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Cost and Quality of Industry-Sponsored Meals for Medical Residents
To the Editor: There have been ongoing concerns about the costs of gifts from the pharmaceutical industry to physicians, and whether such gifts may influence their prescribing practices.1 In their recent guidelines about entertainment and gifts, the Pharmaceutical Research and Manufacturers of America (PhRMA) stated that "in connection with [informational] presentations or discussions, occasional meals (but no entertainment/recreational events) may be offered so long as they: (a) are modest as judged by local standards; and (b) occur in a venue and manner conducive to informational communication and provide scientific or educational value."2 The American Medical Association and the American College of Physicians have published similar guidelines that call for limits on the value of gifts.3-4
The PhRMA guidelines took effect July 1, 2002. Little is known about its impact on industry-sponsored meals and the relative cost of these events. We examined the cost of dinners and the type of restaurants chosen by pharmaceutical companies for company-sponsored educational events for medical house staff at the University of Pennsylvania in the 6-month period following inception of the new guidelines.
Methods
We conducted a retrospective observational study of the period between July 1, 2002, and December 31, 2002, which analyzed pharmaceutical company events sponsored for internal medicine house staff at the University of Pennsylvania, Philadelphia. Departmental policy requires that pharmaceutical representatives must contact the chief residents or other administrative staff, who in turn distribute the announcements via electronic mail to all medical house staff.
We collected all e-mail advertisements for pharmaceutical-sponsored dinners directed at medical housestaff during this 6-month period. Cost and food ratings were assigned to each restaurant that served as an event site based on the Philadelphia Zagat Survey for 2002 and 2003.5 Mean costs and food ratings were determined for all restaurants in Philadelphia based on the complete Zagat Survey. Two-sample t tests were used to determine whether cost and food ratings of sponsored events were higher than the Philadelphia average.
Results
In the 6-month period following inception of the PhRMA guidelines, 27 informational presentation events in conjunction with dinner were advertised through the Department of Medicine to medical house staff. One event was a happy hour at a cigar bar where no dinners were served and was thus excluded from the analysis. The 26 dinner events were held at 18 different restaurants.
The average price per meal according to the Zagat Survey at the industry-sponsored venues was $42.08. This was significantly higher than the Philadelphia average of $29.65 (P<.001). There were 8 events at venues with prices in excess of $50. The Philadelphia Zagat Survey divides restaurants into 4 price categories: inexpensive, moderate, expensive, and very expensive. Of the 26 dinner events, only 5 (19%) were held at restaurants categorized as "moderate," signifying a price range of $15 to $30 per person and none were held at "inexpensive" restaurants.
The Zagat Survey rates food quality on a scale of 0 to 30 with 26 to 30 representing "extraordinary to perfection," 20 to 25 representing "very good to excellent," and 15 to 19 representing "good to very good." The mean food rating per meal at industry-sponsored dinners was 22.35, significantly higher than the Philadelphia average of 20.27 (P = .002).
Comment
Although both PhRMA and American Medical Association guidelines permit "modest" meals and other gifts, neither specifies a dollar amount.
Findings at our institution suggest poor compliance with the spirit of the PhRMA guidelines in the first 6 months of their inception. Dinners were frequently held at high-priced restaurants that are known to be among the best in Philadelphia. Our study probably underestimates the degree to which the restaurants chosen for industry-sponsored events cost more than "an average restaurant" in Philadelphia, as the Zagat Survey does not rate many low-cost or franchise restaurants. Examination of whether these guidelines are being followed appears to be important as they may be an important vehicle for preserving the public's trust.
Funding/Support: This work was funded by the VA Center for Health Equity Research and Promotion.
David Grande, MD
University of Pennsylvania School of Medicine
Philadelphia
Kevin Volpp, MD, PhD
Center for Health Equity Research and Promotion
Philadelphia Veterans Affairs Medical Center
Philadelphia
1. Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA. 2000;283:373-380.
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2. Pharmaceutical Research and Manufacturers Association. PhRMA code on interactions with healthcare professionals. Available at: http://www.phrma.org. Accessed June 4, 2003.
3. American Medical Association Council on Ethical and Judicial Affairs. Clarification of gifts to physicians from industry. Available at: http://www.ama-assn.org/go/ceja. Accessed June 30, 2003.
4. Coyle SL. Physician-industry relations, part 1: individual physicians. Ann Intern Med. 2002;136:396-402.
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5. Klein M, ed, Andrews B, ed. Zagat Survey 2002/03 Philadelphia Restaurants. New York, NY: Zagat Survey LLC; 2002.
Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
JAMA. 2003;290:1150-1151.
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