AMA Begins Effort to Educate Doctors, Drug Company Sales Representatives about Ethical Guidelines Concerning Gifts

The American Medical Association is launching a $1 million campaign to inform medical students, physicians-in-training, doctors and drug company sales representatives about its ethical guidelines against accepting gifts from pharmaceutical companies, the Washington Post reports. The guidelines, developed in 1990, were created to respond to public concern about drug companies giving doctors "expensive gifts, lavish dinners, trips or cash payments" as part of their marketing practices. The Post reports that many "observers" believe that rising prescription drug costs are related to the "aggressive marketing of new drugs to doctors and patients." Recent studies and media reports indicate that the practice of giving doctors pens, notebooks, coffee cups and other accessories "emblazoned" with a drug company's name or new drug has increased. In 2000, drug companies spent $15.7 billion on marketing, up from $9 billion in 1996. Lisa Bero, a researcher at the University of California-San Francisco's Institute for Health Policy Studies, said, "Even the smallest gifts make doctors feel more favorable towards a company. Acceptance of gifts is also associated with formulary decisions favoring new drugs from the company that gave the gift." Under the AMA guidelines, doctors are permitted to attend drug company-sponsored conferences and receive drug samples or textbooks that "will directly benefit their patients." But the guidelines recommend that doctors do not accept individual gifts that cost more than a "minimal" amount or gifts that have "strings attached," such as if the gift is an incentive or reward for prescribing a particular drug. Because surveys indicate that doctors are unaware that the guidelines exist, the AMA decided to launch the campaign (Okie, Washington Post, 8/30). The AMA began mailing "informational material" to doctors on Aug. 27 (Tanner, AP/Raleigh News & Observer, 8/30).

Rx Companies Donated to Campaign
The AMA's efforts have received some criticism, mostly because nine pharmaceutical companies contributed $675,000 toward the campaign. AstraZeneca International, Bayer Corp., Eli Lilly and Co., Glaxo SmithKline, Merck and Co., Pfizer Inc., Pharmacia Corp., Proctor and Gamble Pharmaceuticals and Wyeth-Ayerst Laboratories each contributed between $50,000 and $100,000 to the campaign (Washington Post, 8/30). The AMA contributed $400,000 (AP/Raleigh News & Observer, 8/30). Sidney Wolfe, director of Public Citizen's Health Research Group, said, "They're certainly not going to encourage doctors to adhere to (the guidelines) when they're setting this kind of example. The campaign is not going to have any credibility." The money from drug companies was used to pay for educational kits and a new AMA Web site on the issue, former AMA President Alan Nelson said. He added, "The idea that somehow that money is tainted is not accurate in my view. This is a legitimate education program that should benefit the public." Kurt Kroenke, president of the Society of General Internal Medicine, said that as long as the drug companies had no say in how the money was used, the AMA's decision to accept the money is "reasonable" (Washington Post, 8/30).