Medical students occupy the lowest level in the health care hierarchy. They have to be supervised when they treat patients, they can’t write prescriptions and sometimes they don’t even know their way around the hospital where they’re learning to become doctors.
But to pharmaceutical sales representatives, they are blue-chip recruits. A small investment of time and attentiveness now — along with some free lunches, late-night snacks, pens and notebooks — can pay off handsomely down the road in personal relationships and brand loyalty when those students start to practice medicine.
That’s the way things have worked for years. But increasing concerns about apparent and real conflicts of interest are leading to a fundamental rethinking of those kinds of ties, which are bolstered by billions of dollars in marketing expenses each year. And the effects of the changes won’t be confined to medical students.
A little more than two years ago, the state of Minnesota banned drug company sales representatives from giving doctors food or other gifts worth more than $50 a year. Maine, Vermont and West Virginia have since enacted similar restrictions.
Missouri’s Sen. Claire McCaskill, a Democrat, along with Iowa Republican Chuck Grassley and Wisconsin Democrat Herb Kohl, introduced federal legislation to create a “physician gift registry.” It would require drug companies and medical device companies to report any cash payments, free travel and other extras they provide to doctors.

But change is happening fastest on medical school campuses in St. Louis and elsewhere around the country. As Post-Dispatch medical writer Blythe Bernhard reported this week, area medical schools, at the urging of their accrediting association, are expected to institute a ban next month on gifts from drug companies to medical students and faculty.
Drug companies and firms that make such medical devices as artificial knees and hips justify their marketing activities as educational outreach. The meals and small gifts they provide are a concession to physicians’ busy schedules, companies say, a way to get a few minutes of doctors’ time to update them with the latest product information.
There’s certainly some truth to that argument. But the billions of dollars spent marketing products directly to doctors is evidence that drug and device makers are getting a return on their investment. Americans spent $216 billion on prescription drugs in 2006, an increase of nearly 80 percent over the $121 billion spent in 2000.

Doctors’ groups reject the idea that physicians are swayed by a few inexpensive gifts. But some of the company-provided perks are considerably more substantial. They can include trips to educational conferences held at expensive resorts in exotic locations where doctors and their families are wined and dined. Doctors who frequently prescribe a particular brand name drug also have been rewarded with large speaking or consulting fees that can rival their practice income.
In 2005, five companies that make the most widely used hip and knee implants were named in a federal investigation for violating anti-kickback laws. Congress also is investigating drug company marketing practices. Bans and gift registries are a start toward assuring patients that their doctors’ clinical judgment isn’t clouded by financial considerations.
The simple truth is that when drug and medical device makers offer a free lunch, the rest of us pay the bill.

(Post-Dispatch file photo)