Pharmaceutical Sales Representatives in the United States and China: The Need for Professional Public Space.

"Restrictions on Gifts and Disclosure of Payments in the United States The conflicts of interest in medical practice have been studied for decades. In the 1950s, Dr. Charles D. May believed that if the industry continued to impose undue influence on the medical profession, the public would soon be up in arms and the more or less “ethical” elements of the industry itself would promote some responsible companies to change their aggressive marketing methods. For a very long time, some people held similar views, but at least so far, they have been proven mistaken [54, 10]. The public seems to have got used to the fact that physicians have long accepted gifts and payments from industry. People felt it was “less wrong” for physicians to accept gifts from PSRs than it was for judges from lawyers and sports referees from players [41]. Quite a few patients believed that surgeons would make the best choices for their health regardless of financial relationship with industry, and the interactions between surgeons and device manufacturers would improve their care or not be affected [28]. Faced with mounting evidence of PSRs’ undue influence, the medical profession and the government have finally realized that they should take the initiative. In 1992, the American Medical Association (AMA) first issued ethics guidelines addressing pharmaceutical marketing and industry gifts [5]. In the addenda “Clarification of Opinion 8.061” adopted by the AMA [6] and the Code on Interactions with Healthcare Professionals published by the Pharmaceutical Research and Manufacturers of America (PhRMA) in 2002 [84], non-educational and practice-related gifts to physicians or those valued at more than 100 U.S. dollars were explicitly forbidden. Over the next few years, several states enacted statutes to further limit industry gifts. For example, Minnesota prohibits gifts with a total annual combined retail value of over 50 dollars since 2006 [34]. In 2009, Massachusetts issued regulations including a ban on all gifts except for modest meals in the provider’s practice setting, drug samples, and indirect support for educational programs [85]. However, early evidence suggested that many pharmaceutical companies and physicians did not follow the guidelines [92]. To increase the transparency of the physician-industry relationship, Congress passed “The Physician Payments Sunshine Act” in 2010 as a part of “Affordable Care Act”, requiring that detailed information about payments and other “transfers of value” worth over 10 dollars from manufacturers of drugs, medical devices and biologics to physicians and teaching hospitals be disclosed to the public [86]. Data began to be collected in August 2013 and released publicly in September 2014 [90]. Before this regulation, some states had already enacted statutes on the disclosure of payments [1, 25, 109]. The research on the actual effects of these regulations is not sufficient at present, and the current results are varied. Some studies suggest that even gifts of negligible value and free drug samples, which complied with the regulations, would still have a psychological influence on physicians [24, 30, 54], and there was no evidence that data disclosure has changed the behavior of physicians or industry [61, 88]. In contrast, other studies reported that current policies played an active role in reducing the influence on prescribing behavior [27, 58], but whether these policies affect the quality of care for patients was still unclear [65, 27]. From the perspective of patients and the public, disclosure of payments affected their trust in physicians [50, 51]. They supported the disclosure of physician-industry interaction [28], but only a few Americans reported knowing or using the Open Payments website [124, 52]."

"This article is funded by Postgraduate Research & Practice Innovation Program of Jiangsu Province (CN) (KYCX18_0207) and China Scholarship Council."