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Comment by refurb | Hacker News Reader

This should be kept in context. Let's say the manufacturer presented new data at a conference. During that presentation they provided lunch and refreshments. Everyone of those doctors that attended will now show up in the CMS database.

Do we think that a $15 lunch is going to influence a physician to over-prescribe a drug?

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They could eliminate the suspicion by not buying lunch.

A relative of mine was a pharma salesman. She had a database with the lunch preferences for every doctor on her circuit, and bought several lunches a day.

> bought several lunches a day

Sequentially, or in parallel?

Parallel. For any given clinic, she would know which doctors worked there, and what their preferences were at the nearby take-out sandwich shops.

Whenever I used to go to a clinic, I noticed that if it was around lunchtime, the salesmen started piling up in the lobby.

Sure free lunch has always been seen as a perk even for the supposedly rational and logical people like programmers (being slightly sarcastic there). I've heard of people going for a lower paying jobs and citing free lunch as deciding factor.

Moreover there are other ways to influence doctors. In some states they have to pass certifications or exams for continued education. Pharma companies would pay the companies writing the tests to insert names of their drugs in there.

There are speaking fees and other such things. Eventually the law catches up but by then they find a new loophole.

Getting lunch from your employer isn't the same and doesn't cause a conflict of interest. Its not about the lunch but rather who the lunch is coming from.

If you worked for google and Uber was buying your lunches then there would be a conflict of interest.

I was just trying to point out that rational people will do silly things for free lunches. And the original claim that lunches wouldn't make a difference in opiod prescription is not always true.

They would not be providing lunch if it did not work. Advertising demonstrates how easy people are swayed by subconscious connections.

Yeah, but I'm not sure how much of an effect it has on the quantity of opioids prescribed. Drug lunches probably influenced which drug I prescribe (for some reason Norco was the most popular oral opioid in our hospital, maybe because it only has 2 syllables). Though I've never attended an opioid lunch.

Free lunches, pens, merchandise, cruises...all of these tactics work and have proven ROI for the drug manufacturers. They've known for years that they're worthwhile investments. It's not really the doctor's fault, it's just reality until there's stricter regulation.

It is absolutely a doctor's fault if they prescribe medications that are unnecessary because of kickbacks.

Yes, but it's also human nature, or big pharma couldn't rely on it. If we care about this stuff, it needs to be legislated or reorganized away, it's not realistic to expect 'people to do a better job'.

It's not really their fault if companies exploit their subconscious biases. They aren't taking any meaningful bribe and acting on it, they are just interacting with those companies.

Norco is common because it's a mild opioid that is able to treat the majority of "intermediate" pains. If your pain can be treated with ibuprofen you don't need urgent care. If it can't then Norco is the lightest alternative most likely to help.

I honestly think it makes a difference. People don't necessarily think about the monetary value of something. It's like paying for employees' lunches every day. At $10 each the cost is 5104= $200/month. I am pretty sure they will be more excited about free lunch than $200/month more.

Why not? When my wife worked at an insurance agency they always refered people to mechanics/etc that stopped by and gave them candy every few months. Not all doctors handle their profession with the respect and care we'd like.

Cognitive dissonance actually means that a small payment can be stronger than a large one. If you accept a large payment to listen to a pitch, it's easy to tell yourself it's just for the money. If it's not enough to believe that, then you must actually be interested in hearing about it.

> Do we think that a $15 lunch is going to influence a physician to over-prescribe a drug?

Why then does the manufacturer spends that $15? Are you an marketing expert? On which studies and data do you base this conclusion?

Except you organize that conference in Hawaii, all expenses paid.

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