Case and Commentary
Jan 2005
Throughout this discussion, "industry" refers to all "proprietary health-related entities that might create a conflict of interest." While relationships between industry and the medical community have resulted in important benefits for patient care, there has been growing concern about the potential negative consequences of the relationship. In particular, commentators have increasingly questioned the appropriateness of some of the gifts and other subsidies that are given to physicians by companies in the pharmaceutical, device, and medical equipment industries. Some of these gifts and subsidies may have inappropriate effects and are therefore cause for concern. Accordingly, Opinion 8.061, "Gifts to Physicians from Industry" addresses the appropriateness of gifts given to physicians by health care industries.
To avoid the acceptance of inappropriate gifts, physicians should observe the following guidelines:
(1) Any gifts accepted by physicians individually should primarily entail a benefit to patients and should not be of substantial value. Accordingly, textbooks, modest meals, and other gifts are appropriate if they serve a genuine educational function. Cash payments should not be accepted.
(2) Individual gifts of minimal value are permissible as long as the gifts are related to the physician's work (eg, pens and notepads).
(3) The Council on Ethical and Judicial Affairs defines a legitimate "conference" or "meeting" as any activity, held at an appropriate location, where (a) the gathering is primarily dedicated, in both time and effort, to promoting objective scientific and educational activities and discourse (one or more educational presentation(s) should be the highlight of the gathering), and (b) the main incentive for bringing attendees together is to further their knowledge on the topic(s) being presented. An appropriate disclosure of financial support or conflict of interest should be made.
(4) Subsidies to underwrite the costs of continuing medical education conferences or professional meetings can contribute to the improvement of patient care and therefore are permissible...Payments to defray the costs of a conference should not be accepted directly from the company by the physicians attending the conference.
(5) Subsidies from industry should not be accepted directly or indirectly to pay for the costs of travel, lodging, or other personal expenses of physicians attending conferences or meetings, nor should subsidies be accepted to compensate for the physicians' time...It is appropriate for faculty at conferences or meetings to accept reasonable honoraria and to accept reimbursement for reasonable travel, lodging, and meal expenses...
(6) Scholarship or other special funds to permit medical students, residents, and fellows to attend carefully selected educational conferences may be permissible as long as the selection of students, residents, or fellows who will receive the funds is made by the academic or training institution...
(7) No gifts should be accepted if there are strings attached.
Some of the gift-giving practices by industry are ethical and beneficial to patients. Nonetheless, the practice of gift giving raises a number of ethical concerns. First, industry invests in promotional activities because promotions increase sales. There is no evidence that physicians knowingly or intentionally compromise their patients' care as a result of gifts from industry. Nevertheless, the practice of gift giving may subtly influence practice patterns such that they are based on considerations other than scientific knowledge and patient needs. Moreover, gifts may also affect a physician's continuing education because physicians only have time to attend a limited number of conferences, and industry can make their conferences more attractive by subsidizing the costs of attending.
Second, even if gifts from industry have no effect on a physician's practices, there may be a public impression of impropriety, especially if the gifts are of substantial value. Public trust in physicians may be undermined if it appears that the choice of a drug, device, or other product is influenced by the fact that the physician received a gift from the company that manufactures the product.
Finally, the costs of gifts from industry to physicians are ultimately passed on to the public. In effect, patients pay for a benefit that may be experienced primarily by their physicians.
For further discussion of this topic, see also the "Clarification of Opinion 8.061, Gifts to Physicians from Industry" in the Code, and see <www.ama-assn.org/go/ethicalgifts>, especially module 4.
