Ethics Case 1 Remonte. Rivera, K., Sagayaga. Siy. Talan.

Case Its Saturday lunch time, three medical clerks were just relieved of their duties and were about to go home when they saw a pharmaceutical company setting up a long table. They were invited to try some pizza and get free supplies of penlights, bags, pens, notebooks, while they listened to the sales representative telling them about a new drug. One of the medical clerks was even invited to join a grant sponsored by the company so he can attend a conference in Paris. After hearing about this, the dean of the college started considering banning all pharmaceutical industry-promoted activities to prevent prescribing bias.

1. What is the main dilemma/conflict or core issue involved in the case? Whether or not medical practitioners (students or doctors) should accept gifts or favors from pharmaceutical companies, and whether these benefits affect physicians’ prescribing behavior

2. Who are the parties who will be affected by the decision, both directly and indirectly? Physicians Evidence to show that relationships with drug companies influence prescribing behavior Contact with drug company representatives leads to prescribing of their drugs 1 physicians exposed to advertising are more likely to accept commercial rather than well established scientific views 2 drug company advertising is associated with an inability of some physicians to identify erroneous claims and propensity to engage in non- rational prescribing behaviour Peay MY, Peay ER. The role of commercial sources in the adoption of a new drug. Soc Sci Med 1988; 26: Lexchin J. Interactions between physicians and pharmaceutical industry. CMAJ 1993; 149: Haayer F. Rational prescribing and sources of information. Soc Sci Med 1982; 16:

2. Who are the parties who will be affected by the decision, both directly and indirectly? Physicians Duality of interests in doctors engaged in relationships with pharmaceutical companies

2. Who are the parties who will be affected by the decision, both directly and indirectly? Patients Primary stakeholder in health care Directly affected by physicians’ prescribing behavior The drugs they receive may not be the drugs best supported by evidence Example: Free samples may be given to patients Once the supply runs out, patients may not be shifted to other, less expensive drugs

2. Who are the parties who will be affected by the decision, both directly and indirectly? Shareholder/pharmaceutical company Great contributors to medical knowledge and practice, at the high cost of drug development Promotion and marketing make up a large part of drug companies’ activities 1/4 – 1/3 of budgets, totaling more than US$11 each year in the US

3. What are the key values involved? Distributive justice Benefits should accrue to those who bear the burden: physicians should not benefit from the patients’ payments for drugs Fiduciary trust/benevolence Physicians should act in the patient’s best interest (an external influence affecting the physicians’ actions may violate this principle) Balance of self-interest and altruism

4. How can you best resolve this situation? You may have several options to resolve the case. Cite some ethical principles that may guide your decision-making process. Various levels of advice have been advanced to medical practitioners about accepting gifts. blanket rejection gradient of moral acceptability based on cost gifts should not be excessive and should not influence decision- making test of whether the recipient would be willing to have the arrangements publicly known