June 2000 • Volume 6 • Number 6
Gifts to physicians from industry
Sidestepping an ethical quagmireBY CINDY McCANSE
It's a familiar refrain but one that bears repeating: Physicians should be cautious about accepting gifts from industry.
Norman Kahn Jr., M.D., left, vice president for education and science, talks with attendees at the AAFP Annual Leadership Forum session on ethical guidelines.That's the word family practice leaders received in a breakout session at this year's AAFP Annual Leadership Forum in Kansas City, Mo. Facilitators Norman Kahn Jr., M.D., vice president for education and science; Clayton Hasser, vice president for publications and communications; and David Baldwin, CME accreditation manager, used case histories to drive home their message about interactions between physicians and pharmaceutical interests.
"The point of being here today is to re-acquaint you with the ethical guidelines," said Kahn at the April 28 session. "It's easy to say that if you're ethical, you're good, and if you're unethical, you're bad. But let's wallow around in that middle area. We have to struggle with these issues."
Consider the following scenario:
A pharmaceutical firm invites physicians to a southern resort for a three-day consultant's conference. Participants arrive on Friday. The clinical program Saturday morning features two 45-minute didactic presentations, a one-hour discussion of case studies and a one-hour consulting session. Saturday afternoon is devoted to recreational activities, with choices ranging from golf to a manicure and pedicure. Departure is on Sunday. Each physician receives a $500 consulting fee. The program sponsor pays lodging and air travel.
Is this an ethical arrangement? Probably not. What if the consulting period were increased to three hours? Seems better, doesn't it?
According to guidelines developed by the AMA's Council on Ethical and Judicial Affairs in response to increased federal scrutiny of gift-giving activities, a couple of issues still must be addressed before an ethical green light can be given in this case.
AMA's "Gifts to Physicians from Industry" reads, in part, "It is appropriate for faculty at conferences or meetings to accept reasonable honoraria and to accept reimbursement for reasonable travel lodging and meal expenses. It is also appropriate for consultants who provide genuine services to receive reasonable compensation and to accept reimbursement for reasonable travel, lodging and meal expenses. Token consulting or advisory arrangements cannot be used to justify compensating physicians for their time or their travel, lodging and other out-of-pocket expenses."
Physicians must examine their personal motives as well as those of the sponsoring entity in such cases, Kahn said. Does the physician have sufficient expertise to qualify as a bona fide consultant?
Also, physicians should be on guard about the type of input solicited and how it will be used, particularly in situations in which a sponsor asks for feedback on a new drug or medical device, Hasser said. "If they're in the late stages of a marketing campaign, they're probably not going to really listen to what you have to say."
Another potential ethical problem with this scenario is the value of the social activities. The AMA guidelines stipulate that such activities be of modest value, generally defined as no more than $100.
This is only one example. Far more common are office visits from pharmaceutical representatives offering free samples and industry support for CME programs. As much as physicians may protest that they emerge from such marketing barrages unscathed, recent literature paints a different picture.
A study in the Jan. 19 Journal of the American Medical Association found that physicians' dealings with pharmaceutical companies do change their prescribing and professional behaviors. Although the type or degree of behavior change varied according to the specific interaction, overall, physicians were more likely to prescribe the company's drug regardless of any demonstrable benefit over similar drugs and more apt to request that it be added to their hospital's formulary.
Patients often view such interactions as inappropriate. A study in the March 1998 Journal of General Internal Medicine found that more than one-third of patients surveyed believe acceptance of any industry gift obligates a physician to prescribe that company's drug.
As one session attendee said: "All you have to do is think of how this would look on 60 Minutes if Mike Wallace were talking about it."
Review the AMA guidelines at http://www.ama-assn.org/cmeselec/cmeres/cme-6.htm.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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