The Council on Ethical and Judicial Affairs (CEJA) of the American Medical Association (AMA) recently sent out a reminder of the guidelines it has in place regarding gifts to physicians from industry. The current reminder is issued because of the council’s concern with an apparent escalation of inappropriate gifts.

The guidelines were originally developed and published in 1991, then revised in 1992. The APA Ethics Committee first distributed the guidelines to members in 1992, annotated with an interpretation specifically for psychiatrists. The Ethics Committee has maintained the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry since 1973. The booklet was most recently revised in 1998. Last month, the Ethics Committee sent the AMA’s reminder on gifts to the chairs of the ethics committees of each district branch.

"I think [the CEJA is] concerned over what look like inappropriate gifts, especially from the pharmaceutical companies," said Carol Davis, director of the APA Office of Ethics and Professional Responsibility. "For example, within APA we saw concern for pharmaceutical companies supporting symposia at the annual meeting. The appropriate people took that to heart, and new procedures were developed to address the concerns".

The AMA guidelines do address both subsidizing and sponsoring CME conferences and professional meetings, as well as entertainment sponsored by industry as part of an educational conference. These subsidies and sponsorships would be considered ethical if they are of modest value, they foster discussion among conference attendees and faculty, and the educational part of the conference comprises the substantial majority of the total time.

Herbert Rakatansky, M.D., chair of the AMA Council on Ethical and Judicial Affairs, sent copies of the CEJA’s Opinion 8.061, "Gifts to Physicians From Industry," and its subsequent "Clarification of Gifts to Physicians from Industry" to all state and national professional and specialty societies.

"The issue," he wrote in his accompanying cover letter, "seems in large part to be a lack of education of both physicians and industry."

He continued, "We must take the initiative to self-regulate in order to reduce the potential conflicts of interest, thus maintaining professionalism in medicine and avoiding renewed interest by the federal government." The letter details that the guidelines were developed to protect a patient’s ability to trust that a physician’s prescribing habits were based on the patient’s best interest. The letter goes on to say that the guidelines were also meant to reduce the amount of money spent by pharmaceutical companies on gifts and the hope that those savings would be directed into research or reduction of costs to the consumer.

Despite the guidelines, Rakatansky wrote, "we still receive many requests for clarification on gifts to physicians from industry." By redistributing the "Clarifications on Gifts. . ." document, which addresses many of the inquiries that CEJA has received, Rakatansky hopes to help physicians and industry understand the delicate conflicts of interest that may develop.