Is there any such thing as a free

You receive an expensive 'thank you' gift from a pharmaceutical representative. What should you do with it?

THE DILEMMA
A pharmaceutical representative came to see me about a new drug. I sat patiently throughout the presentation and kept the information bundle handed out. I have not had time to read the materials the representative left with me, but I have since received a flashy MP3 player as a 'thank you for your time' gesture. What should I do with it?

A GP'S VIEW - DR RAJ THAKKAR, a GP in Wooburn Green, Buckinghamshire
Some would argue this is not a dilemma at all and one should simply not accept it. It may be worth considering what the representative is trying to achieve. Would a drug company offer an expensive present without expecting a return?

On the face of it, it may be quite nice to have a 'free' toy. But would it persuade you to prescribe the drug to even one or two patients in return? Market research suggests it would, in which case the 'gift' is actually a bribe.

What should you do if this situation arises? Don't be afraid to confront the representative in question and say you feel uncomfortable with such a gift. At least you can go to bed with a clean conscience. Asking the representative to exchange the gift for books or equipment for the practice may be more appropriate if the other members of the practice team agree. The donation to the practice may be considered in the patients' best interests but will it still alter your prescribing habits? The message here is simple. If you do not receive gifts from representatives, you can not be beholden to them.

A MEDICO-LEGAL OPINION - DR NICK CLEMENTS, former GP and medico-legal adviser at the Medical Protection Society
Views regarding the offering and acceptance of gifts of all kinds have evolved over the years. This is particularly true of gifts and hospitality from the pharmaceutical industry.

The GMC provides specific guidance on this point in their booklet Good Medical Practice. The 'Conflicts of Interest' section makes it clear that doctors must neither request nor accept 'any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients'.

Gifts or inducements connected to the advertising or promotion of pharmaceutical products are also strictly controlled by legislation, including the Medicines (Advertising) Regulations 1994 and various EC directives. These specify that where products are being promoted to someone qualified to prescribe them, no one may supply, offer or promise any gift unless it is both inexpensive and relevant to medical practice.

To be considered 'inexpensive' the item should not cost the company more than £6. I would advise that you return it to the representative. A report or complaint should also be considered.

A PATIENT'S VIEW - AILSA DONNELLY, member of the RCGP Patient Partnership Group
Whether or not the doctor has read the information bundle is irrelevant. In the real world it is not normal practice for sales representatives to follow up sales calls with a valuable 'thank you for your time' gift and this will be seen by most patients as a possible bribe, which could potentially compromise the doctor's integrity and clinical judgment.

If the gift is accepted, the GP may at the very least feel morally obliged to read the literature and prescribe the drug. Research has shown that doctors who claim that they are unaffected by such gifts are merely unaware that they have been influenced. Ethically, this doctor cannot and must not accept the MP3 player and should return it to the pharmaceutical company immediately.

It sounds as if this company may be flouting the ABPI code of practice; if so, the doctor should report it. An essential part of the doctor-patient relationship is trust. If there is a hint that doctors are being influenced by inducements from pharmaceutical companies then the basis for this trust is irreparably damaged.

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