Big excitement this week at Review Central: One of our colleagues was selected to receive a free pizza lunch for the entire office. The pizza—I trust to no one's surprise—is to be delivered by a financial consulting firm who will pitch portfolios with the pepperoni.

Physicians will certainly recognize the ploy, though the cuisine spread before them in such free lunch seatings is generally quite a bit loftier.

I pass no judgment, either on the tactic or on the motivations in these scenarios. We ourselves stuff a free lunch in your mailbox every month. In every case, you make a judgment whether to invest your valuable time, the real cost of every free lunch. The key, of course, what's for dessert; what's the value-added that comes with the meal.

Physicians face these judgments far more often today than in the past, and over a far more serious matter than whole life insurance. Many doctors today get most of their information about new drugs, technologies and therapies from such sources as manufacturer-sponsored events, dinners, detailing visits, and, yes, advertising-supported publications just like this one.

There is nothing inherently wrong in any one of those avenues of education. What problems do arise center on two issues. One is when physicians fail to keep the nature of the transaction in mind, that is, there is no free lunch. The other is when the provider of the information disguises its motivation.
The former seems rare in this profession, at least in my experience. Ophthalmologists, perhaps of necessity, appear very astute at judging motivation, hidden or otherwise. Most just don't have the time for snake oil.
The latter may be more problematic. The process of getting information to physicians and affecting their behavior is becoming increasingly complex, and one that researchers are still working to understand.

An important new avenue in that process, however, is the reason for concern. The patient is becoming a key agent of influence on physician behavior. The rise of direct-to-consumer advertising and other means of shaping patient attitudes is testimony to that.

No one questions the right, in fact the responsibility, of a provider of medical products and services to make a profit. And I trust the overwhelming majority of providers I've known in this field to be moral and ethical people.
But many patients simply don't have the physician's judgment and, in some cases, intelligence, to enable them to distinguish a profit-driven message from one whose primary motivation is good patient care, whether that's refractive surgery or a new drug or a new technique.

Too many haven't learned that the pizza isn't free.