title: Who's buying lunch: are gifts to surgeons from industry bad for patients?
abstract: Why does gifting exist in the medical marketplace? It provides a sales advantage in a competitive marketplace by establishing crucial relationships with the patients' fiduciary: the physician and surgeon. Do gifts to physicians from industry harm patients? One can cite mountains of indirect evidence that they do, and maybe in the case of recalled devices and drugs there are actual corpses, but these examples are retrospective and it is impossible to prove that removing detailing eliminates the harm. Banning gifts to surgeons would not completely fix the ethical problem of pharmaceutical and device marketing. Gifts are important because they buy access and foster relationships, but inherent bias in research and the medical literature makes it very difficult to remain objective. It is a race, and education has not kept pace with advertising; only 10% of 575 internal medicine physicians thought they had had sufficient training during medical school and residency regarding professional interaction with sales representatives. Would banning gifts help at all? Would enforcing an unpopular ethical code protect patients? There might be a small improvement, but not as significant as eliminating representatives and product samples altogether. This is not likely to happen without an enormous fight against the wealthiest industry in America. The solution is education. To borrow industry's argument, physicians and surgeons are ethical creatures with capacity for judgment and integrity. They need to understand and believe the magnitude of the problem. Detailing exists because there is a market for it, empowering surgeons with ethical training reduces the demand for goodies, and at some point the popular choice will be to buy their own lunch. Business ethics are not medical ethics. Industry is behaving exactly as it must to maximize profits. Although it is painful for some surgeons, surgical residencies, and professional organizations to envision a future with diminished corporate gifts, it is every surgeon's responsibility to consider whether their dealings with the pharmaceutical and medical equipment industries withstand the harsh light of realities presented herein.
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA. grantdav77@hotmail.com
authors.forename: David C
authors.initials: DC
authors.lastname: Grant
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Iserson
mesh_terms: D004345:Drug Industry / Q000941:ethics*; D004992:Ethics, Medical; D013502:General Surgery / Q000941:ethics*; D037921:Gift Giving / Q000941:ethics*; D019981:Health Care Sector / Q000941:ethics; D006801:Humans; D010817:Physician-Patient Relations / Q000941:ethics