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Industry gifts to physicians: Less is more

Organized medicine issues a timely reminder on the ethical problems raised by physicians who accept gifts from drug and other companies.

Editorial. Oct. 22/29, 2001.

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Return on investment is the standard by which everything in the business world is judged. The free stuff that companies of every stripe dole out is no exception.

So billions are spent every year on meals, tickets and trinkets in the pursuit of increasing sales. Unfortunately, the medical field is included, even though it shouldn't be.

Industry gifts carry a clear potential to raise a conflict with the standard that's supposed to apply in medicine, of what's in the best interest of the patient. Even simply the appearance of impropriety undermines the trust patients have in their doctors. There is a clear need in medicine for boundaries on what gifts can be offered or accepted.

That message is at the core of a major new initiative lead by the AMA, in partnership with other medical organizations, and focused on industry gifts to physicians. Its goal over the next year and a half is to educate doctors -- as well as representatives of drug, device and equipment makers -- about what's acceptable and what is not when it comes to gifts to doctors.

It is a timely message. Interest in this issue last peaked about a decade ago, but abuses have since crept back into the system. Some of the more blatant ones are "dine-and-dash events" (take-out dinners for the entire family, or books, and even Christmas trees, offered in exchange for a few minutes of a doctor's time), over-the-top meals and entertainment, and questionable honorariums and travel expenses.

Many physicians are unaware of the guidelines first issued by the AMA Council on Ethical and Judicial Affairs in 1990, and further commented on by CEJA last year. Among those who are most likely to be unfamiliar with them are the nearly 200,000 physicians who have gone into practice during the 1990s. There has also been enormous turnover among industry reps during those years. Another audience is the group of physicians now in training, who are also increasingly being courted by industry and who are at risk of getting hooked on the notion that gifts are their due.

The AMA guidelines are not an outright ban. They recognize that the industry has the right to responsibly advertise its products. Much of these drugs and hardware are, after all, of significant benefit to patients.

However, the guidelines also explain and provide examples of when gift-giving goes too far. The overarching values they express include guidance that anything a doctor receives from industry should be of modest value, should be primarily to benefit the patient and should come with no strings attached.

All told, about $2 million will be spent on spreading this important message. Physicians can expect to hear about it primarily through medicine's network of state, local and specialty societies, as well as through a special AMA Web site. The industry will also be using materials from the program for its own workers.

Funding for the initiative comes primarily from nine pharmaceutical companies, which have provided more than $650,000 in grants. That money will be combined with more than $1 million worth of in-kind contributions from organized medicine, such as staff time, advertisement space and other activities. This funding arrangement caused a short-lived flap at the time of the initiative's launch recently. Critics leaped on the irony of drug companies giving money to the AMA to tell doctors not to take gifts of their own.

However, the industry helped create this situation -- one that has come back to haunt it as concerns rise about the cost of prescription drugs -- and it should help to clean it up. Worth noting is that the industry had no say in writing the guidelines.

This initiative is also an investment in the hope of a return, with the goal of adding to one of medicine's most important assets, its professionalism.

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 ADDITIONAL INFORMATION: 

For more information

A brochure on the ethical issues raised by industry gifts is available free to physicians by calling (312) 464-5101. Even more information is available on the AMA Web site (http://www.ama-assn.org/go/ethicalgifts).

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