By MICHAEL KIRSCH, MD
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.
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.
Michael Kirsch, MD, is a private practice gastroenterologist in the Cleveland, OH, area. He shares his thoughts about issues in medicine and medical practice at MD Whistleblower.
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You got very interesting debate started on your post and its worth a lot of comments. Very less people are able to talk so well about this topic. A big thumbs up from me.
I doubt that the cost of flat screen TVs and comfortable chairs increases the hotel costs of the hospital very much. I just visited an international hospital in Thailand which had very deluxe rooms (huge flat screen TV, computer for the patient, computer for the nurses, mini kitchen. sofa, wood paneling, etc.). It seemed like a luxury hotel. We were also impressed with the staff who were plentiful and extremely attentive. All of the equipment in the hospital was state of the art. The total cost of the care was about 10% of the price quoted by our local (linoleum floor, spartan room) hospital. I don’t think that the cost of the hotel facilities plays much role in the cost of the care.
Also, the problem of drug samples is not the cost of the samples themselves (drugs are really cheap to manufacture) but the fact that doctors will Rx the more expensive sampled drug rather than an equally good generic drug.
I am a physician, but in the last 5 years have spent more time than I would have wanted on the other end of the relationship, as medical and surgical patient and as primary support person for a family member with two successive – and successful – cancer journeys. Here’s my take on the ‘hotel’ aspect of hospitals.
One cranky or obstructive employee or professional can erase all the (+) karma of that atrium and the photo gallery in the cafeteria in a nanosecond.
Conversely, the professional or employee who takes extra time to help more than makes up for Motel 6 decor.
As a patient, when I started thinking about access to wireless or the decor, I was pretty close to being ready to go home. As a visitor, however, it was much easier to spend hours upon hours in the hospital if the chair was comfortable, the wireless worked (not just keeping up with work but keeping family across the country in the loop), there was a comfortable and quiet place to recharge myself, decent and varied food, and clean and well marked restrooms. But functional and findable was all I wanted. Opulent was actually a negative – it is not an environment I like when well.