No More Free Lunch

About a year ago, our administration banned what are known as drug lunches.

Anaesthesia who use a very limited menu of drugs, most of them now generic or with no real competition probably misses out on Big Pharma's largess and hospitality compared with other specialties.  We did however get the odd free lunch.

When BMS (Pentaspan) and Fresenius-Kabi (Voluven) were involved in colloid wars both reps brought very nice lunches to the OR lounge once a month or.  They were very tasty and we only had to listen to one company tell us how bad the other's product was.  Personally I didn't think clinically there was much difference, Voluven was easier to spike plus you could inject stuff in the bag so I used it.  When BMS showed the white flag, the Voluven guy kept on showing up with delicious lunches although he was now only competing with normal saline and Ringer's lactate. We also had Abbott, who market Sevoflurane.   The only competition with Sevoflurane is Desflurane which I also use but because we do a lot of cases with laryngeal masks at our hospital we use a lot of Sevoflurane.  There is a generic Sevo, coming up and while we are eating our lunches, the rep makes sure we are cognizant of the drawbacks of the potential generic competitor.

I appreciate the lunches, although I always eat too much and am sluggish during the afternoon.  From my point of view, they are a waste of time for the rep.  What colloid we get or what type of Sevoflurane we get is decided by someone in a room far away, who has never been near an OR and probably thinks Sevoflurane is a dietary supplement.  If I hang up a bag of Voluven instead of Ringer's Lactate it is because I think it is going to be better in the situation I am in.  The whole crystalloid-colloid thing bores me.  I earn a good living, I can afford to buy lunch.  I usually bring it from home.   I shouldn't be bothered by banning drug lunches.

Except.......

Our hospital does a lot of total joints and orthopedic trauma.  This means that everyday we have reps from the orthopedic hardware companies sitting in our lounge, walking around the OR and directing the nurses and surgeons in installing their expensive products.  The hospital even lets them park in the doctor's parking lot and gives them lockers.  There are at least 5 of them and assuming they all earn $100,000 a year, that's half a million dollars worth of sales force hanging out in our OR.  Do you think the companies that employ them are going to tell them to tell the surgeon to implant the most cost-effective hardware ?  That's why, instead of the old Moore's prosthesis which cost $300, people who haven't walked in years are getting the modular Moore at considerable extra cost.  This isn't enough, we are know doing total hip replacements in 90 year olds with broken hips.  The old DHS is of historical interest, everybody now gets a gamma nail.

And of course every OR committee meeting we hear about how many millions over budget we are, mostly due to the cost of orthopedic hardware.  But the real problem is that once a month or so anaesthesia  (used to) gets a free lunch!