'Inappropriate' gift-giving raises concerns at AMA

We read with interest and concern the column entitled "On the flip side: Doctors detail the rep" in the July issue. The article depicts strategies, from free dinners to car washes, that pharmaceutical representatives employ when promoting products to physicians.

The Council on Ethical and Judicial Affairs of the American Medical Association has ethics guidelines regarding gifts to physicians from industry. These guidelines were promulgated in 1991, in part as a response to the federal government's increased scrutiny of gift-giving activities, and were voluntarily adopted by PhRMA. They are meant to educate physicians on how to minimize conflicts of interest, as well as the appearance of conflicts, when accepting gifts from industry. These ethics guidelines are encompassed by Opinion 8.061 of the AMA's Code of Medical Ethics and the addendum "Clarification of Gifts to Physicians from Industry" that was published in the Food and Drug Law Journal in 1992.

The CEJA guidelines apply both to gifts to physicians from industry and entertainment sponsored by industry as part of an educational conference. All gifts must entail a benefit to the patient and may not be of substantial value (interpreted as less than $100). Industry sponsored entertainment that is part of an educational conference is appropriate if it is of modest value, if it facilitates discussion among attendees and faculty, and if the educational part of the conference accounts for a substantial majority of the time.

The techniques described by the pharmaceutical representative in your article, such as "dine-and-dash," would not constitute entertainment as part of an educational conference. Furthermore, gifts listed in the article, such as flowers, movie tickets and car washes provide no benefit to the patient. Physicians should refuse to take part in these activities.

We would like to urge pharmaceutical representatives to employ techniques that comply with the ethics guidelines of the American Medical Association. In addition, we want to encourage you to share these guidelines with your readers, many of whom are involved with distributing gifts to or planning events for physicians.

We are concerned with what appears to be an escalation over the past few years of inappropriate gifts. The issue seems in large part to be a lack of education of both physicians and industry. These guidelines are set out so a patient can trust that a physician's treatment recommendation is based only on the patient's best interests. Moreover, the guidelines are designed to minimize the amount of money spent on gifts - money that could be better spent on research or on alleviating the high cost of prescription drugs.

The appearance of improper activities in this area is as harmful to the industry as it is to physicians. We must take the initiative to self-regulate lest we find ourselves the subjects of renewed interest by the federal government.

Thank you for your time.

Editor's response

Although the AMA's concerns were raised by one article, numerous articles that reveal similar industry gift-giving habits have appeared in Pharmaceutical Representative over the past several years. These articles reflect the reality of the marketplace, for better or worse, and that marketplace is the creation and responsibility of all involved in it.

Please turn to p. 3 to find out how you can participate in a special online discussion about industry gift-giving practices. PR