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Docs Oblivious To Gift Guidelines

AMA looks to head off conflicts of interest through educational campaign on ethics

SUNDAY, Sept. 30, 2001 (HealthDayNews) -- Everyone loves a freebie, and no one knows that better than marketing departments. But when it comes to drug companies offering doctors gifts that range from coffee mugs to round-trip airfares to educational conferences, what's appropriate and what's not?

That's a question many doctors don't have a clear answer for -- even though the American Medical Association (AMA) does, a recent study says.

Published AMA guidelines stress that doctors should accept only minimal gifts that are work-related -- like pens or notepads.

The guidelines also say that, although it's acceptable for drug companies to underwrite the cost of educational medical conferences, physicians should not accept money from the companies.

But the study, published in The American Journal of Medicine, found that 42 percent of first- and second-year residents at the University of California, San Francisco (UCSF) Medical School thought it was OK for a company to pay for their travel to an educational conference. And about 15 percent of the 105 residents said they saw no problem with accepting luggage from a drug-company representative.

Dr. Michael Steinman, a clinical fellow at UCSF and lead author of the study, says that, although the survey covered only residents, he suspects the responses would probably be the same across all levels of doctors.

"I don't think residents are necessarily more or less prone to take gifts," Steinman says. "What's significant, however, is that they are in the formative stages of their training and are establishing the professional ethics to take into their careers."

Compounding the problem, says AMA spokesman Robert Mills, is that the gifts pharmaceutical companies are using to try to influence doctors' preferences are more creative than ever.

"We're hearing of more and more occasions where these gifts are getting out of hand, ranging from sports event tickets to one instance I heard of where someone was offering manicures for the doctor's entire staff," Mills says.

So what's wrong with accepting gifts if a doctor makes it clear to a drug company representative that he won't be influenced by the largesse?

"The problem is, very few physicians believe they will be influenced by these gifts," Steinman says. "And that makes sense, because each of us really believes with genuine conviction that our own motives are unimpeachable.

"But a lot of the influence tends to be more subtle. It establishes sort of a feeling of good will, maybe giving the sales rep a little bit of an opening to come back next time to talk up their product. So it's really much more subtle than people being just blatantly bought out," he says.

Even though the pharmaceutical industry spends more than $5 billion annually on such gifts, the ethical considerations are rarely -- if ever -- addressed in medical education, Steinman says.

"We asked people the extent to which they'd received training in medical school and residency about the ethics of interactions between physicians and the drug industry, and we found that 44 percent of residents said they had no education in medical school. And of those who had some amount of education about that, almost all said it was minimal," he says.

Once doctors finally make it out of residency and are part of a practice, one would assume concern or debate about the gift-giving would heat up.

Not so, says Steinman.

"It's an issue that occasionally comes up in informal discussion, but it's sort of accepted that the reps come and people take the gifts and it just kind of happens without really being objectively analyzed and discussed in a rigorous way."

But the problem hasn't gone unnoticed by the AMA, which is in the process of planning an educational campaign on its gift-giving guidelines.

"Not only is the campaign going to be for the doctors, but for the pharmaceutical reps because they need to play by the same rules as well," Mills says.

The AMA's immediate past president, Dr. Randolph Smoak Jr., says the campaign will serve as a wake-up call for those physicians who either never took much note of the guidelines or haven't considered them in a while.

"Periodically, in any organization there's a need to reinforce or bring attention to certain rules or ethical guidelines," he says. "We haven't done this in 10 years, and in that time, roughly 160,000 physicians have graduated from medical school. And think of how many new people are working for the pharmaceutical industry now, as well."

"So our objective is to bring this to the attention of both the physicians as well as those in the pharmaceutical industry," Smoak adds.

What to Do: The AMA's guidelines on accepting gifts are posted on the association's Web site.

SOURCES: Interviews with Michael A. Steinman, M.D., clinical fellow, University of California, San Francisco School of Medicine; Robert Mills, spokesman, American Medical Association, Chicago; study from the May 1 issue of The American Journal of Medicine
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