Calculate the True Cost of What Appears Free

It had been a long day. I attendeda medical conference in Chicago,and my friend, PikoopAndropov, a Russian expatriatewho has a doctorate in economics,had been driving his taxi cab. Wealways try to get together whenever Iam in Chi-Town and met for late-nightdrinks at a hotel bar.

Dr. Constan: It's so nice to see you,my old friend. How's the taxi business?

Mr. Pikoop: Business good. Withname like Pikoop Andropov, I am naturalat this. Say, what's that bag ofstuff you've got? You buy me present?

Dr. Constan: That? Just the giveawaysfrom the conference. You know,pens, notepads, paperweights. A bunchof junk, really. But it's fun to talk to thedrug reps; they're some of the nicestpeople you'd want to know. I don'tunderstand why some people get soupset with drug reps because they givephysicians all this stuff.

Mr. Pikoop: Very interesting. Thesepeople don't believe in a free society orcapitalism, do they?

Dr. Constan: How's that?

Mr. Pikoop:Well, you tell me beforehow government wants you doctors tobe like other capitalist businesses—tocompete for customers. Health savingsaccounts. Advertising. Slogans on signsoutside office. Competition make priceof medical care go down, everyone ishappy. Doctors just like everyone else.But everyone else is courted by vendors,especially those governmentguys. Why they object when you doctorsdo same?

Dr. Constan: Yes, but physicians aredifferent. Lives are at stake. Patientswant to know that we're doing what isright for them, not what we're obligatedto do because we get useless presentsfrom drug reps. So they bombardus with ethics rules and Stark laws.

Mr. Pikoop: Now you talk like oldCommunist Party secretary I knew inRussia. They just tore down statue ofhim in park.

Dr. Constan: I understand yourpoint, Pikoop, but I have to admit thatsometimes I feel guilty about all thestuff they throw at me. Look at themoney they spend. They could lowerthe price of their drugs, and patientswould benefit.

Mr. Pikoop: Why? Guilty aboutpens and notepads? Cookies anddonuts? Free lunches? Every businessin America gives stuff away. It's advertising.Economic system would collapsewithout advertising, no? If drugcompany goes out of business, howthat help your patient?

Dr. Constan: True. Still, it seems likea waste. I've got more pads and pensthan I could ever use.

Mr. Pikoop: If you give them to me,I sell them in Russia. Fancy worthlesspens like gold in Russia. I give you halfof proceeds for your retirement plan.By the way, have you calculated cost ofaccepting those gifts?

Dr. Constan: What do you mean,the cost of accepting them?

Mr. Pikoop: I do calculation oncocktail napkin. See here. You workthis many minutes per year. You makethis many dollars. You earn $1.50 perminute. The 10 minutes you talk todrug rep costs you $15. If you werecardiovascular surgeon, it would be$75. How you getting any good dealfrom interaction? By the way, Dr. Lou,I understand the true reason you doctorstalk to drug reps. It's not for freepens; it's because they're so nice. Theysmile, they give you interesting information,they help make your day morepleasant. You doctors have prettytough job. You need that.

Dr. Constan: That's very interesting.Tell me something, Pikoop, how comean immigrant has more sense than allthe smart people who make policy inthis great country?

Mr. Pikoop: Old Russian proverb: Ittakes really smart person to do somethingreally dumb.

Louis L. Constan, a family practice physician

in Saginaw, Mich, is the editor of the Saginaw County Medical Society Bulletin

and Michigan Family Practice. He welcomes questions or comments at 3350 Shattuck

Road, Saginaw, MI 48603, 989-792-1899, or louisconstan@hotmail.com.