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The Moral Is
Tue June 10, 2014
Commentary: It's Not Just Physicians Who Are Influenced By Gift Giving
The same human characteristics that build community can also work against its well-being. As humans, we give back to those who are kind to us and we feel indebted to those who show us kindness. In this edition of FM89’s commentary series The Moral Is, philosophy professor Christopher Meyers of CSU Bakersfield argues that our disposition for reciprocity can work against the common good.
I gave a talk a few years back to a room full of physicians, during which I urged them to generally decline all gifts from pharmaceutical representatives – all gifts, even such seemingly trivial items as logo-emblazoned pens and notepads.
The core of my argument was that, as professionals, their primary duty is to act on behalf of their patient’s well-being. Anything, hence, that negatively impacts that duty represents a conflict of interest and should be avoided. I further pointed out that study after study has shown that even such trivial inducements as pens and notepads – let alone expensive meals or trips to exotic islands – alter prescribing patterns.
Upon receipt of such gifts, the studies show, physicians are more likely to prescribe new products that hold no demonstrated advantage over existing ones and they are less likely to prescribe generics. Often, too often the studies show, those new prescriptions are not the best choice for the patient. That is, too often the seemingly trivial gift produces, by definition, a conflict of interest.
The reaction to my argument that evening was not surprising: Many physicians were indignant that I would suggest that their medical judgment could be swayed by something as inexpensive as a 50 cent pen. In their mind, I was suggesting they were unethical, too-easily corrupted by inconsequential gifts.
Just to the contrary: I was suggesting they were human. The now quite vast literature on bias and conflict of interest reveals something heartening, even inspiring, about the impact of gift-giving and receiving: Humans seem to be hard-wired toward reciprocity. We feel indebted – in a deep, primal way – when someone gives us a gift. That is, we feel driven, often at a subliminal level, to give something in return.
Said differently, our instinctive reaction is to feel grateful upon receipt of a gift and also to feel like we should return the favor. Further, unless we strive to overcome that natural reaction, we will most likely act accordingly. Such reciprocity is, anthropologists suggest, one of the bonds that makes for cooperative, caring communities. To feel so obliged reveals one to be more human, not more easily corrupted.
The pharmaceutical companies of course know this and spend billions every year promoting their products. And, no surprise, they track physician prescribing habits and whether those change in response to gifts. They also give more valuable gifts to high prescribers and fence-sitters. And they do all this, again, because it works.
These influences are now widely acknowledged, which is why the American Medical Association has recently begun discouraging gift acceptance and demanding that physicians be fully transparent in their commercial and marketing relationships – not just with drug companies, but also with device manufacturers, imaging companies, surgery centers, and the like.
Again, the AMA is not saying its members’ decisions are any more easily tainted than are non-physicians’; they are simply acknowledging such physicians’ humanity.
And I am not saying there’s anything unique to physicians and drug companies. All these same arguments apply to charitable groups, and to college professors, and to lawyers … to all of us – including our elected representatives, a theme I will take up in a future essay.
Christopher Meyers is a Professor of Philosophy and Executive Director of the Kegley Institute of Ethics at California State University, Bakersfield. The views expressed are his own and do not necessarily reflect those of the University or the Institute or Valley Public Radio. The Moral Is was produced by KVPR and the Bonner Center for Character Education at Fresno State. See more commentaries online at KVPR.org
The Moral Is