Pharmaceutical Gift Giving: An Ethical Dilemma in Health Care
On the face of it, pharmaceutical gift giving may not appear to be an ethical dilemma affecting health care research. However, the big pharmaceutical companies, such as Pfizer and Merck, spend nearly $30 billion annually on gifts to physicians to increase their revenue (“Why Small Gifts,” 2009). These same large pharmaceutical companies fund and conduct large healthcare research projects. Research has shown that any kind of gift giving can influence behavior and thus presents an ethical dilemma (“Why Small Gifts,” 2009). However, despite the research demonstrating an ethical dilemma, the big pharmaceutical companies continue their gift giving practices. One might wonder how research funded or conducted by these companies could be affecting the outcome of the research.
The American Medical Association (AMA) cites two guidance documents for physicians in regards to interactions with pharmaceutical representatives (“Interactions with Pharmaceutical,” n.d.):
1. 2003 Department of Health and Human Services Office of the Inspector General’s (DHHS OIG) Compliance Program Guidance for Pharmaceutical Manufacturers; and
2. 2002 Pharmaceutical Research and Manufacturers of America’s (PhRMA) PhRMA Code on Interactions with Healthcare Professionals.
Neither ban gifts from pharmaceutical companies or its representatives but, instead, offer guidance, such as “illegal intent will make the whole gift suspect.” The PhRMA code “suggests” that gifts should be given infrequently and be valued under $100 (“Interactions with Pharmaceutical,” n.d.) The Association of American Medical Colleges (AAMC) “urges” medical schools and teaching hospitals to ban all pharmaceutical gift giving, stating that there is “psychosocial and neurobiological evidence that gift-giving of any kind can affect decision making” (Secor, 2008).
A study of 192 individuals was conducted by the Penn State College of Medicine (Green, Masters, James, Simmons and Lehman, 2012). The study demonstrated that 51% of the respondents wanted to know if their physician had accepted a gift from a pharmaceutical company that exceeded $100 and 25% said they’d be less likely to take a prescribed medication if their physician had recently accepted a gift from the pharmaceutical company. However, most patients responded that their trust was not affected by small, token gifts such as logoed materials such as pens or notepads. The study found that overall when physicians accept gifts from pharmaceutical companies it negatively affects the doctor-patient relationship and inhibits trust (Green et al., 2012).
In a fact sheet presented by the PEW Prescription Project (“Why Small Gifts,” 2009), even small gifts, such as pens and notepads, change behavior and create a sense of obligation. The project also found that with small gifts, it’s frequently not just one or two small items. One medical resident reported in a six-week period a pharmaceutical drug representative offered over 63 logoed trinkets and meals. The study (2009) also pointed out that no company, especially one in the for-profit industry such as a pharmaceutical company, would spend money on marketing products and gifts if they weren’t effective. Even the smallest of items are reminders of the pharmaceutical company or the drug they’re pushing.
The research reveals that there is an ethical conflict with pharmaceutical gift giving, yet it still persists. It makes me wonder where else this lack of ethical behavior on behalf of large pharmaceutical companies is showing up in healthcare and healthcare research. If they see no ethical issues with gift giving, where else might their ethics lack?
Green, M.J., Masters, R., James, B., Simmons, B., Lehman, E. (2012, May). Do Gifts From the Pharmaceutical Industry Affect Trust in Physicians? Family Medicine, Vol. 44, No. 5.
Interactions with Pharmaceutical Industry Representatives. (n.d.) Retrieved May 27, 2013, from http://www.ama-assn.org//ama/pub/physician-resources/legal-topics/business-management-topics/interactions-pharmaceutical-industry-representatives.page
Secor, Dane. (2008). AAMC Joins Movement to Restrict Pharmaceutical Company-Physician Relationships. Academic Internal Medicine Insight, (6:3.)
Why Small Gifts Matter. (2009, February 12). PEW Prescription Project. Retrieved from www.prescriptionproject.org