Politics and Your Practice: Drop that Mug, Doc

Mark Montigny, a Massachusetts state senator, wants to make it illegal for physicians to accept gifts from drug companies.

“If a doctor needs a Caribbean vacation or a mug or a pen he or she is probably not very successful and needs to be in another business,” Montigny told USA Today.

Don’t let Montigny’s dimwitted statement prompt you to dismiss his effort.

Legislators in at least 15 states are considering new laws that would either restrict or ban such gifts. Members of Congress also want to probe deeply into this issue.

Public discussion regarding physicians accepting gifts from pharmaceutical companies is a serious matter that could undermine the credibility of physicians in public debates on other major issues.

Four years ago, as healthcare costs skyrocketed and the percentage of the U.S. gross domestic product spent on drugs rose even faster, the pharmaceutical industry instituted voluntary gift guidelines in hopes of avoiding new laws and regulations. They were betting on these changes eliminating the perception that physicians could be wooed into compromising their objectivity by accepting lavish trips, meals, and other goodies from drug companies. If you’ve been in practice for more than a few years, you’ve probably noticed a difference in the largesse of your local pharmaceutical drug reps.

Other groups have gone further. Kaiser Permanente forbids its physicians from accepting any gifts from drug reps. The result: Compared to the national norm, its physicians prescribe the most heavily marketed drugs less often - without compromising patient care, according to Kaiser.

This reform movement picked up additional steam earlier this year with an article in the Journal of the American Medical Association. The authors argued that “the impulse to reciprocate for even small gifts is a powerful influence on people’s behavior.” Even little trinkets compromise physicians’ judgment and have a negative effect on patient care, the authors said. They called for a total ban on all gifts, meals, and drug samples as well as an end to paying physicians to attend meetings sponsored by drug companies.

In the wake of the JAMA article, USA Today editorialized that “doctors are sufficiently well-compensated that they can live without pharmaceutical freebies.”

Does your acceptance of a pharmaceutical-bought pen or a free trip create a conflict of interest? Legal experts say that conflicts occur when someone in a position of trust has a contradictory personal or business interest. But there are many ways to address conflicts. The primary one is disclosure.

Does the prominent display of coffee mugs or pens emblazoned with Claritin or Vioxx in a physician’s front-desk area count as disclosure? It certainly seems more blatant than a three-day, all-expense-paid trip to Vail to learn about a new medical treatment.

Mugs and pens, of course, are a mere trifle. But what about the drug samples and other benefits pharmaceutical companies regularly distribute to physician practices?

When you look for them, conflicts are everywhere, far beyond a physician’s office. Earlier this year, The Baltimore Sun reported that Johns Hopkins Medicine stunned medical ethicists by allowing a skin-care company to market its products with an implicit endorsement, making it seem as if Hopkins put the product through an independent study. Newspapers and healthcare blogs are chock full of many such alleged conflicts.

You will undoubtedly be hearing much more about this issue. And you should decide: What constitutes a conflict? What’s best for your patients? Let us know what you think.

Write to me at kkarpay@physicianspractice.com. The views expressed here are my own, and do not necessarily reflect those of Physicians Practice.

This article originally appeared in the June 2006 issue of Physicians Practice.