Study says residents cloudy on AMA pharmaceutical gift policy

A new report shows that medical residents aren't well-versed on the AMA's guidelines for interacting with drug company representatives.

By Tanya Albert, amednews staff. May 21, 2001.

The American Medical Association's guidelines about what gifts physicians should and should not accept from pharmaceutical companies are often called the Association's most ignored ethical opinion. A study released this month seems to confirm that.

About 42% of first- and second-year residents at the University of California, San Francisco, said it was OK for a company to pay for their travel to an educational conference, according to a study published May 1 in The American Journal of Medicine.

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About 15% of the 105 residents surveyed said they didn't see a problem with accepting luggage from a drug representative.

Neither would be acceptable under AMA guidelines.

"Sadly, it wasn't particularly surprising," said Michael A. Steinman, MD, the study's lead author. "It confirms what we've seen anecdotally all along. ... This is deeply entrenched in medical culture."

Pharmaceutical industry representatives spend more than $5 billion annually -- or about $9,000 per practicing physician -- on visits to hospitals and physician offices. And they often offer social outings as a way to get more face time.

All in the name of education

For example, in one recent marketing effort, Claritin manufacturers Schering-Plough included some physicians in ceremonies at major league ballparks to cast the first all-star ballot. Claritin is the official allergy medication of Major League Baseball.

William O'Donnell, a spokesman for Schering-Plough, said the promotion was educational because it sends a message to patients to go see their doctor if they are having any allergy problems.

Some say it goes a step too far.

"To now use real doctors as pitchmen for a product -- that is questionable," said Arthur Levin, director of the New York-based Center for Medical Consumers, a nonprofit advocacy organization working to improve the quality of health care.

But according to the San Francisco study, 50% of medical residents who thought that industry-sponsored recreation events were inappropriate said they had either participated in an event or intended to do so.

The study focused on residents because they are just beginning to form prescribing habits.

It asked the young physicians about nine items: pocket antibiotic guides, meals at departmental conferences, dinner lectures with a faculty speaker, journal article reprints, pens, social or recreational outings, textbooks, travel expenses for a CME conference and luggage.

When residents were deciding which gifts they felt were appropriate, the study found that most considered the cost of the gift rather than its educational value in judging whether it would be appropriate.

And 60% of residents said gifts don't influence their prescribing habits, but only 16% thought that gifts wouldn't influence other physicians' prescribing habits.

Obligation to comply

AMA President-elect Richard F. Corlin, MD, said physicians have a personal obligation to comply with the guidelines.

"Interactions should be geared toward education," said Dr. Corlin, a gastroenterologist in Santa Monica, Calif. "Physicians should be able to use the information. And any gifts to physicians should be truly nominal in value and nothing that is going to sway the physicians."

The rules stress that physicians should accept only minimal gifts that have an educational value or are work-related, such as a textbook, pen or notepad. They also say while it's acceptable for companies to underwrite the costs of a continuing medical education conference, physicians should not directly accept money from the companies.

Pharmaceutical company organizations also have agreed to adhere to those standards.

Pharmaceutical Research Manufacturers of America, which represents the leading research-based pharmaceutical and biotechnology companies in the country, in 1990 adopted the AMA guidelines into its own "Code of Pharmaceutical Marketing Practices."

PhRMA spokeswoman Meredith Art said companies were complying with the codes.

"Any concerns about marketing should be forwarded to the company involved or PhRMA with specific details so that we may pass the information to the appropriate company," Art said.

But Dr. Steinman, an internal medicine fellow in San Francisco, said the study underscored the need for better educating physicians on what the guidelines say.

"We can't just be talking the talk," he said. "We need to be walking the walk."