Doctors, drug companies, and gifts.

Doctors often accept gifts from drug companies. We analyze this practice and conclude that accepting a gift has complex practical and ethical repercussions. Gifts cost patients money, and they may change society's perception of the profession as serving the best interest of patients. Also, accepting a gift establishes a relationship between the physician and the drug company that obliges a response from the physician. Accepting gifts and the resulting relationship have ethical implications as well. First, the use of patients' money to pay for gifts can be unjust. Second, the fiduciary relationship between physician and patient may be threatened if prescribing practices are affected (as intended by the drug company). Third, physicians' characters may be altered by a practice that fosters self-interest at patients' expense. We discuss the need for guidelines for the profession to help physicians promote their patients' well-being.