A social science perspective on gifts to physicians from industry.

-cal or professional interest clashes with financialself-interest, a situation that arises commonly inmedical practice. When physicians are remuner-atedforperformingspecifictestsandprocedures,theyfaceaconflictofinterestwhentheyalsorecommendthosesametestsandprocedures.Whentheyarepaidforreferralstoclini-caltrials,physiciansareintheconflictedpositionofdecid-ing whether their patients are appropriate for the studies.Performingindustry-supportedresearch,physiciansfaceanimplicit demand for a positive finding to obtain further fi-nancialsupport.And,whenpharmaceuticalcompaniescourthigh-volumeprescribers,writingprescriptionsbecomesanactnotonlywithfinancialandhealthconsequencesforpa-tients, but also with financial consequences for the physi-cian.Thislastsourceofconflictofinterestisthecentralfo-cus of this commentary.Indiscussionsofgiftsfromindustry,whetherinmedicaljournals, the media, or in political debates, it is possible toglimpse a common perspective. The biasing effect of ac-ceptinggiftsistreatedasamatterofdeliberatechoice.Theconventionalperspectiveonacceptinggiftsimpliesthatphy-sicianswhoarebiasedbytheprospectofpersonalgainsaredecidingtodosomethingunethical.Undoubtedly,thisper-spectivecontributestotheindignationwithwhichmanyphy-sicians respond when it is suggested that gifts create bias.Becausethebiasisseenasintentional,anallegationofbiasis an implicit accusation of impropriety.Many policies dealing with conflict of interest seempremisedonthisunderstanding of bias. For example, con-sider policies on gift size. The recent guidelines for indus-tryputforthbythePharmaceuticalResearchandManufac-turers of America

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