Healthy Skepticism Library item: 443

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Publication type: news

AMA turns down proposal to ease guideline on gifts Doctor says policy ignored by many
Associated Press 2004 Jun 15

Full text:

The American Medical Association rejected a proposal Monday that would have softened the group’s stance against drug industry “freebies,” including paying for doctors’ trips to industry-sponsored educational conferences.

Dr. Peter Lavine, a Washington, D.C., orthopedic surgeon who offered the proposal at the group’s annual meeting in Chicago, argued that doctors deserve to be compensated for attending such conferences, where they often learn crucial information about new medical equipment and procedures.

It does not make sense to allow money for tuition “but not hotels,” he said Sunday during a committee hearing on his proposal. “The policy is a mess.”

Lavine said that many physicians ignore the existing policy, which says doctors should accept only gifts that have some direct benefit to patients, and discourages things like free trips to conferences, hotel accommodations and other personal expenses.

The AMA’s policymaking delegates agreed without debate to accept the committee’s recommendation rejecting the proposal.

Several doctors said during Sunday’s debate that physicians face stiff pressure from drug companies marketing their products and that the proposal would increase the chances for them to be unduly influenced.

“It is very hard to admit that your behavior can be changed by someone else’s behavior,” said Johns Hopkins University neurologist Dr. Michael Williams. “To suggest that we are so self-aware that we can overcome that just doesn’t make any sense.”

On a related topic, the delegates deferred action on a proposal aimed at strengthening the AMA’s policy discouraging “shadowing,” the practice of drug company representatives sitting in on patients’ visits with their doctors.

The proposal would have urged doctors to refuse payment— sometimes hundreds of dollars daily—for shadowing, which critics say is meant to influence what drugs are prescribed.

But doctors raised concerns about a provision in the proposal that would require them to explain in advance the role of any “third parties” who sit in on patient visits and give patients a chance to refuse to allow the visitors.

Doctors said they were concerned the language was too broad and might lead to medical students or other legitimate observers being barred from the examining room.

The AMA last year adopted a policy discouraging shadowing unless patients consent. The proposal was referred for further review, and a revised version may be considered at the AMA’s December meeting.