Healthy Skepticism Library item: 2230

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Morse L.
Scenario: How a resident can spell relief from "ethical heartburn"
AMNews 2001 Dec 3

Full text:

A reader recently asked us to address what ethical considerations should guide residents who are required, as part of their responsibilities within their training programs, to solicit large sums of money from pharmaceutical companies for educational events. In particular, what should residents do when their sense of professional integrity conflicts with their supervisors’ expectations and results in “ethical heartburn”? Furthermore, the reader asked us to define boundaries in situations where pharmaceutical representatives demand “favors” (e.g. to promote a pharmaceutical company’s product) in return for funding an educational program. We asked a member of the Council on Ethical and Judicial Affairs to respond to these questions.

Reply:

Before addressing the issue I must disclose that I am postgraduate year 46, and my response, in part, may be influenced by the fact that I was a resident/fellow two generations ago. Things certainly have changed!

This scenario is yet another example of how “gifts to physicians from industry” is flagrantly out of control, both in the way physicians have come to expect favors and in the way industry tries to use them for leverage. A physician’s association with industry does not have to be characterized by these serious problems. During my career, I enjoyed an educational connection with representatives from the pharmaceutical industry. In fact, a physician’s education in pharmacology begins in medical school and spans an entire career. During this time, maintaining certain relationships with drug reps may offer opportunities for continued learning. The relationship, however, should be free of financial incentive or other forms of undue pressures. In medical ethics there should be no quid pro quo: Medical ethics is fundamentally different from business ethics.

According to the guidelines that were adopted by the AMA in 1990, funding from industry to support academic programs should be unrestricted and “contribute to the improvement of patient care.” While using the resources of industry to underwrite the cost of medical education is acceptable, the “responsibility for and the control over the selection of content, faculty, educational methods and materials should belong to the organizers of the conferences or lectures.” Acknowledgement that an educational program received funding from a pharmaceutical company is appropriate — in fact, such disclosure is an important mechanism to help manage what otherwise could be perceived as undue influence.

I do not think, however, that it should be the responsibility of a resident or fellow — or any trainee — to solicit money from the pharmaceutical industry to support institutional educational programs. The responsibility for funding educational activities and for their administration rests with the department chair. If a resident or fellow experiences “ethical heartburn” because of conflict between the expectations of a supervisor and a sense of professional integrity, it is most appropriate to discuss the matter with the chair of the department. If the assignment came from this person, the resident or fellow may seek assistance from peers who share a concern for the integrity of the training experience. In no instance should one compromise an ethical stance when “favors” are requested by a drug rep. It is inappropriate.

The AMA, in conjunction with the pharmaceutical industry, has recently launched a major campaign to inform drug reps, physicians, residents/fellows, medical students and other health care professionals of the AMA’s Council for Ethical and Judicial Affairs’ guidelines concerning gifts to physicians from industry. The campaign will extend over the next 18 months. Their educational materials are available from the AMA or through the Web site (http://www.ama-assn.org/go/ethicalgifts).

Physicians have an ethical responsibility to place the health and welfare of the patient ahead of their own economic self-interests. Reining in the extravagance of pharmaceutical promotional activities and reducing the estimated $14 billion spent on physician marketing should be reflected in lowering the cost our patients or their insurers spend for drugs. In the final analysis, educational activities should promote the products of a specific company, with the cardinal rule for prescribing any drug being: its mode of action, its effectiveness, its margin of safety and its cost.

All physicians, educators and trainees, should be mindful that there really should be no such thing as a free lunch