Sunday, February 27, 2011

Free Drug Samples and Hospital Hotels: Which is the Greater Evil?

Many folks criticize pharmaceutical companies for providing physicians’ offices with free drug samples. They claim that this giveaway harms consumers because drug companies must raise their prices to cover the costs of these freebies. Of course, this is undeniable. Any business expense, such as payroll or advertising, has to be covered and is expectedly borne by the consumer. If a company chooses not to advertise, outsources manufacturing to a country with cheaper labor, offers limited benefits to its employees, then they can sell their product at a low price. In this hypothetical example, anemic sales may doom the company quickly.

Naturally, free samples are not really free. The rest of us pay for them. While this is true, I don’t think it is evil. Unlike the U.S. government, at least drug companies are covering their costs and not simply borrowing money every year to meet budget. Interesting concept.

Two of the community hospitals I work at have undergone transformations. One is owned by the dominant health care behemoth in Cleveland and has just completed a near $200 million renovation and expansion. The other smaller hospital is one of the few remaining Cleveland area hospitals that are still independent. I’d like to sneak there at night and hoist up a ‘Live Free or Die’ flag up the flagpole, to celebrate its independent streak, but I’m sure that there are video cameras everywhere and that I would be in violation of several bylaws. The apt punishment might be that I would have to spend a cold Cleveland night chained to the flagpole reading electronic medical record manuals out loud.

Both of these hospitals have private patient rooms that look more like hotel suites then hospital rooms. Patients are just a click away from work and play as there is wireless internet. Why do patients need flat screen TVs?  Perhaps,  they emit healing humors to help speed recoveries. Forget about those hardback chairs next to patients’ beds where visitors would stiffly sit. Now, there is posh furniture to sink into. Artwork is everywhere. Every new hospital these days is equipped with an essential architectural structure – an atrium.

What’s the angle here? Is this a marketing war between competing hospitals? Is the new comfort standard for a hospital similar to a high end cruise ship? That gives me an idea. What if a hospital system purchased a cruise line to serve as a floating hospital across the high seas? I’m amazed we haven’t seen this yet. Remember, you read it here first.

Get that gallbladder out!
Visit exciting ports of call!
 Enjoy world class entertainment! 
Splurge on our decadent midnight chocolate buffet!

Where’s the outrage here? Are these hundreds of millions of dollars helping sick people get well? Couldn’t this money be directed to a more worthy objective? Why aren’t health care reform-minded folks picketing and protesting? Or, does it make more sense to carp over free Nexium samples and pizza for the office staff?

It is true that physicians who have been actual patients gain a valuable perspective. I’m willing to make the sacrifice. Put me up in one of these carpeted, plush rooms with room service and soft music. It will be tough, but if it’ll help me to be a better doctor, then I’m willing to endure the pain.

14 comments:

Elaine Schattner, MD said...

Nice picture of the Taj, Michael. I don't have a problem with fancy hospital rooms if they're paid for by individuals, privately. But if you have a for-profit hospital, where the idea is to draw in higher-paying patients, and doctors might be motivated to do more procedures for those patients with dollars in hand...that's another story.

Brad F said...

Michael,
There have been a boat load of articles in lay newspapers on this subject, and within the last 6 months, a terrific review in NEJM.

Lots of folks are questioning the wisdom of 5-star amenities in the hospital realm.

Not really clear on your questioning reformers and picketing though? So many issues to discuss, not the least of which is Medicare, FFS vs caps, etc. This is not an 'A' list quagmire by any means, but certainly one that gets discussed, and needs vetting.

I cant knock you though for citing it as a problem. You are 100% correct.

Brad

James P. Pinkerton said...

Great site--just added MDWB to my blog roll.

Michael Kirsch, M.D. said...

Comments appreciated. Just seems vulgar to have 'Club Med' hospital care when we have working folks who can't afford medical insurance. Those who argue so vociferously for raising taxes on high earners are mute on this issue.

James, delighted to have you on the blog and expect regular offerings of your erudite input.

