AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. December 2000, Volume 2, Number 12.

Journal Discussion

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Gifts to Physicians from Industry

Readers are referred to a JAMA article by Ashley Wazana to discuss whether gifts of industry bias physician attitudes and alter prescribing decisions.

Keith Bauer, MSW

Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA. 2000; 283:373-380.

Questions for Discussion

In his study to determine the extent of and attitudes toward the relationship between physicians and the pharmaceutical industry, Dr. Ashley Wazana notes that the pharmaceutical industry spends an estimated $8000 to $13,000 per year on each physician in marketing its products. Promotional campaigns by the pharmaceutical industry often provide physicians with essential information about new drugs and current research.

Not infrequently, however, their marketing activities include gifts to physicians in the form of logo-covered pens and free meals, as well as subsidized travel and support for symposia and continuing medical education programs. Most medical societies do not ban these gifts, but they do have explicit guidelines for regulating the value and type of gift that is appropriate as well as the conditions under which these gifts should be given and received (see, for example, AMA Policy 8.061, Gifts to Physicians from Industry).

Despite these guidelines, many share a concern that gifts may bias physician attitudes and alter prescribing decisions. This study helps to substantiate these concerns. Dr. Wazana suggests educational and policy interventions as partial solutions to counteract the influence of the pharmaceutical industry.

1. Do pharmaceutical industry gifts to physicians have any direct or indirect benefits for patients? What are they?

2. Can patients be harmed by the current gift-accepting practices of medical professionals? How? Do potential benefits exceed potential harms?

3. Should the medical profession curb the pharmaceutical industry's influence on physician attitudes and prescribing choices? If so, how?

a. Augment professional education about existing guidelines.

b. Adopt stricter guidelines that ban all gifts from the pharmaceutical industry.

c. Support federal legislation that legally prohibits the pharmaceutical industry from giving gifts to physicians.

Articles and books on bioethics continue to expand in both number and the range of topics discussed. Between 1989 and 1998, more than 4,000 articles alone were published in MEDLINE-cited journals. Some of the major topics examined are the patient-physician relationship, end-of-life care, reproductive medicine, genetics, and the allocation of scarce medical resources. From these publications, we will be selecting a handful of articles and chapters, some of which reflect issues of perennial concern to physicians, others reflect more recent quandries resulting from advances in biomedical technology.

A new article or book chapter will be featured every month, accompanied by questions intended to guide readers along the path of ethical reasoning and to promote discussion.

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