Free lunches are not the answerBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39568.498125.80 (Published 08 May 2008) Cite this as: BMJ 2008;336:1034
- Brett D Montgomery, clinical senior lecturer
- 1Discipline of General Practice, School of Primary, Aboriginal and Rural Health Care (SPARHC) University of Western Australia, Crawley, WA 6009, Australia
I share Dr Patel’s concerns about doctors’ continuing education and the quality of hospital food.1 However, I disagree that “free” lunches are the best solution to either of these problems.
No clinician can be expected to follow the progress of experimental drugs in hundreds of journals. That is why we have independent sources of information about drugs—such as the Drug and Therapeutics Bulletin, NPS Radar, and Prescrire International—which aim to distil a complex evidence base into accessible guidance for busy clinicians. Prescrire International published a review of ivabradine last year, which deemed it “best avoided.”2 According to the abstract, concerns include a lack of evidence of superiority to standard antianginal drugs and evidence of increased adverse cardiac events in patients taking ivabradine compared with those taking atenolol or amlodipine.2 Did Dr Patel hear these messages from his smiling drug representative? I found this information via a PubMed search in about the time it would have taken Dr Patel to eat his lunch.
Contact with drug representatives is positively associated with prescribing new drugs, prescribing costs, and non-rational prescribing.3 Industry paid meals are associated with formulary addition requests.3 New drugs are not necessarily safe; how many patients may have been harmed by free lunches promoting rofecoxib? And “free” lunches are not really free—they are paid for by drug sales. It would be wise to improve investment in doctors’ prescribing education, but let’s not deceive ourselves that free lunches are a substitute for this.
Competing interests: BDM is a member of Healthy Skepticism, an organisation that aims to reduce harm from inappropriate drug promotion.