Medical Verdicts

Gifts to physicians: a question of ethics

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<huc>Q</huc> Does the $300 cap on gifts from pharmaceutical companies to physicians apply to such traditional activities as dinner presentations or “Speakers’ Bureau” educational meetings sponsored by these companies? In addition, how did this rule originate?

<huc>A</huc> You might understand the rule better if I answer your second question first. In December 1990, the American Medical Association’s (AMA) Council on Ethical and Judicial Affairs published guidelines regarding inappropriate gifts to physicians from industry representatives.1 Initially, 7 rules were promulgated so that physicians could avoid accepting gifts that were inconsistent with the Principles of Medical Ethics. The council subsequently issued an addendum that attempted to clarify the ethical guidelines in a question-and-answer format, with direct answers to specific gift situations.2

Increasing physician awareness. Since these guidelines are now more than 10 years old, the AMA has become concerned that many physicians are not aware of their existence. In fact, media reports in early 2001 suggested there was an increase in gift-giving practices that did not adhere to these rules. As a result, in August 2001, the AMA established the Working Group for the Communication of Ethical Guidelines on Gifts to Physicians from Industry. This group is comprised of the AMA and more than 30 physician organizations, including the American College of Obstetricians and Gynecologists (ACOG), healthcare organizations, and industry representatives (both pharmaceutical companies and equipment manufacturers). Further, the ACOG Committee on Ethics updated its committee opinion on this subject in October 2001.3

Defining who is affected. Most physician organizations, including ACOG, have incorporated the AMA Ethical Opinions/Guidelines into their own code of ethics, and many state and local medical societies have done the same. Translation: It is highly likely that these guidelines—or variations thereof—apply to you whether or not you are a member of the AMA. For example, some societies have adopted more specific gift guidelines. I suspect that the $300 cap on gifts that you mentioned is a state or local society rule because the AMA addendum states that gifts in excess of $100 are inappropriate.

Applying the rules. To answer your first question, dinner presentations are appropriate if the dinner is a modest meal. It should be similar to what a physician routinely might have when dining at his or her own expense. The educational component must have an independent value such as a presentation by an authoritative speaker rather than a sales representative from the sponsoring company.

As far as Speakers’ Bureau meetings are concerned, I assume you are referring to whole-day or weekend seminars with a number of authoritative speakers and Continuing Medical Education (CME) credit. These meetings are more questionable, especially when they are directly conducted by the pharmaceutical company or equipment manufacturer, with minimal participation, input, or control from an academic or accredited medical society sponsor or intermediary. As with dinner meetings, the guidelines permit only modest hospitality in connection with such programs. Rather, it is preferred that industry provide funds to academic institutions or accredited medical societies so they can conduct independent educational seminars.

A look at the key points. Following are some excerpts from the guidelines:

  • Gifts should not be of substantial value, i.e., anything in excess of $100.
  • Gifts should primarily entail a benefit to patients, not the physician, e.g., complimentary drug samples. Diagnostic equipment such as a stethoscope is only appropriate if it is of modest value. Value is determined by what the physician would pay at retail, not what the company paid at wholesale. Educational programs are appropriate because they can provide an indirect benefit to patients by enhancing the quality of care.
  • Reimbursement of travel, lodging, and meal expenses for an educational meeting is inappropriate unless the physician is a bona fide member of the faculty for that meeting.
  • Social or entertainment events at a conference should not be lavish and expensive and should be open to all conference participants.
  • The modest meal rule can include payment for the meals of a physician’s spouse.

For more information on these guidelines, visit the AMA Web site at www.ama-assn.org/ama/pub/category/4002.html.

Disclaimer:

Mr. Heland’s comments reflect generally applicable legal principles. However, these comments should not be construed as constituting legal advice. Because laws can vary considerably from state to state and because each legal situation has its own unique characteristics, readers should consult their own attorneys about how best to manage a particular situation or issue.

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