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http://www.ama-assn.org/sci-pubs/amnews/amn_02/edlt1104.htm#2

Regarding "Lighten up on decrying gifts to doctors" (Letters, Sept. 23/30) and "Profession should stop bashing itself over pharmaceutical industry gifts" (Letters, Aug. 26):

I hope that the physician authors of the letters cited above will continue to find gratifying careers in medicine when interactions between our profession and industry become more highly regulated. This will inevitably occur if our professional colleagues continue to arrogantly ignore the differences between individual physicians accepting gratuities from salesmen attempting to influence how they spend other people's money (known in other industries as "kickbacks") and, for example, professional societies accepting advertising fees.

The research results on this matter are quite clear. Physicians who accept gifts from pharmaceutical companies increase prescribing of products sold by the company who made the gift.

The latest round of health care inflation, led by pharmaceutical costs, has brought this issue to the attention of the public. There are already consumer groups calling for legislation on this issue. Regulation will result when a majority of the public perceive that their health care dollars are being used to pay for something other than their health care.

This outcome will be facilitated by those who cannot show restraint in their acceptance of gifts from industry. A free round of golf or an evening of entertainment will hardly be a comfort when physicians are perceived as unable to put patients' interests above their own, resulting in yet another area of regulation and a loss of professional independence.

I doubt that the physicians who wrote the letters I cited would feel the same sense of entitlement for politicians who accept gifts to influence votes on critical legislation. Similarly, investment analysts have recently taken a hit for making favorable recommendations for clients who have paid fees to the analysts' firms.

When the stock market takes a nose dive, we lose money. When our professional image takes a nose dive, physicians lose their most valuable and hard-fought asset, the respect and trust of the public. There is no free lunch.

--Thomas D. Wendel, MD, MPH Sacramento, Calif.

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