A Ban on Free Gifts

It has been a long time coming: the AAMC has finally taken a strong stance against the distribution of free gifts (from pens and bags to food, travel expenses, vacations, ghost-written papers, etc.) to physicians, medical school staff members, and students by pharmaceutical and medical device companies (reference). The AAMC is not a ruling body for medical schools, but it does provide guidelines and directives that most medical schools choose to follow. Responding to the growing efforts of companies to influence the medical decisions of doctors, the AAMC has proposed an all-out ban, no strings attached.

Surprisingly, several executives from major pharmaceutical companies including Amgen, Eli Lilly, and Pfizer were on the task force, although it seems their dissenting opinions were overruled by the majority. One of the Amgen representatives expressed conditional support for the AAMC’s report “because we have a different view about the accuracy concerning representations about the motives of the participants.” This is not entirely untrue, but it illustrates the subversive nature of the tactics many companies have used to influence prescription writing, device usage, and product endorsement behavior of physicians. Various studies have consistently demonstrated that physicians who accept gifts underestimate their susceptibility to influence by the drug and device makers over their medical practice decisions. Most physicians do not perceive their acceptance of free gifts as prostituting themselves to these companies, when in reality, they are allowing these companies to take advantage of their sense of entitlement (something often developed in medical school).

Some members of my generation of physicians-in-training might complain: “Our predecessors received free gifts and tens of thousands of dollars in speaking fees; why shouldn’t we?” My response: suck it up. How hard is it to buy your own pens and lunch? The movement within the field to expose financial conflicts of interest has done a reasonable job of revealing the extent of potential influence of drug and device makers over medical practice, but it is now our job to take a stand and say “no.” 

  1. williamjusino said:

    I started my current job in the House of Reps. earlier this year, not very long after Congress adopted new ethics rules regarding gifts and travel. They did not enact a total ban, but gifts by lobbyists or anyone who employs one were drastically reduced: the limit is now two gifts worth up to $15 per year, meals are all but banned, and travel is sharply restricted (international travel pretty much banned). The works “all but” and “restricted” make it sound like there are lots of exceptions, and there are some, but it is much harder now to gain influence with gifts than it was only three years ago.

    We sometimes joke that it would be nice if lobbyists could buy us lunch, take us to baseball games and fly us out to conferences in Vegas. While we are joking, I get the sense that many staffers and members here might also underestimate their susceptibility to influence. I know I probably do. I’m glad we have these new rules. Journalists have understood for a long time that even the appearance of conflict of interest poisons their ability to do their jobs. Lawmakers and we who assist them still have work ahead of us. I am glad to see that med schools are also on top of this.

  2. Ben said:

    I’m not sure I agree with this ruling — if only b/c I’d like to believe that my doctor (or Congressman or lawyer or whoever) is an individual capable of independent thought… but it seems statistics is out to prove me wrong…

  3. Apollo said:

    I wish it were true too, Ben. However, I think this is more a testament to the power to influence of companies over physicians rather than a statement on the ability of physicians to think independently (semantics, perhaps). Doctors are human and have human susceptibilities, though I hope that most can be conscientious enough to minimize or eliminate their effects and potential harm.

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