AMA educates docs on gift guidelines

The Chicago-based American Medical Association has launched an educational effort to raise awareness of ethical guidelines regarding promotional gifts from medical industry representatives. The 18-month initiative will target physicians, medical students and sales representatives from pharmaceutical, medical device and equipment companies, asking them to comply with guidelines published in the Journal of the American Medical Association in 1991 (see sidebar) by the AMA's Council on Ethical and Judicial Affairs.

The initiative comes at a time when the issue of industry gift-giving is gaining greater attention in the media. Recent studies have also illustrated the connection between gift-giving and prescribing.

"Acting on this situation now is important to all of us, physicians and industry representatives alike. Some gifts to physicians by companies serve an important and beneficial function for both physicians and patients. But gifts that don't adhere to the AMA's code - or other similar guidelines - may create the perception of unethical behavior. That perception, in turn, undermines our credibility with patients and the public," said Richard F. Corlin, president of the AMA. "Bottom line: Ongoing interaction and strong communication between physicians and industry are vital for good patient care, but we must ensure that those interactions are always ethically based."

Corlin urged physician and industry organizations to educate their members and employees about the guidelines using a free booklet offered by the AMA, titled "What you should know about gifts to physicians from industry." He also encouraged them to become familiar with the CEJA guidelines on gifts and a special addendum by the CEJA that answers some of the frequently asked questions about the issue, all of which are available on the AMA's Web site at www.ama-assn.org/ama/pub/category/5689.html.

A working group

To help with the process of educating doctors, the AMA has formed a working group to "raise national awareness of these and other ethical guidelines on this subject and to urge physicians and industry representatives to comply with them in their everyday interactions."

In a statement released by the AMA, the group said, "Physicians have a unique professional relationship with patients and have an ethical responsibility to place the health and welfare of the patient ahead of economic self-interest. Physicians should be mindful that accepting gifts or other remuneration that does not comply with ethical guidelines may give the appearance of undue influence and jeopardize the physician-patient relationship."

The working group is supported by grants from the AMA, as well as pharmaceutical companies like West Haven, CT-based Bayer Corp., Peapack, NJ-based Pharmacia Corp. and Eli Lilly and Co., Indianapolis.

The group initially plans to raise awareness by communicating with physicians and industry representatives through letters, opinion pieces, direct mailings and other techniques. Later, the initiative will expand to include educational resources for medical schools and residency programs, as well as industry training programs, orientations and continuing education.

AMA gift-giving guidelines

The AMA has stressed that the new program is about raising awareness, not enforcing the guidelines, and has said that additional sales representative training will be left up to individual pharmaceutical companies. "This initiative is aimed at education, not enforcement," read a backgrounder from the AMA. "The working group strongly believes that awareness-building is the most important step, and that is the focus of the initiative." PR

The following are the gift-giving guidelines published by the American Medical Association in 1991:

1. Any gifts accepted by physicians individually should primarily entail a benefit to patients and should not be of substantial value. Accordingly, textbooks, modest meals and other gifts are appropriate if they serve a genuine educational function. Cash payments should not be accepted. The use of drug samples for personal or family use is permissible as long as these practices do not interfere with patient access to drug samples. It would not be acceptable for non-retired physicians to request free pharmaceuticals for personal use or use by family members.

2. Individual gifts of minimal value are permissible as long as the gifts are related to the physician's work (e.g., pens and notepads).

3. The Council on Ethical and Judicial Affairs defines a legitimate "conference" or "meeting" as any activity, held at an appropriate location, where (a) the gathering is primarily dedicated, in both time and effort, to promoting objective scientific and educational activities and discourse (one or more educational presentation(s) should be the highlight of the gathering), and (b) the main incentive for bringing attendees together is to further their knowledge on the topic(s) being presented. An appropriate disclosure of financial support or conflict of interest should be made.

4. Subsidies to underwrite the costs of continuing medical education conferences or professional meetings can contribute to the improvement of patient care and therefore are permissible. Since the giving of a subsidy directly to a physician by a company's representative may create a relationship that could influence the use of the company's products, any subsidy should be accepted by the conference's sponsor, who in turn can use the money to reduce the conference's registration fee. Payments to defray the costs of a conference should not be accepted directly from the company by the physicians attending the conference.

5. Subsidies from industry should not be accepted directly or indirectly to pay for the costs of travel, lodging or other personal expenses of physicians attending conferences or meetings, nor should subsidies be accepted to compensate for the physicians' time. Subsidies for hospitality should not be accepted outside of modest meals or social events held as a part of a conference or meeting. It is appropriate for faculty at conferences or meetings to accept reasonable honoraria and to accept reimbursement for reasonable travel, lodging and meal expenses. It is also appropriate for consultants who provide genuine services to receive reasonable compensation and to accept reimbursement for reasonable travel, lodging and meal expenses. Token consulting or advisory arrangements cannot be used to justify the compensation of physicians for their time or their travel, lodging and other out-of-pocket expenses.

6. Scholarships or other special funds to permit medical students, residents and fellows to attend carefully selected educational conferences may be permissible as long as the selection of students, residents or fellows who will receive the funds is made by the academic or training institution. Carefully selected educational conferences are generally defined as the major educational, scientific or policy-making meetings of national, regional or specialty medical associations.

7. No gifts should be accepted if there are strings attached. For example, physicians should not accept gifts if they are given in relation to the physician's prescribing practices. In addition, when companies underwrite medical conferences or lectures other than their own, responsibility for and control over the selection of content, faculty, educational methods and materials should belong to the organizers of the conferences or lectures.