NEW MAXIM FOR MEDICINE

Most doctors are honest people and are dedicated to the classic rule of medicine: “First, do no harm.” But the case is being made that they should add another maxim: “Take no bribes.”

Is bribe too harsh a word for the common practice by many doctors of accepting gifts from drug manufacturers? Not if you have seen a declaration in the Journal of the American Medical Association. An article in January signed by 11 nationally prominent medical educators called on academic medical centers to prohibit even trivial gifts like coffee mugs from companies that make drugs and medical appliances.

According to the article, nearly 90 percent of the $21 billion marketing budget of the pharmaceutical industry is directed at physicians. That $19 billion outlay paid doctors for free meals, travel and other expenses and fees for attending lectures and conferences, for their time spent at such meetings, provision of ghostwriting services, grants for research projects, and consultation services, the authors wrote.

They cited a survey showing that the industry in the year 2000 the industry sponsored 314,000 events specifically for physicians. They said, “The purpose behind such industry contacts is unmistakable: Drug companies are attempting to promote the use of their products.”

Free samples also would be barred, on the ground that they tend to bias physicians and patients in favor of expensive medications when cheaper alternatives may be just as effective.

Guidelines about gift acceptance have been issued by many groups, but the authors found these to lack stringency or any system of monitoring. They wrote that the impulse to reciprocate for even small gifts is a powerful influence on behavior. They dismissed the frequent assurance of “no strings attached,” suggesting that reciprocity may be the primary motive for gift-giving. Why else give a doctor a mug or memo pad with a drug firm’s logo on it?

Stanford University has barred physicians working for its two hospitals from accepting even small gifts from the drug industry. It said the new policy, effective Oct. 1, was intended to eliminate corporate influence from medical decisions.

The industry has fired back. The New York Times quoted a lawyer for the Pharmaceutical Research and Manufacturers of America as saying that the new policies were a “disservice to patients and physicians” because they would deprive doctors of the advice of company sales representatives on drug products, how to use them and how not to use them.

True enough, but the real purpose and effect of the payments and gifts is to bias doctors in favor of particular products.

Freebies and kickbacks are widely accepted abuses in other fields. But when it comes to medical care, patients should be entitled to unbiased judgment by their doctors.