BOX 6-1

Excerpts from Statements on Gifts by American Medical Association and American College of Physicians

American Medical Association

Ethical Opinion E-8.061: “Ultimately, it is the responsibility of individual physicians to minimize conflicts of interest that may be at odds with the best interest of patients and to access the necessary information to inform medical recommendations. … (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. … (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). … (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” (AMA, 2002 [updated]).

American College of Physicians

“The acceptance by a physician of gifts, hospitality, trips, and subsidies of all types from the health care industry that might diminish, or appear to others to diminish, the objectivity of professional judgment is strongly discouraged. As documented by some studies, the acceptance of even small gifts can affect clinical judgment and heighten the perception and/or reality of a conflict of interest. Accordingly, physicians need to gauge regularly whether any gift relationship is ethically appropriate and evaluate any potential for influence on clinical judgment. In making such evaluations, it is recommended that physicians consider such questions as 1) What would the public or my patients think of this arrangement? 2) What is the purpose of the industry offer? 3) What would my colleagues think about this arrangement? 4) What would I think if my own physician accepted this offer? In all instances, it is the individual responsibility of each physician to assess any potential relationship with industry to assure that it enhances patient care and medical knowledge and does not compromise clinical judgment” (Turton and Snyder, 2007, p. 469, revising Coyle et al., 2002a).

With respect to consulting, the ACP policy also advises physicians to “guard against conflicts of interest when invited to consult or speak for pay on behalf of a company” because “[i]t is likely that a company will retain only individuals who make statements or recommendations that are favorable to its products, thus compromising the physician’s scientific objectivity” (Coyle et al., 2002a, p. 399). Furthermore,

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