Intended for healthcare professionals


Doctors told to shun rewards from industry as size of payments becomes clear

BMJ 2006; 332 doi: (Published 02 February 2006) Cite this as: BMJ 2006;332:255
  1. Fred Charatan
  1. Florida

    Doctors in teaching hospitals should lead the way in refusing to take gifts from the pharmaceutical and medical device industries, because it damages the reputation of the profession, a leading article in JAMA said this week (2006;295: 429-33).

    The article was published in the month that, during a whistleblower court case originating in Memphis, Tennessee, some spine surgeons were exposed as having accepted hundreds of thousands of dollars from a medical devices company for undertaking limited amounts of work.

    The JAMA article, which generated widespread publicity, with articles in the Wall Street Journal, the New York Times, and the Washington Post, pointed out that drug companies alone spent $13 000 (£7360; €10 800) a year per doctor on marketing activities, “the costs of which are reflected in higher drug prices.”

    Pharmaceutical companies spend more than $20bn a year on marketing, about 90% of which is directed at doctors. This is far more than they spend on research or direct consumer advertising, the article said.

    “My mother told me never to accept gifts from strangers. If a stranger wants to give you a gift, it's very likely they want something in return,” Jordan Cohen, the president of the Association of American Medical Colleges and a coauthor of the JAMA article, was quoted as saying in the Washington Post (25 January, p A08).

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    Whistleblower Jacqueline Poteet, a former employee of medical devices firm Medtronic, has accused it of giving bribes to surgeons

    Credit: KATE MEDLEY

    “There is solid evidence it isn't the size of the gift, it's the gifting itself that creates a sense of loyalty and indebtedness,” said Sharon Levine, associate executive director of Kaiser Permanente's Northern California group practice, in the same article in the Washington Post.

    The Kaiser Permanente's 6000 doctor practice in Northern California and the Yale University School of Medicine are among the only institutions in the United States to implement policies similar to those outlined in JAMA.

    The JAMA article says that voluntary guidelines don't go far enough. It recommends:

    • Banning all gifts, including free meals. Research shows that even inexpensive gifts, such as pens, can distort doctors' behaviour

    • Prohibiting doctors from accepting free samples, a “powerful inducement… to rely on medications that are expensive but not more effective”

    • Excluding doctors with financial ties to drug companies from serving on panels that decide what drugs should be prescribed

    • Prohibiting drug makers from directly financing continuing medical education.

    The whistleblower court case exposed huge payments to some surgeons involved with the company Medtronic, which is based in Minneapolis. Medtronic is one of the largest makers of medical devices in North America, with $10bn in annual sales.

    Jacqueline Poteet, a former senior manager of travel services at Medtronic, filed a lawsuit in a US District Court in Memphis two years ago, accusing the firm of giving spine surgeons “excessive remuneration, unlawful perquisites and bribes in other forms for purchasing goods and medical devices.”

    Internal documents from Medtronic filed as part of the lawsuit show that Medtronic spent at least $50m on payments to doctors over some four years, up to June 2005.


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