Are small gifts more problematic than large gifts?

Two of the articles assigned for this week note that there is a
general presumption that, while large gifts by pharmaceutical
companies to physicians may be ethically problematic, de minimis gifts
(i.e. gifts of negligible value) are not (Dana & Loewenstein, 2003, p.
252; Katz, Caplan, & Merz, 2003, p. 39). Both articles argue that this
presumption is false; like large gifts, de minimis gifts do influence
behaviour, and should therefore be the subject of ethical scrutiny. I
wonder if a stronger argument can be made. Could de minimis gifts be
more problematic than large gifts? Two considerations may support an
affirmative answer to this question.

First, Katz et al. (2003) distinguish between balanced exchanges and
negative exchanges. They argue that gift-giving by pharmaceutical
companies should be seen as a negative exchange, in part because “the
profit potential significantly exceeds the value of the gift” (p. 42).
Since the value of de minimis gifts is so small, the ratio of profit
potential to the value of the gift is likely to be very high, and may
be substantially higher than that of large gifts.

Second, Dana and Loewenstein (2003) argue that disclosure is only
effective if those informed know by how much to discount a physician’s
opinion in light of a conflict of interest (p. 254). However, many
people lack the requisite information to make such judgements
accurately. Since people are likely to have false beliefs about the
effect of de minimis gifts, they may be less likely to form accurate
judgements with respect to such gifts than they would with respect to
large gifts.

posted by Sismondo on behalf of AM

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