1f:T429,

To the Editor.

—Controversy surrounds the relationship between the pharmaceutical industry and physicians.^1-3Congressional hearings have focused on the extravagant gifts that some physicians have received from pharmaceutical companies, implying that many physicians routinely accept these gifts (Am Med News. December 28, 1990). Recently, the American Medical Association (AMA) published guidelines stating that gifts to physicians are acceptable if they entail a benefit to patients and are of no substantial value.⁴Gifts of minimal value are also acceptable if they are related to the physician's work.⁴Despite these reports, there are few data in the medical literature examining to what extent current pharmaceutical gift-giving behaviors may comply with recent guidelines. Exhibit hall gift promotions are a common part of major medical meetings. While attending a recent national meeting of a major medical specialty, I studied a selection of pharmaceutical exhibits to determine the types and proportions of20:T40f,THE USE of gifts and other questionable marketing practices by pharmaceutical companies has been under heavy fire from both the Senate Labor and Human Resources Committee and the American Medical Association (AMA). A disabling salvo was fired last month, when the AMA's House of Delegates adopted, without dissent, ethical guidelines proposed by the Council on Ethical and Judicial Affairs that deem unethical the acceptance of vacations or cash to pay for travel expenses, gifts of substantial value, cash, and lavish meals and entertainment from pharmaceutical companies—marketing practices that have been liberally applied through the years to influence physicians' prescribing decisions. (See p 501 for the actual guidelines.) The 100-plus member Pharmaceutical Manufacturers Association (PMA) adopted these same guidelines 2 days later.

Pricey Promotions Revealed

The following week, the Senate Labor and Human Resources Committee, chaired by Sen Edward Kennedy (D, Mass), conducted 2 days of hearings in which testimony by

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