In ‘All Gifts Large and Small’, Kats, Caplan, and Merz discuss the idea of a conflict of interest, focusing on the relationship between physicians and pharmaceutical company reps. The authors conclude that no matter the size of the gift, it still has the potential to bias the judgement of the health care provider, (even unconsciously, or unknowingly) and therefore should not be permitted. Furthermore, professional organizations, governments, and society all have an obligation to the interests of patients to enforce policies that prevent gift giving. Not only is this conclusion appropriate, it is necessary.
The aforementioned restrictions are not necessary because all health care providers are cheaters or lairs, or that they cannot rationally control their biases. On the contrary, most are trustworthy, upstanding professionals. However, whether they realize it or not, even small gifts or tokens of appreciation from pharmaceutical reps can have significant consequences on prescribing habits, or pharmaceutical preference – they have the potential to undermine a physician’s objectivity and can interfere with their medical and financial interests. (Kats, Caplan, and Merz) These consequences can lead to a blatant disregard of a patients’ interests, which is completely unacceptable. There are, in my view, very few factors that can permissibly weigh against a patients’ interest, especially without also providing significant benefit.
On consequences of receiving gifts, Katz, Caplan and Merz also state:
“Gift exchange underlies the human tendency to engage in networks of obligation. When a gift or gesture of any size is bestowed, it imposes on the recipient a sense of indebtedness. …The social rule of reciprocity imposes on the recipient an obligation to repay, in kind if possible, for favours, gifts, invitations, and the like.”
Is it truly possible for physicians and others who might receive a gift to ignore, or not feel this obligation? Dr. Sheldon Cooper would not think so…
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