Toni Brayer, MD said...

Michael Kirsch, MD: Great post. While I had a bit of trouble finding the connection between taj hospital suites and free drug samples, you did tie them together (kindof)

I agree with you about this new trend of 5 star concierge hospitals. They are clearly aimed at the wealthy patient who has choices. The problem is, there aren't enough of those patients out there to fill them and as Medicare/Medicaid becomes the prime payor, these marketing efforts may prove to be a big mistake. Private rooms-yes. Flat screen TVs and atriums and marble bathrooms are an extra cost that we should not have to bear as a population. We should not be building hospitals that cost more than some small countries annual budget. We are building a $1.5 billion dollar hospital in SF.

Anonymous said...

Last time I looked, you couldn't buy a tube TV if you tried. This is the competitive model in action, fellas. Last time I looked, most docs don't like to think about a single-payer alternative. Also, what about all the docs who prescribe the samples of some tweaked drug otherwise going off patent instead of a generic? That's real money....

A. Bailey said...

The only solution I can think of for this conundrum is massive amounts of new Federal legislation.

@anonymous (why don't you use your name?) - the impetus to use "tweaked" drugs is usually consumer-driven. With the economic profiling that doctors are subjected to, it's in our financial interest to prescribe the least expensive drug, not the new expensive stuff.

Michael Kirsch, M.D. said...

I suspect that most physicians could treat most patients quite will with only 20 or so old fashioned generic medicines available. A PPI, beta blocker, few antibiotics, prednisone, digitalis, diuretics, etc.

@Toni, yeah, there's somthing obscene about creating palatial hospitals when the system and many individuals need health care resources so desperately.

healthy living said...

Ask the patients in third world countries. If you have experienced being admitted to a provincial hospital just to share beds with 2 other patients, then you would dream of staying in a hospital suite. These wards are cheap but it worsens your condition. On the other hand, although you pay $$$$ in hospital suites, at least you can recover quickly and you can just work for the expensive bills later.

Michael Kirsch, M.D. said...

@healthy living, is a posh hospital suite a prerequisite for excellent care?

LifeOnMulberry said...

1- concern that reimbursement will be linked to patient satisfaction (CMS surveys, HCAPS scores here in NY)
2 - wealthy patients pay their bills and/or are insured. For elective procedures, they'll commute from another state/country... And wealthy patients want to be comfy.

Not sure why you wouldnt understand why there's more attention being paid to patient amenities!!

Michael Kirsch, M.D. said...

@jb, thanks for you thoughtful views. Of course, I recognize that the well off will live better and have a higher standard of living than others. It just seems jarring to me that new hospitals are now equipped with 'cruise line' amenities, while we have a health care system starved for resources. I uunderstand your point, but am merely suggesting there is great irony here.

I celebrate the advances that the drug companies have made, and have expressed this repeatedly in this blog. Respectfully, I believe that you could take care of most patients reasonably well with only a small number of medicines available.

Thanks again for commenting. I look forward to reading your views on future posts.

Anonymous said...

Our great American healthcare system encourages "competition". Since healthcare consumers are not equipped (nor is medicine itself) to understand the relative quality of the services they are buying, they are influenced by fancy rooms and lobbies and the like. I would agree that competition for hospitals-whether inter-hospital or with physicians, has yet to reduce healthcare costs. We merely add more infrastructure, and our medical widget piece-work system simply insures that everyone will continue to make a living by overusing the unnecessary diagnostic and therapeutic capabilities. Before you are critical of the hospitals, you should understand the incentives with which they are presented. Are you as critical of your physician colleagues who open up their own office-cum-MRI? Colonoscopy center? Mohs surgery facility? We have way too many hospitals and doctors in so many locations--but competition remains the favored model by many. There is not enough healthcare consumer information in the world to think that "competition" will make a dent in our healthcare costs.

Michael Kirsch, M.D. said...

Throughout this blog, my own profession and my own specialty have not been spared. No protected special interests here. Thanks for your comment.

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