Healthy Skepticism Library item: 14777

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Publication type: news

Susman E.
US doctors touchy on topic of pharma gifts
The Medical Post 2001 Jul 17

Abstract:

AMA delegates vocally reject call for yet another look at ethical limits

Full text:

American doctors still bristle when the subject of ethical limits on what they can receive from pharmaceutical companies as gifts is raised.
In fact, attempts even to study the imperfect and often ignored guideline were snuffed by delegates to the annual meeting of the American Medical Association.
Although a key committee proposed further study, the AMA’s House of Delegates voted to kill the proposal, lest it fall into the hands of the AMA’s Council on Ethical and Judicial Affairs (CEJA) for additional tinkering.
Leave Report Be
“Don’t send this report back to CEJA,” pleaded Dr. Stephen Schwartz, a psychiatrist in Huntington Valley, Penn. “Don’t give CEJA another chance to do anymore on this. I think that have done enough already that has harmed our membership.”
According to current guidelines in the AMA’s Code of Ethics, doctors are supposed to limit gifts they receive from pharmaceutical companies to $100 (US). That figure represents the value of items to the doctor, explained Dr. Herbet Rakatansky of Providence, R.I., the chairman of CEJA. “That’s $100 retail,” he said.
The question of what’s ethical and what’s not raises its controversial head at virtually every semi-annual meeting of the 290,000-member AMA House of Delegates.
Many physicians are concerned the integrity of the profession is being undermined by seemingly uncontrolled largesse on the part of drug companies; other doctors reject the idea that the receipt of gifts from pens and note cards to luxurious travel to attend continuing medical education sessions would affect their prescribing habits.
Limit Ideas Introduced
This year, a resolution to revisit the gifts’ limit was introduced by the Minnesota delegation. Those delegates expressed concerns that pharmaceutical companies spend $11 billion a year on promoting directly to doctors, obviously with the hope of influencing prescribing habits.
“Scientific studies have shown that physicians who are detailed by drug company representatives end up prescribing the sponsored drug, even though the drug may not have been shown to be any more effective than a less expensive , older drug,” said Dr. Raymond Christensen, a family physician from Duluth, Minn.
Dr. Christensen said his delegation was moved to offer the resolution due to “an escalation of what pharmaceutical companies have been offering and erosion of physicians’ personal resolve not to accept the gifts.”
He said studies have shown the cost of marketing to physicians significantly contributes to raising the overall cost of pharmaceuticals paid by consumers.
Other doctors took umbrage at the proposal. “What the AMA is

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ing in and assuming that I am some kind of crook,” said Dr. Michael Ellis, an otolaryngologist from New Orleans. “That’s the last thing I need from the AMA.”
Dr. Schwartz said, “There is sufficient policy on this already. Trivial gifts at this level do not affect ethics of a physician.”
Added Dr. Micheal Greene, a family physician from Macon, Ga., “We are making an assumption that accepting gifts equals a change in behaviour.”
But perhaps it does, said Dr. Warren Jones, an adolescent medicine specialist from Potomac, Md. “The reason we get offered these things,” he said, is because it moves the needle (boosts sales of a drug).”
The arguments before the special House of Delegates reference committee on constitution and bylaws prompted the committee on constitution and bylaws prompted the committee to recommend that the item be sent to the AMA Board of Trustees for further action. The board would have most likely referred the question to CEJA to determine if changes in the guidelines were warranted.
“Despite the existence of CEJA guidelines that address the issue of gifts, your reference committee heard considerable testimony on this matter,” committee chairman Dr. William Mangold Jr., a urologist in Tucson, Ariz., reported to the House of Delegates. “In particular, there was concern that the resolution, in effect, constituted a directive aimed at the pharmaceutical industry to modify its practices.”
He added, “Although some individuals believed that specific restrictive limits were not necessary and physicians could not retain some discretion in regard to gifts they accept or events they attend, many did agree there was positive value to greater efforts to disseminate existing guidelines.”
Dr Mangold said because a broad range of issues were discussed, an extensive review of the matter would be the most appropriate next step and therefore wanted to trustees to take another look at the policy.
But the delegates wanted no part of further study. Comments by Dr. Schwartz and others on the floor of the House of Delegates were greeted roars of applause. The proposal was killed in an overwhelming voice vote.
“Ethical policy can’t regulate anybody,” and Dr. Edward Hill, a family physician from Tupelo, Miss., and a member of the AMA Board of Trustees.
He said the obvious resentment of CEJA by delegates to the meeting was an indication that “lots more education on ethics in medicine is needed.”