Conflicts of interest – industry gifts to physicians

Physician obligations to the profession

Voluntary guidelines and policy statements published over the last 15 years have had some effect in curbing some of the practices, such as all-expenses paid vacation in luxury resorts, that could be seen as blatant bribes. But, by pharmaceutical industry’s own guidelines, gifts will continue to be given especially in professional meetings in which the company’s products are promoted. Because voluntary guidelines have had only limited success, a group of academic physicians and representatives from the Association of American Medical Colleges have called on academic medical centers to take a leadership role in abolishing potential sources of unwanted influence by drug companies.¹² The hope is that academic medical centers, which have responsibility for educating and training physicians, will have an influence in shaping the attitude of future physicians toward these conflicts of interests. There is some validity to this assumption. A recent study reported that students at a medical school that had policies prohibiting gifts from drug companies were less likely to be influenced by drug company promotional items than students from medical schools that had no restriction on gifts from drug companies.¹¹

Some years ago, the Marketing Executive of a large drug company was invited by the author’s institution to debate their promotional activities. He declined the invitation but confided that there were two reasons for their gift program: (1) that the rival companies were doing it in a fierce competitive market, and (2) that without some gifts to catch their attention, doctors would not give them their time of day. Surveys of resident physicians confirm the view that without meals as inducement they were less likely to attend drug company sponsored CME meetings.¹³ Physicians are therefore at least somewhat complicit with the drug companies in perpetuating these activities. But physicians’ obligations to the medical profession demand that they put patients’ interest ahead of material gain outside of regular remuneration. If physicians rejected the overtures of commercial medical companies with as much indignation as they display when accused of being influenced by them, then these practices and conflicts of interest would probably cease. In the words of Goldfinger, “In this world of medical commerce, it still takes two to tango”.¹⁵

Key points

• Drug companies exert influence on physicians’ practice behaviors by bestowing a wide variety of gifts on them, from trinkets to gourmet dinners and travel reimbursements to attend company sponsored meetings.

• Even inexpensive gifts influence physician behavior by creating “brand awareness” and implicit associations with the products of the companies that provide the gifts.

• Accepting gifts creates obligations for physicians that are in direct conflict with their obligations to patients.

• Company gifts are funded from the sale of companies’ products to patients. Hence patients suffer additionally by having to pay for these gifts.

• Voluntary guidelines by professional medical organizations have had very little effect in curbing drug companies’ influences on physician practices.

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