Seventy-four per cent of the emergency medicine residents surveyed by Keim et al.¹⁰ felt that sales representatives sometimes crossed ethical boundaries by giving gifts. Fourteen per cent of internal medicine residency programme directors reported observing unethical activities by sales representatives¹⁰. These included detailing in clinical areas, making false claims, giving monetary gifts, and conducting unauthorised studies.

A study by Poirier et al.³⁹ of people who make decisions about formularies in US private hospitals, found that most (93%) felt that providing non-monetary benefits to doctors to influence formulary decisions or product use was unethical. The respondents included chairs of pharmacology and therapeutics committees, directors of pharmacy, and pharmacists involved in evaluating drugs for inclusion in formularies. More pharmacists than doctors rated providing meals to influence decisions as unethical (22% versus 12%).

A US study by La Puma et al.⁴⁰ examined payments to doctors to participate in post-marketing research on new medicines. Most of the doctors they surveyed (64%) felt it was acceptable to be paid a fee for each patient enrolled in post-marketing research. Most patients (56%) felt that this was unacceptable. Fewer doctors than patients felt that patients should be informed if the doctor was being paid a fee per patient enrolled (75% versus 86%).

CONCLUSION: Only four studies have addressed this issue and each of them looked at different aspects of the question, making it hard to draw any conclusions. From one study it appears that doctors think that it is more ethical to accept fees for enrolling patients in clinical trials than do patients.