sales reps respect it.
"At the end of the day, it is the customer, so we listen to what the customer says," she said.
A doctor's office can still call Lilly with questions about a drug or to request a visit. Doctors also can find drug information on the company's Web site.
Sexton is director of Lilly's "sales force of the future" project, which the company launched last year to serve doctors better. It involves a reorganization of sales personnel to cut the number of visits they make and enable them to work better with doctors.
If physicians ban sales reps entirely, they miss out on several things, Sexton said. For instance, the company supplies good patient-education material on diseases it treats, such as diabetes. Reps also help doctors understand the medication.
"Sometimes you read something, and you don't quite understand [it]," she said. "That typically can only come out in a one-on-one dialogue. That's where physicians still find value in a sales rep."
A drug company sales force generates "tens of thousands of pages of scientific data" about their products and have the most complete information about treatments, according to the Washington, D.C.-based trade association Pharmaceutical Research and Manufacturers of America.
"In the end, pharmaceutical marketing is one of several important ways for health care providers to receive the information they need to make sure medicines are used properly and patients are safely and effectively treated," PhRMA Senior Vice President Ken Johnson said in a statement.
Bien thinks Arnett doctors can get by just fine without this input. He said peerreviewed journals offer plenty of insight into new treatments. Plus, doctors can still receive educational materials from a drug company if they request it.
And he believes they can save money by opting for less-expensive generic medications instead of receiving free samples that eventually lead them to buy prescriptions for costly brand-name drugs. All those advantages reflect the goal behind the ban.
"It's an issue about care and about trying to offer the best care that we, as an organization, can to the people of this region," Bien said.