Chapter 33

Introduction

• Gifts from drug companies to physicians were once very common.

• A 2001 study indicated that 97% of residents had at least one branded item (e.g., reference books, pens, information cards).

• Concerns about conflicts of interest have led to a decline in such gifts.

• This chapter discusses arguments for and against accepting these gifts and provides guidelines.

Types of Gifts

• In 2012, pharmaceutical manufacturers spent over $15 billion on drug detailing to US physicians and nearly $6 billion on drug samples, averaging around $26,000 per physician.

• Total promotional spending was almost double that of research and development costs.

Continuing Medical Education (CME)

• Drug companies invest over $2 billion annually in educational and promotional meetings.

• More than 60% of CME funding now comes from commercial sources, including the pharmaceutical sector.

• CME programs must disclose drug company payments and review for potential bias.

• Company-sponsored CME programs often focus less on prevention and lifestyle compared to academic-sponsored programs.

Meals and Hospitality

• Drug companies provide food at hospital conferences or CME events to boost attendance.

• Pharmaceutical representatives often pay for meals for physicians and their staff.

Drug Detailing

• Pharmaceutical representatives offer tailored information and gifts, along with free drug samples.

• Studies show that exposure to drug company information correlates with increased prescriptions and higher costs.

• Representatives create prescribing profiles and utilize strategies to connect with physicians.

Reasons for Drug Companies to Offer Gifts

• Gifts can enhance physicians' product recognition and influence prescribing behavior, leading to an increased likelihood of prescribing sponsor medications.

• Physicians who accept gifts often do not believe those gifts influence their decisions.

Reasons for Accepting Drug-Company Gifts

• Some argue that gifts can subsidize medical education and improve attendance at professional events.

• Drug samples are seen as providing access to medications for underserved populations; however, this may be less beneficial than perceived.

Objections to Accepting Drug-Company Gifts

• Gift Impact: Impaired Objectivity

  • Gifts can compromise objectivity in medical presentations.

  • Speaker presentations may not disclose all adverse information.

• Trust Issues

  • Gifts can undermine patient trust and may influence public perception negatively.

• Perception of Professionalism

  • Dependence on drug company gifts can devalue the medical profession in the public's eyes.

• Reciprocity Expectations

  • Gifts foster expectations of reciprocation and can lead to biased prescribing.

• Healthcare Costs

  • Patients effectively pay for the gifts, contributing to the overall rise in healthcare costs.

Recommendations

• Transparency

  • Physicians must disclose received gifts in CME program syllabi.

  • Under the Physician Payment Sunshine Act, companies must report substantial payments to physicians.

• Boundaries for Acceptable Gifts

  • Certain supports (e.g., grants for CME) are acceptable with disclosure, provided there is no influence on content.

• Forbidding Harmful Practices

  • Restrictions should be placed on gifts that have a high potential for bias or impropriety.

  • Recognized organizations suggest avoiding direct payments for participation in non-educational activities.

Summary

• Acceptance of gifts from drug companies can impair objectivity and undermine public trust while increasing healthcare costs.

• The principal focus of physicians should be on their patients' interests.