Telling physicians they shouldn't accept gifts from drug companies is all well and good. But convincing them that doing so is wrong is another matter.
A new study by Carnegie Mellon University researchers found that physicians rationalize such gifts as payback for all the sacrifices they made to get their education -- although they may not realize they're doing it.
The attitude, the researchers said, is one of "because I'm worth it."
The paper was published Tuesday in the Journal of the American Medical Association. Lead researcher and author Sunita Sah brought a unique perspective to the project -- she is a former practicing physician who once consulted for pharmaceutical companies on sales and marketing to doctors.
"I've worked both sides of the fence," she said, "so I've been interested in conflict of interest for some time."
The project was supervised by George Loewenstein, professor of economics and psychology, who has done extensive study of human psychology in economic decisions.
He called the gifts "barely disguised bribes." But many of the 301 physicians in the study didn't see them that way, though other research has shown gifts do influence how doctors treat patients and conduct research.
The study comes at the same time as an unrelated report on conflict of interest in the medical profession -- researchers found half of the surgeons who accepted big money from orthopedic device manufacturers failed to note that relationship in their scientific articles.
The participating doctors in the Carnegie Mellon study did not say they were taking gifts -- only that it was acceptable to do so.
But, Sah noted, 94 percent of physicians have some kind of relationship with pharmaceutical companies.
These may range from accepting pens and stationery to free equipment, lunches, consulting fees and paid talks touting a drug at conferences.
Her former physician colleagues considered gifts normal perks of the job because, she said, they weren't getting cars or big bonuses. The study showed the more deprived the subjects felt, the more they justified the practice.
"It's actually been shown that even small gifts such as pens can affect physicians' prescribing behavior," she said. "Our study looks at some of the psychological mechanisms that enable them to rationalize it."
The study's subjects were pediatric residents from the University of Pittsburgh Medical Center and family medicine residents from across the country. All answered a series of questions about the acceptability of taking different types of gifts from drug companies.
Before completing the survey, one group was first asked about the sacrifices they had made for their education. A second group, also asked about sacrifices, was asked if the hardships could justify taking gifts, prompting the notion that this might be the case. A control group wasn't questioned on sacrifices or cued with a rationalization.
The results: Reminding doctors of their burdens more than doubled their willingness to accept gifts, from 21.7 percent to 47.5 percent. And suggesting a possible justification increased it to 60.3 percent.
That was a surprise, the researchers said, because when asked straight out whether their hardships justified taking gifts, most respondents said it did not.
"Even justifications that people don't accept at a conscious level can nonetheless help them to rationalize behavior that they otherwise might find unacceptable," Sah said.
"The conclusion is that physicians are going to find a way to rationalize accepting these bribes as long as they are offered and are legal," Loewenstein said.
"In other areas of life, bribes are a crime. The obvious policy response is eliminating the ability of pharmaceutical companies to pay physicians to prescribe their drugs."
He noted that UPMC had "gotten ahead of the curve and prohibited affiliated physicians from accepting gifts from pharmaceutical companies and device manufacturers."
But the health care system still contains plenty of conflicts of interest that fall outside the scope of the study.
One of these was exposed Monday in the Archives on Internal Medicine.
A first-of-its-kind project by researchers from the Institute on Medicine as a Profession found that nearly half the surgeons who received $1 million or more in payments from orthopedic device companies did not disclose that information in their scientific articles. The conflict was discovered when researchers used company records to check the accuracy of disclosures in medical journals.
Sah, who completed her Ph.D. at Carnegie Mellon's Tepper School of Business, said she hoped the study would move doctors to police themselves.