If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 2 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check out all posts in this series.
This month’s stumper
A pharmaceutical company sponsors a physician lecture concerning thrombotic complications of the oral contraceptive pill (OCP). At the start of the presentation, the company's representative makes a short presentation regarding their particular brand of OCP. He then proceeds to announce that his company would like to initiate a project wherein every physician who gives a certain number of prescriptions each month will be rewarded with the special prize. He also adds that no one outside of the physicians in this lecture will be made aware of this project and all information regarding this will be kept confidential.
Which of the following is the most appropriate action?
A. Agree to participate in the project but request to direct part of the financial income for scientific research.
B. Agree to participate in the project if the prize is not a financial reward.
C. Agree to participate in the project if the price of the company's OCP is lower than that of other OCPs.
D. Decline this offer as it will lead to a conflict with patient's interests.
E. Refuse to participate in the project because patients themselves should choose method of contraception.
F. Report this case to the Food and Drug Administration (FDA).
G. Request more detailed information about the monetary value of the prize.
H. Request more information about this OCP and details of this project.
The correct answer is D.
Kaplan Medical explains why
Pharmaceutical companies often provide funding for educational opportunities for physicians. This involvement is considered acceptable by some and unacceptable by others. Pharmaceutical company involvement, however, should never place the physician in a situation in which the interests of the patient are not placed in a primary position. In this scenario, the physician will be rewarded for giving prescriptions for this particular oral contraceptive pill. This reward system may place the physician's interest against that of the patient. For example, a given patient may benefit more from another OCP, but the physician will feel pressure to prescribe the pill that will bring him the gift. Most specialty societies thus declare that physicians should not accept gifts if they are given secondary to the physician prescribing certain medications. Declining this offer is the only one correct answer in this situation.
Why the other answers are wrong
Choice A, B and C: Agreeing to participate in the project under any condition is unethical even in cases in which part of the financial income is directed for scientific research, the prize is not a financial reward, or if the price for the medication is lower than for other OCPs.
Choice E: Refusing to participate in the project because patients themselves should choose the method of contraception is incorrect because the physician should help their patient in choosing a suitable method of contraception. Physicians should not force them to make this choice because of the physician's personal interests that have nothing to do with the patient's interests.
Choice F: Reporting this case to the Food and Drug Administration is not necessary, because the FDA does not deal with ethical issues.
Choice G and H: It is not necessary to request more information about the prize or about this OCP and details of this project. All these conditions do not change the unethical form of selling pitched by the company, i.e. influencing the choice of a medication based on sales and not the patient's interests.
Tips to remember
- When participating in drug trials, interest of the patient should always be the number one priority.
- Physicians should take extreme caution in taking measures that may present a conflict of interest.
- Choose the patient's comfort and safety over anything else.
- Never trade patient's interest for any other gain.
For more prep questions on USMLE Steps 1, 2 and 3, view other posts in this series.
The AMA and Kaplan have teamed up to support you in reaching your goal of passing the USMLE® or COMLEX-USA®. If you're looking for additional resources, Kaplan provides free access to tools for pre-clinical studies, including Kaplan’s Lecture Notes series, Integrated Vignettes, Shelf Prep and more.
