Food Stamps for Doctors: Mass Legislature Votes Today

Today, the Massachusetts legislature will consider a measure introduced by House speaker Robert DeLeo to repeal the historic drug company gift ban law enacted only two years ago. Why? Because wealthy restaurant owners are lobbying to return the state to the days when it was a haven for wining and dining doctors.

The interesting thing is that doctors themselves have resigned themselves to the law, and have largely embraced it. For example, Partners Healthcare, which includes both Mass General Hospital and Brigham and Women’s, forbids its staff from accepting any drug company meal, on site or off-site, and has banned its faculty from giving “educational” talks at restaurants (read their policy here).

It’s rather embarrassing that Massachusetts lawmakers have decided to ignore Harvard Medical School’s example, and are instead receiving their health policy instruction from restauranteurs. The most vocal of these nouveau medical ethics gurus has been Steve DiFillippo, owner of the Davio’s chain of Northern Italian Steakhouses, Avila’s, and a new line of Davio’s frozen foods. Below is a picture of Steve posing with Mayor Menino at the opening of one of his restaurants.

Last April, DiFillippo appeared on WGBH's Greater Boston to present his own version of Medical Ethics 101: “Besides my parents," he said, "who do I trust the most? It’s my doctor. I trust my doctor to go to an educational dinner where it's doctor on doctor and learn about the drug. And recommend the right drug.”

Emily Rooney: “You don’t think they are going to be unduly influenced?”

Steve DiFillippo: “We’re talking about doctors. You know, they go to doctor school for 12 years…to become a doctor. I think I can trust my doctor to make an educational decision.”

I appeared with DiFillippo on that program. What viewers did not see was that in the pre-show lounge, DiFillippo was working the crowd. Speaker Robert Deleo happened to also be in the lounge, where he was waiting to be interviewed about his effort to legalize casino gambling in Massachusetts. DiFillippo planted himself by his side and groused about how much income restaurants were losing from the ban on free meals for doctors. It was an eye-opener for me, seeing the political process in action. DeLeo and DiFillippo obviously knew one another from somewhere. They shook hands, they smiled, they chatted--it was the ancient machinery of wealth multiplying itself by rubbing up against power.

Evidently, DiFillippo’s knew what he was doing, because within three months, DeLeo had introduced legislation to repeal the gift ban. I assume that the Speaker has his heart in the right place in that he wants to stimulate the Massachusetts economy. Unfortunately, he is willing to trade ethics for money, both in his successful championing of casino gambling (a shady recreational pursuit which has ruined several of my patients’ lives) and now in his willingness to allow drug companies to resume bribery-as-usual of Massachusetts doctors.

If you happen to be a doctor looking forward to a bright future of free meals, here is a portion of Davios’ steakhouse offerings. Lick your chops!

Trickle Down Deception: Restaurants and the Pharmaceutical Industry

Yesterday I debated Steve DiFillippo, owner of Davio's and Avila's restaurants, on the WGBH program Greater Boston, hosted by Emily Rooney. The topic? The effect of the Massachusetts Gift Ban law on area restaurants.

On one level, it was a friendly debate on the economic impact of the law on those restaurants that depend on drug company sponsored dinners for a chunk of their income. You can watch the debate here. Please don't comment on my bad hair day.

But on another level, this is a larger and more worrisome issue, which is the trickle-down effect of deceptive marketing practices on the economy, such that very good people unwittingly help to perpetrate deceptive marketing practices.

When you do these news shows you arrive a half hour early and are greeted by the producer, who brings you to a waiting room where all the other guests are sweating it out in preparation for their five minutes of fame. For example, I got to meet House Speaker Robert DeLeo, who was there to talk up his proposal to legalize casino gambling in Massachusetts. I then had a pre-debate chat with Steve DiFillippo. He has created some amazing restaurants, one of which I have a personal connection with. My wife and I had our wedding rehearsal dinner at Davio's when it was in its former location on the Charles River in Cambridge.

Steve is a completely ethical person, does great community work, and was just given the Torch of Liberty award by the Anti Defamation League. Yet, here he was arguing that drug companies should be allowed to wine and dine doctors in order to sell them on their newest drugs. From his perspective, doctors, with all their training, should be smart enough to separate the hype from the truth. But unfortunately our extensive training does nothing to immunize us from the effects of marketing, as many companies have discovered. Merck, for example, found that hiring doctors to pitch other doctors at restaurants and other venues led to four times more Vioxx prescriptions. It didn't matter how much they spent on restaurants, they knew they would get a handsome return on their investment. Unfortunately, a bunch of people who took that Vioxx died of heart disease, and the drug was eventually taken off the market. As patients, we deserve to have our treatment decisions based on the medical literature, and not on the pitches of salesmen who have softened up their clients with cabernet and filet mignon.

I think if Steve and the other restaurateurs didn't have a dog in this race, they would agree with this. But they do have a dog in the race. And when your income stream depends on believing something, it's highly likely that you will believe it.

Steve, like thousands of other business owners, is a victim of "trickle-down deception." It begins with the drug companies, and spreads and expands where the money goes. Other victims include advertising companies, medical education communication companies, publishers, lunch caterers, celebrity spokespeople, etc.... In each of these industries, there are ethical people who believe they are just making an honest buck. But they are unwittingly participating in a system that depends on a basic deception: trying to dress up advertising in the guise of education.

The solution is to simply do what we are doing--keeping a close eye on the industry and reporting their most deceptive practices. Unfortunately, when they just can't behave themselves, we have to expend a lot time and effort to pass laws regulating them. The ensuing trickle down effect of honesty is something we can all support.