title: Pharmaceutical sales representatives and the doctor/patient relationship.
abstract: As marketing efforts by drug companies become more aggressive, physicians are being asked to provide clinical "preceptorships" to pharmaceutical sales representatives. During a "preceptorship" of this type, the company representative spends a day with the physician seeing patients "as an educational experience," and the physician receives an "honorarium" from the drug company in return. We explore the implications of this practice. First, we examine the nature of the doctor/patient relationship and the fiduciary obligations incumbent upon physicians in their role as healers. Second, we examine four interlocking ethical principles-nonmaleficence, beneficence, respect for patient autonomy, and justice-that should govern doctor/patient encounters. Third, we critique several hypothetical scenarios involving individuals who might put forth a claim to enter the doctor/patient relationship (ie, a pharmacist, a social scientist, the husband of the patient, and a pharmaceutical sales representative). We conclude that the practice of providing clinical "preceptorships" to pharmaceutical sales representatives is unjustifiable, is unethical, and should not be permitted.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. wall@msnotes.wustl.edu
authors.forename: L Lewis
authors.initials: LL
authors.lastname: Wall
authors.forename: Douglas
authors.initials: D
authors.lastname: Brown
mesh_terms: D026686:Beneficence; D003132:Commerce; D004345:Drug Industry / Q000592:standards* / Q000639:trends; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017850:Economics, Pharmaceutical; D006801:Humans; D007400:Interprofessional Relations; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D014481:United States