Laws and raised eyebrows aside, pharmaceutical companies continue to reward doctors for prescribing their drugs with gifts ranging from pens and paper to free dinners and trips.
A new study by two researchers at Carnegie Mellon University, published in the Journal of the American Medical Association, helps to explain how doctors rationalize acceptance of such gifts. The study found that physicians consider the gifts as a form of reward for the sacrifices they made obtaining their education.
The study's lead author, Sunita Sah, is a physician herself who is completing her Ph.D. at Carnegie Mellon's Tepper School of Business. Fellow author George Loewenstein, the Herbert A. Simon Professor of Economics and Psychology, calls the gifts "barely described bribes" as other studies show they influence prescribing behavior.
More than 300 pediatric and family medicine residents answered a series of questions that asked about the acceptability of receiving different types of gifts from pharmaceutical companies.
Before completing the survey, however, one group of doctors was first asked about the sacrifices they had made in getting their medical education. A second group also was first asked these sacrifice questions and then asked whether such sacrifices could potentially justify acceptance of gifts (a rationalization that explicitly introduces the idea that this might be the case) before filling out the gift acceptability questions.
A control group was asked about the acceptability of receiving gifts without being first asked about personal sacrifices or being cued with a potential rationalization.
Reminding physicians first of their medical training burdens more than doubled their willingness to accept gifts — from 21.7 percent to 47.5 percent — and suggesting the potential rationalization further increased their willingness to accept the gifts to 60.3 percent.
The impact of the suggested rationalization was surprising because, when asked whether their hardships justified taking gifts, most respondents said it did not.
"This finding suggests that even justifications that people don't accept at a conscious level can nonetheless help them to rationalize behavior that they otherwise might find unacceptable," said Sah.
Both authors agree that the implications of the study are straightforward.
"Given how easy it is for doctors to rationalize accepting gifts, which, from other research, we know influences their prescribing behavior, the inescapable conclusion is that gifts should simply be prohibited," said Loewenstein, who has done extensive research and writing on the role of human psychology in exacerbating conflicts of interest.
"Given the powerful human capacity to rationalize what benefits us," Sah added, "it is unlikely that we will be able to make a dent in the problem by, for example, educating physicians about the risks posed by conflicts."