The Senate Committee found that 18 PMA firms spent $165 million on symposia, gifts, and reminder items in 1988, up from $34 million in 1975. The Senate Committee also argues that the consumer ends up financing these promotional activities, which deliver no health benefit, through higher drug prices.

It is evident that gifts cost patients money. Prescription drugs are a major patient expense, and promotion of these products adds dollars to their cost. Patients are paying for these lavish incentives in the form of higher prices for their prescription medications.

In addition, physicians are concerned that drug firms are spending $165 million a year to influence them. For many years the practice of giving gifts to physicians was considered the norm. However, many physicians have felt uneasy about it.

There are costs associated with gift-giving. Gifts cost money, and the cost is ultimately passed on to patients without their knowledge. Unlike other forms of promotion, many gifts are private and not seen by patients. The acceptance of gifts does more than cost money or hurt the reputation of medicine.

All gifts establish a relationship between the donor and recipient, a relationship with vague but real obligations. It is this relationship, the gift relationship between physicians and PCs that is believed to be ethically dangerous to physicians. Gifts from PCs feed human tendencies toward satisfying greed and self-interest.

Gifts do not benefit patient care, nor concern for the patient. n addition, gifts may threaten the physician-patient relationship in which the physician is the patient’s agent or trustee whose first consideration is the patient’s interest, including choice of medications. If gifts influence the physician to inappropriately prescribe a drug, or prescribe a drug that is more expensive or less effective than competing products, the physician-patient relationship is threatened. It follows that when physicians accept personal gifts from drug companies, not only is society’s perception of the profession threatened, but also the integrity of the physician-patient relationship.