Industry gift-giving guidelines

In an effort to help physicians avoid acceptance of inappropriate gifts from pharmaceutical, device and medical equipment industries, the American Medical Association maintains ethical guidelines for gift-giving. Last updated in 1996, the guidelines, condensed below, are worth reviewing periodically.

1) Any gifts accepted by physicians individually should primarily entail a benefit to patients and should not be of substantial value.

When considering the value of a gift, a physician should appraise an item by what it would cost him or her in the retail market, as opposed to what the industry actually paid for the item.

Gift certificates fall into a "grey" area of ethics: The AMA has not taken a black-and-white stance on whether gift certificates are acceptable or not and leaves it up to individual physicians to determine if accepting a gift certificate is ethical or not.

Vouchers that directly increase the income of a physician, however, such as a reimbursement voucher for uncompensated care a physician has provided, are considered inappropriate.

Drug samples are acceptable "gifts" to physicians because they benefit the physician's patients.

2) Individual gifts of minimal value are permissible as long as the gifts are related to the physician's work.

This guideline states that inexpensive items such as pens and notepads are acceptable. Tickets to the Nutcracker or the World Series are not.

3) 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 sales 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.

The AMA does not distinguish between subsidies from the educational vs. the sales arm of a company. The standard of ethics applies to any subsidy from any division within the company.

Also, under the guideline, physicians are advised not to accept checks or certificates from sales reps and/or their companies that reduce registration fees. "The gift of a reduced registration should be made across the board and through the accredited sponsors," the AMA states.

4) Subsidies 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 physician's time.

In a nutshell, physicians should not accept reimbursement for travel, lodging and out-of-pocket expenses. Exceptions to this rule include meetings where on-site education and training demonstrations are necessary for physicians to understand a particular product.

However, if a physician travels to a pharmaceutical company to review or comment on a product, or discuss independent research, the company may pay reasonably for the physician's time and expense. A physician can also accept reimbursement for travel and lodging if he or she is invited to participate in an industry focus group, as long as the purpose of the focus group is research-based rather than product promotion-based.

5) Scholarships or other 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.

6) No gifts should be accepted if there are strings attached.

This is the underlying theme of all the guidelines. PR