Companies in the pharmaceutical, medical device, and medical equipment industries often give physicians gifts. These gifts serve socially beneficial functions, such as funding for educational seminars and conferences. There has been growing concern, however, that some gifts may be costly and are simply gratuitous, without benefit to society nor augmentation of physicians’ knowledge. Some gifts that reflect customary practices in the healthcare industry may not be consistent with the principles of medical ethics. To avoid the acceptance of inappropriate gifts, the American Medical Association (AMA) has established some guidelines. This list is adapted from the AMA’s latest guidelines, revised in 2014.
- Any gifts accepted by physicians individually should be of limited or moderate value, and in some way should primarily be of benefit to patients. Some of these gifts may include medical textbooks or modest meals with a lecture or seminar; these serve educational purposes. Cash (or checks) should not be accepted.
- Items of minimal value are acceptable, if they are related to the physicians’ work, such as pens and notepads.
- The use of drug samples for personal or family use is permissible, unless these practices interfere with patient access to drug samples. [Fewer and fewer pharmaceutical products are distributed as samples. For many companies/institutions, sampling has been discontinued entirely.] It would not be acceptable for non-retired physicians to request free pharmaceuticals for personal use or use by family members.
- Subsidies to underwrite the costs of continuing medical education conferences or professional meetings can contribute to the improvement of patient care and therefore are permissible. Since the giving of a subsidy directly to a physician by a company’s representative may create a relationship that could influence the use of the company’s products, any subsidy should be accepted by the conference sponsor. It can be applied to the conference registration fee. Payments to defray the costs of a conference should not be accepted directly from the company by the physicians attending the conference.
- Subsidies from industry should not be accepted directly or indirectly to pay for the costs of travel, lodging, or other personal expenses of physicians attending conferences or meetings.
- The Council on Ethical and Judicial Affairs designates a conference or meeting as “legitimate” when the event is primarily dedicated to promoting objective scientific and educational discourse and activities. Educational presentation(s) should be the focus of the event. Furthering the physicians’ knowledge on the topic(s) of interest must be the primary incentive for the gathering. Financial support should be disclosed, as well any conflicts of interest.
- Physicians should not accept subsidies to compensate for their time. Subsidies for hospitality should not be accepted outside of modest meals or social events held as a part of a conference or meeting. It is appropriate for faculty at conferences or meetings to accept reasonable honoraria and to accept reimbursement for reasonable travel, lodging, and meal expenses. Token consulting or advisory arrangements cannot be used to justify the compensation of physicians for their time or their travel, lodging, and other out-of-pocket expenses.
- Scholarships or other special funds to permit medical students, residents, and fellows to attend carefully selected educational conferences may be permissible. The selection of students, residents, or fellows who will receive the funds should be made by the academic or training institution. Carefully selected educational conferences are generally defined as the major educational, scientific or policy-making meetings of national, regional, or specialty medical associations.
No gifts should be accepted if there are strings attached. For example, physicians should not accept gifts given in relation to the physician’s prescribing practices. In addition, when companies underwrite medical conferences or lectures other than their own, responsibility for and control over the selection of content, faculty, educational methods, and materials should belong to the organizers of the conferences or lectures.
As a whole, these guidelines seem reasonable. None of my patients will benefit from me dining at Detroit’s Rattlesnake Club, with appetizers starting at $150.00. I have accepted some things, though, which may be on the fence today – a weekend at the Grand Traverse Resort, at which I made a brief presentation to other physicians. No gifts have affected my prescribing. When I had my first child during residency, a manufacturer supplied infant formula for the first year of life. I had less to worry about, and my patients had a more relaxed physician. It was good for all concerned. I’m in favor of (un)common sense.