The recent proposal by the Association of American Medical Colleges to ban all gifts, food, and even minimal support to hospitals, doctors and students, while well-intentioned, is ludicrous in it rigidity, naiveté and shortsightedness. The urged ban on trivial perks such as pizza lunches and sandwiches for medical students and residents in effect throws the baby out with the bath water. Not only is the baby hurt by this. We all are.
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When was the last time you were bribed by a piece of pizza or a logo pen with five days worth of ink?
Unfortunately, this proposal ignores all subtlety, is dismissive of the many benefits of industry relationships with medicine, and considers individuals and medical organizations rudderless in their efforts to be steered by a personal and professional moral compass.
No legitimate doctor would argue for the propriety of inducing physicians to use products such as pharmaceuticals or medical devices through industry-sponsored faux-scientific meetings at resort locations. Likewise, expensive gifts such as computers, while arguably used for scientific purposes, often carry unstated expectations of product support. And no one can argue that padded consulting agreements to doctors who have no real work input into product development are fundamentally unethical — perhaps even illegal.
Oversight, guidelines and the ability to withstand public scrutiny are essential to maintaining the public trust, which is the backbone of any physician-patient relationship.
But an effort to minimize conflict of interest with an inane ban on minimal gifts from industry not only seems silly, but this heavy-handed, bureaucratic ruling could have a very real adverse impact on patient care if it results in disincentives for physicians to partake in continuing medical education, even those sponsored by industry.
This ban would encompass free samples of medication to individual physicians or students. I don’t know how most doctors use these samples. But in my practice, these are given to patients who need a short course of medication and may not have a drug plan or the means to buy the medication themselves. The Academy would rather have these donated to the medical school to be dispensed. That’s all the medical schools need — the additional infrastructure and bureaucracy of another mini-pharmacy. Do you want to go from your doctor’s office to another building in the medical school for some free drug samples? Better yet, do you want your doctor to decide to forgo the hassle of dealing with the rules on free samples and instead just write you a full-cost prescription? The loser in this scenario: You, the patient.
Med students are often broke and can usually expect to finish school with debts in excess of $120,000 (incidentally, with the unintended consequence of attracting students to high-paying subspecialties instead of primary care. Who loses there?). An industry-sponsored lunch, even given the fact that a product may be discussed, gives students a chance to get together. In fact, due to their demanding schedule, free food is not infrequently an inducement to attend an otherwise skippable conference, which may contribute to their education.
This brings me to education. Most pharmaceutical and medical device companies have themselves developed strict guidelines about what is permissible support for educational activities. These mirror the guidelines for ethical practice of medicine issued by the American Medical Association and organizations such as the American Academy of Orthopedic Surgeons, which specifically outline conditions for ethical industry support of educational activities. For example, the content of any scientific program, wherever held, must be clearly educational, delivered by recognized experts and not created by the sponsoring company.
Industry financial support defrays the cost of the scientific meeting, which would otherwise be born by individuals, schools, hospitals or medical organizations. These guidelines are well understood by physicians and companies, are intended to recognize the critical importance of continuing medical education of doctors, and understand that intermingling of physicians and industry’s top scientists should be encouraged, not hindered, since this interaction can serve to benefit patients through innovation and new discovery.
This is a benefit to all of us, and is certainly consistent with the physician’s central mission of staying up to date on scientific advances in order to provide the best patient care. As academic medical centers come under increasing financial pressures, industry support for educational efforts is likely to play an even more important role in future years.
To throw this away in some misguided attempt to avoid the appearance of unseemly influence of industry on physician’s decision making is a simplistic, holier-than-thou response to what is essentially in 2008 becoming a non-issue, as medical organizations, individual physicians, and industry alike respond to increasing scrutiny by the federal government by changing substantively how they relate to one another. The mission of the Association of American Medical Colleges is to improve the health of all. There is nothing in the mission about taking on the role of thought police for medical students.
So students and residents — enjoy your pizza — sit down, learn about a new heart valve, a new antibiotic, a new advance in gene therapy and get on with your duties to your patients.
Dr. Edward V. Craig is Attending Surgeon at the Hospital for Special Surgery in New York City and Professor of Clinical Orthopedic Surgery at Cornell Medical School.
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