Effect of reminders of personal sacrifice and suggested rationalizations on residents' self-reported willingness to accept gifts: a randomized trial.
BACKGROUND
Despite expanding research on the prevalence and consequences of conflicts of interest in medicine, little attention has been given to the psychological processes that enable physicians to rationalize the acceptance of gifts.


OBJECTIVE
To determine whether reminding resident physicians of the sacrifices made to obtain training, as well as suggesting this as a potential rationalization, increases self-stated willingness to accept gifts from industry.


METHODS
Three hundred one US resident physicians from 2 sample populations (pediatrics and family medicine) who were recruited during March-July 2009 participated in a survey presented as evaluating quality of life and values.


METHODS
Physicians were randomly assigned to receive 1 of 3 different online surveys. The sacrifice reminders survey (n = 120) asked questions about sacrifices made in medical training, followed by questions regarding the acceptability of receiving gifts from industry. The suggested rationalization survey (n = 121) presented the same sacrifice questions, followed by a suggested possible rationalization (based on sacrifices made in medical training) for acceptance of gifts, before the questions regarding the acceptability of gifts. The control survey (n = 60) asked about the acceptability of gifts before asking questions about sacrifices or suggesting a rationalization.


METHODS
Physician self-stated acceptability of receiving gifts from industry.


RESULTS
Reminding physicians of sacrifices made in obtaining their education resulted in gifts being evaluated as more acceptable: 21.7% (13/60) in the control group vs 47.5% (57/120) in the sacrifice reminders group (odds ratio, 1.81; 95% confidence interval, 1.27-2.58; P = .001). Although most residents disagreed with the suggested rationalization, exposure to it further increased the perceived acceptability of gifts to 60.3% (73/121) in that group (odds ratio relative to sacrifice reminders group, 1.45; 95% confidence interval, 1.22-1.72; P < .001).


CONCLUSIONS
Providing resident physicians with reminders of sacrifices increased the perceived acceptability of industry-sponsored gifts. Including a rationalization statement further increased gift acceptability.
Sah
Sunita
S
Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA 15213, USA. sunitasah@cmu.edu
Loewenstein
George
G
D016265:Conflict of Interest; D003625:Data Collection; D003657:Decision Making; D004345:Drug Industry; D004501:Education, Medical; D005260:Female; D037921:Gift Giving / Q000941:ethics*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010414:Pennsylvania; D010820:Physicians / Q000523:psychology*; D011788:Quality of Life; D017010:Reminder Systems