June 2000 • Volume 6 • Number 6
Ethical? Or not?
Each of the following scenarios is followed by comments regarding whether it’s ethical according to the AMA Council on Ethical and Judicial Affairs "Gifts to Physicians from Industry" guidelines:
Speakers Bureaus
Scenario: A pharmaceutical firm offers a speaker training workshop in Palm Beach, Fla. Travel and hotel expenses are covered, and each participating physician receives a $1,000 honorarium. The workshop focuses on a product promoted by the sponsoring company.
Comments: In general, physicians who are being trained as speakers or faculty for educational conferences and meetings may not accept travel expenses from industry. If a physician is presenting as a so-called independent expert at a CME event, the fact that this type of training has been provided and the physician reimbursed for travel and lodging raises questions about the physician’s independence. In this instance, the training itself represents a gift because the physician’s role is generally more analogous to that of an attendee than a participant, and the offer of an honorarium is clearly inappropriate. (Note: Speaker training sessions are distinctive from consultative meetings with leading researchers that are funded by industry and designed primarily for an exchange of information about important developments or treatments — including the sponsor’s own research — for which reimbursement of travel expenses may be appropriate.)
In a similar vein, if a company invites physicians to visit its facilities to become educated about one of its products, travel expenses should not, in general, be reimbursed. Physicians should consult with their medical specialty society regarding the appropriateness of travel reimbursement in cases in which it is clearly more practical for the physician to make an on-site visit, such as when a large piece of medical equipment is the focus of attention, or in cases in which the company insists on such visits as a means of protection from liability for improper usage. In no case would honoraria be appropriate, and any travel expenses incurred should be only those that are strictly necessary.
Gifts
Scenario: A pharmaceutical company mails an invitation to physicians to attend a speaker clinical discussion on the role of maintenance drugs in the treatment of a common disease entity. There will be a 40-minute presentation by a thought leader followed by a 20-minute question-and-answer session. For their participation, physicians will be mailed a $100 gift certificate to be redeemed for a medically relevant item.
Comments: Gift certificates fall into a gray area that is not per se prohibited by the AMA Council on Ethical and Judicial Affairs guidelines. Medical textbooks are explicitly approved as gifts under the guidelines. A gift certificate for educational materials — that is, for the selection by the physician from a catalog composed exclusively of medical textbooks — would not seem to be materially different. The issue is whether the gift certificate gives the recipient a sufficient level of control as to make the certificate similar to cash. Cash payments should not be accepted. Preselection by the sponsor removes any question.
Physician Groups
Scenario: A pharmaceutical company provides a grant to a large physician group for an electronic medical records system. Such a system will obviously provide the practice with numerous benefits, including the ability to generate printed, rather than handwritten, prescriptions. The system will also be programmed to track the number of prescriptions written by physicians according to their therapeutic and product categories and report that information back to the pharmaceutical company.
Comments: No gifts should be accepted if there are strings attached. For example, physicians should not accept gifts if they are in any way related to the physician’s prescribing practices. All that said, it is doubtful that the monetary value of such a grant would fall under the $100 limit set by the AMA’s "Gifts to Physicians from Industry" guidelines.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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