“There ain’t no such thing as a Free Lunch”

This old saying refers to “the once-common tradition of saloons in the US providing a ‘free’ lunch to patrons who had purchased at least one drink. Many foods on offer were high in salt, so those who ate them ended up buying a lot of beer.”

Not that there’s anything wrong with any of that.

You go ahead and enjoy yourself at the saloon. We’re just saying lunch in this case isn’t actually free.

In medical school at Georgetown University, a formative moment as a young doctor came for me when I was introduced by the pharmacology department to No Free Lunch which was “a US-based advocacy organization that did outreach to convince physicians to refuse to accept gifts, money, or hospitality from pharmaceutical companies because it claims that these gifts create a conflict of interest for providers. The group also advocated for less involvement of drug companies in medical education and practice in a variety of other ways.” (Wikipedia)

No more free pens, free sticky pads, or free lunch. No in-person meetings in the office with pharma sales reps. No dinners out at nice restaurants, no free tickets to events. It seemed right to me and to plenty of others.

Physicians who allow themselves to be accessible to sales reps have been dwindling. In 2008 80% of doctors were sales rep accessible while the number shrunk to 44% in 2017, in no small part to the work of groups like No Free Lunch.


A physician who would have meetings with the sales reps was a dream come true for the industry. Why? Because to see a representative meant your prescribing habits would change. They had access to reports on the prescriptions that you wrote. They could see your prescription pattern. They could see it change under their influence. And it did change.

It was common for doctors to report in surveys that they suspected their colleagues were probably swayed by the efforts of sales reps, but very few suspected they themselves were influenced.  The prescribing statistics showed otherwise. These armies of narrowly trained experts on the one or two drugs they promoted altered the prescribing habits of the vast majority of doctors who gave them access.

The medications that were being presented were generally the new kids on the block. Altruism is not the intention of pharmaceutical salespersons. They are not making public service announcements. They are marketing products that could make money, with the side effect of driving up healthcare costs. Better to get your prescribing info from a nonbiased source, per recommendations of No Free Lunch.

No Free Lunch taught us to be critical thinkers. They taught us to realize that “new” is not synonymous with “proven.”

The tried-and-true medications had been around for a long time and were cheap. They didn’t and don’t have backers or handlers. They don’t have agents promoting them, neither do non-pharmaceutical and traditional approaches. No one canvases the medical offices touting the benefits of a no-added-sugar diet or of a comfrey compress to a sprained ankle. In fact, it’s the opposite. The cheap traditional approaches are too often tarnished by the representatives of the expensive modern way.

Direct-to-Consumer Advertising

At the turn of the century (and millennium) the regulatory agencies (FDA) loosened their rules. Now doctors were not the only market for drug ads. Consumers could be told of the products and their indications. This was a major change.

Rare Birds

Did you know the U.S. and New Zealand are the only countries that allow direct-to-consumer advertising that includes product claims? Most other countries don’t allow it at all. Canada does allow ads that mention either the product or the indication, but not both.

The Question

Who’s educating the consumer like No Free Lunch did us, doctors? Who is speaking up for the best health principles? A generation of doctors benefitted from the lesson to keep Pharma messaging in perspective. The consumer needs it too.

Big Bucks

The massive Pharma marketing campaigns are persistent, pervasive, and persuasive. Media network revenue from pharma climbs every year; currently, it stands at $20 billion dollars annually.

Here’s a point to remember: they advertise the drugs that make them money. These ads are not public service announcements. According to a recent study published in JAMA, the majority of Pharma’s spending (68%) on the top-selling prescription drugs in 2020, was of ‘low added benefit’ for patients.

High Cost

The direct-to-consumer advertising is no small part of why the US healthcare system spends more than any other country on healthcare. In 2021, the U.S. spent almost 18 percent of gross domestic product (GDP) on health care, nearly twice as much as the average of the 37 other high-income countries.

Research on prescription drug spending suggests that the United States consumes the most prescription drugs in the world. In 2019, the U.S. reported per capita spending of $1,229, whereas Canada only spent $879, Switzerland $894, and France $671.

It turns out Americans take more pills today than at any other time in recent history and far more than people in any other country. More than 131 million Americans take at least one prescription medication. The average number of medications taken among those who take prescription medications is four.

Adverse events

Medications are often very helpful, but they come with risks. A report in 2014 calculated 1.3 million people went to U.S. emergency rooms due to adverse drug effects, and about 124,000 died from those events. A similar report from the late 90s shows large numbers of deaths in the hospital from medication errors.

Poor Outcomes

Then there’s the bottom line: number one in spending, number one in medication usage, but last in outcomes.

People in the United States experience the worst health outcomes overall of any high-income nation. Americans are more likely to die younger, and from avoidable causes, than residents of peer countries.


The main message is this: partaking in lesser solutions is also not addressing the real issues. The food system is so broken that the American menu has us choosing between junk food, processed food, or fast food. We have poor priorities as a nation. This is not random circumstance. This is the result of governmental policy. Cheap food, poor health, lots of drugs. That’s our formula. 

Pharma industry is happy to provide relief to the broken system.  We shouldn’t settle for that.

There are simple steps that can be taken. The first is to see the problem. It is a huge step to know the landscape. The other steps can follow, like to buy organic food when possible. It’s an investment in your health. “Local is an even bigger key. Go against cheap centralized industrial production of food. Be part of local efforts to produce good quality food. Be part of creating a vast army of intentional consumers, informed and with relentless principled behavior.

Here’s to your health, and your continuous striving.