Taking gifts and selling out | VailDaily.com

Taking gifts and selling out

Alan Braunholtz

A problem of giving to any charity is that your mailbox is quickly filled with junk mail and gifts from many more similar charities. I used to be able to get my mail once a week. But now that’s pushing the limits of the post office box. I’d strongly counsel any charity against selling its mailing list. Pretty soon everyone on that list is overwhelmed and numbed from never-ending requests and horror stories that the whole lot is dumped in the bin as donor fatigue sets in.Christmas is an especially bad time for junk mail. Who knows what to do with all the gifts of address labels, calendars and cards? Why waste money on sending out this unasked for junk mail instead of spending it on the honorable cause that persuaded me to pull out my checkbook in the first place?Some recent papers my wife left lying around on the ethics of pharmaceutical gift-giving explained why. It creates an obligation and works to make us pull out our checkbooks again, at least until we reach the straight-to-the-garbage mindset at the contents of a prematurely crowded post office box.Physicians are sensitive to the effects of gifts on their integrity. They’re very aware that their primary obligation is to their patients and of their position of trust. As a result, there are many social science studies on the effects of gifts on doctors.After congressional hearings on commercial influence on doctors’ behavior, the American Medical Association and the Pharmaceutical Research and Manufacturers Association (PhRMA) agreed in 1991 to voluntary guidelines that limited the extravagant gift giving of the 1980s. Gifts valued over $100 were banned.The industry still spent $12 billion annually on these cheaper gifts. This is a smart industry with scientific marketing practices. They’re not going to give $12 billion away for no reason or return, and they charged it as a business expense rather than charitable giving. It’s an effective way to push their drugs. The government noticed the $12 billion and sponsored studies to see if all gifts create a conflict of interest or even violated legislation against kickbacks in federal programs.In response, PhRMA adopted a new, still voluntary, code limiting gifts under $100 to “occasional use” and to benefit patient care. They created a new category of minimal value gifts: all those pens, rulers, note pads emblazoned with the names of strange drugs that you see in any physician’s office. “Modest” meals are OK if offered with a sales or “educational” pitch.The industry argues that these sales pitches that accompany the gift giving are valuable in helping doctors stay up to speed and good for their patients. If the information was were unbiased and educational, doctors would value it for itself without the need for gifts and meals. Doctors don’t require trinkets to read journals or attend ongoing educational seminars. They do it for themselves and their patients. The gifts and meals’ intent is to curry favor and boost profits by influencing physician behavior.Research shows that the more doctors rely on commercial reps for information, the more likely they are to prescribe drugs inconsistent with their patients’ needs. A sales rep is better at selling drugs than patient care or controlling costs.Numerous reviews correlate the number of doctor-sales rep interactions with a rise in the prescriptions of new, more expensive drugs that offer no new benefit, a decrease in cheaper generic prescriptions, and a rise in irrational prescriptions.No one likes to think they can be corrupted, especially by cheap baubles and free meals. Strangely, the more free gifts and meals you receive, the less likely you are to believe that they could influence your behavior. That’s a dangerous, arrogant belief in one’s incorruptibility. To underestimate the power of any gift, no matter how small, is to lower your defenses and be influenced more easily. A cynical anger to the purveyors of marketing wares masquerading as gifts, knowing they’re corrupting your mind and wasting the world’s resources is a safer attitude. It’s easier to do it to a post office box than an attractive, flirtatious sales rep, though.We’re all susceptible. Anyone who believes they’re special because of their “educated and rational” mind is kidding themselves about human nature. Cultures have always contained networks of obligation. Favors instill feelings of obligation and unconsciously we want to return a favor. “Much obliged” easily replaces “thank you,” and these feelings aren’t closely related to the size of the favor involved. Failure to repay favors is not smiled on by any society. No one wants to be called a moocher or free-loader.Refusing gifts is also troublesome, as then you’re unfriendly and uncooperative. To refuse a gift or worse, try to pay for it, is an insult and a good way to get killed when traveling in some of the more traditional cultures. Much better to offer up your watch, pocketknife, etc., as a gift in return.Gift giving is a way we bind ourselves together. But when friends give gifts, they don’t write them off as marketing expenses.The medical field poses unique problems. The interests of the gift giver can conflict with and undermine the trust of the doctor’s main obligation, his patients.There’s a parallel here to our government and the ongoing political fundraising scandals. Congress’s obligation is to the people who chose them as their representatives. Lobbyists are givers of educational junkets, meals and funds who want to put their clients interests before ours. I’m sure it’s easier to listen to a well-informed industry lobbyist than do your own research. The lobbyist probably won’t even slant the information too much – bad info is no favor, really – but the restaurant, luxury box, golf trip and the fact that they’re usually ex-colleagues and friends will.Politicians should be banned from going into paid lobbying for 10 years after leaving politics. That’s harsh, but it would stop them selling the access and insider knowledge their friendships provide to the highest bidder. Access is power and shouldn’t be for sale.Politicians should struggle at least as much as doctors to maintain their integrity.Alan Braunholtz of Vail writes a weekly column for the Daily. Vail, Colorado

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