The study, published in the May Internal Medicine Journal, involved separate survey questionnaires of Australian medical specialists and members of the public on gifts from pharmaceutical companies. Listed were 23 gifts valued between $10 and $250, including items such as pens and computers or activities such as dinner and expenses to attend a conference. The participants were asked whether or not each gift was appropriate.
For public respondents, patient information leaflets, drug samples and appointment books were ranked as the most appropriate gifts for practitioners to accept and movie tickets and a laptop computer for home use as the least appropriate.
For medical specialists, drug samples, patient information leaflets and pens were ranked as the most appropriate gifts to accept while a computer and refrigerator for the surgery and a laptop computer for home use were ranked as the least appropriate.
Overall, public respondents appeared to be more permissive about doctors accepting gifts from pharmaceutical companies than medical specialist respondents.
According to co-author, Professor Ian Kerridge, few studies have reported the attitudes of both individual doctors and members of the public toward the appropriateness of gifts from pharmaceutical companies.
“The basis upon which individual doctors make decisions about the moral acceptability of gifts and the degree to which these concur with public attitudes to gift giving has never been examined in the Australian context,” he said.
“This is particularly significant given that transparency and public accountability are core components of some guidelines on preventing conflicts of interest, including those of the Royal Australasian College of Physicians and the Australian Medical Association. Other guidelines such as those of the American College of Physicians and American Society of Internal Medicine suggest that physicians should gauge the acceptability of any gift from the pharmaceutical industry according to what patients or the public would think about the arrangement.”
Professor Kerridge said the study was also the first to consider whether public acceptability is a suitable criterion for determining the ethical appropriateness of gifts from pharmaceutical companies.
“Both medical specialists and members of the public believe certain gifts from pharmaceutical companies are appropriate but not others. Surprisingly, there was a tendency for members of the public to be more permissive than medical specialists.
“Some professional guidelines place importance on the attitudes of the general public to gift giving. Other guidelines give importance to a need for transparency and public accountability.
“However, we question whether public acceptability is a suitable criterion for determining the ethical appropriateness of gifts.
“Our study suggests that more weight be given to the need for independence of clinical decision making, with empirical evidence indicating that even small gifts can bias clinicians’ judgments.
“We conclude that it is time to eliminate altogether the giving and receiving of promotional items between the pharmaceutical industry and members of health professions.”
The study was supported by a grant from the National Health and Medical Research Council of Australia, Canberra.
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