I think the idea is that the problem is that saying, "taking free stuff from Pharm is okay, as long as it's not worth more than ____" gets on ethically shaky ground (I've learned that this is not a slippery slope, which would have been my go-to).
Disagree with you.
Pay 100 people $200 vs $200,000, you will most definitely get more people bribed & having biased opinions on $200,000.
IMHO, and I do think there are people who in good faith would disagree with me, there are actually some merits to attending a pharm lecture with a dinner or lunch. I'm a busy man, and having a $10 lunch provided to me while listening to a lecture that may actually contain clinically useful data that's not usually presented in a journal (e.g. Risperdal Consta now being available in a deltoid injection) can have positive benefits for patients. Like I said-show me where that was printed in the green journal. In fact, show me where several of the advances of several of the meds are printed because reading only journals is not going to keep you up to date on medications. Journals, while being a great source of information is not an end all be all source. They are more often a random hodge podge of some recent studies, several of which have no clinical relevance, and not an up to date bulletin on the order of Internal Medicine's Up to Date program (which I think is great program and wish Psychiatry had a similar program. I saw one program advertised as being the psychiatric equivalent to Up To Date--and found it nowhere near as good). Textbooks are a great source of data, but are updated only once every several years. Conventions--good source of data--some docs never go to them. Docs that do can only do so once every several months. Seroquel XR came out--was that announced in every journal? No. Several made no announcement on it, while mentioning a clinical case where an antibiotic caused psychosis--which was on the order of a freak occurrence that most clinicians would never face. Does an XR Seroquel make a difference? Yes. It can add convenience to medication regimens, especially for people who are noncompliant and are viewed daily by an ACT team. Now that ACT Team person only has to visit the person once a day instead of 2 or 3 times a day. I wouldn't have known this otherwise in such as quick manner. I would've eventually found out through the non-pharm sources in perhaps 6-12 months. It also saves me time because I can do 2 things at once.
I'm also working about 42-45 hrs a week, but only getting paid for 40. Why? Because the way the state system is run, I feel I cannot provide the quality of care to my patients that I feel needs to be given in 40 hrs. I end up working a few extra hours a week out of my own pocket. Having a pharm lunch could've shaved off about 45 minutes-which could've lead to me giving that time to patient care.
As I mentioned in an above post, I am choosing to see pharm reps on an occassional basis and getting no free gifts (nothing--no pens, no notepads, no books, no free food--nothing) from them because they sometimes do offer data that is clinically relevant and not typically in journals. If I could've gotten a $10 lunch out of it, I could've shaved off lunch time and devoted that time to patients which actually is cost effective to the healthcare system given that my pay is much more than $10/hr.
Of course I'd really rather have an up to date bulletin just give me the new advancements on meds instead of me having to listen to a biased rep, but I don't know of any source that does so without me having to read through pretty much every journal and package insert which is exhaustive & not time effective. One could find out what's on TV by flipping through every channel & spending about 3 minutes a channel, or you can read TV Guide for about 30 seconds. No one has yet devised a TV Guide like medication data update system for psychiatrists.
$10-15 (and let's be fair--x12--if its done once a month) cannot compare to being given $45K a year in gifts. The pens, notepads etc..those I don't care if they are banned or not. I do though think that if pharm reps can give new data or bring in good lecturers (which they do from time to time) and do it during a lunch--it greatly saves time for clinicians. Want to ban that? Fine with me-if you create an alternate source that would report this in a quick & timely manner.
IMHO given the benefit/cost ratio--some limited gifts still create benefit without a risk of a doctor whoring themselves. I'm not going to do so, nor can I think of almost any doctor that'd ***** him/herself for $10/month. I can think of plenty that'd do it for 45K/year.
Why pick on me and my free lunch when you've got guys taking graft from drug dealers?
The argument I'm presenting is going for the big problem first, then see if the problem improves. If there were still widespread problems after the guys getting 50K+ were dealt with, then start going for the smaller offenders.
Its common sense and it does follow a medical model, among several law enforcement models. You treat the most serious problems first. You don't worry about a guy's metabolic status who's 5 lbs overweight if the guy can't breathe. You attack the breathing problem first.
