Tell patients about gifts? Or just say no?

Ethics Forum. Jan. 7, 2008.

Would physician disclosure of all industry gifts solve the conflict-of-interest problem?

Drug and medical device manufacturers cultivate physician relationships with the help of complimentary gifts and services. Some say that disclosing to patients the value of these gifts resolves the physicians' possible conflicts of interest. Others say no gifts at all is the only ethical course.

Response

Research has shown that physician-industry interactions are associated with problematic changes in prescribing behaviors, additions to hospital formularies, and increased perceptions of conflict of interest. The purpose of a gift, after all, is to establish the identity of the donor in the mind of the recipient and to oblige the recipient to reciprocate.

Almost 10 years ago, researchers discovered that patients found gifts less appropriate and more influential than did physicians. These researchers called for broader dissemination of ethical guidelines for changing physician behavior. The AMA, the Pharmaceutical Research and Manufacturers of America and other professional organizations have guidelines on gifts to physicians from the pharmaceutical industry. In 2001 the AMA launched an educational initiative for physicians, physicians in training, and pharmaceutical representatives, in the belief that the guidelines would minimize conflict of interest and preserve integrity and trust in the patient-physician relationship. PhRMA accepted a voluntary code on gifts, but gift-giving practices have continued.