I feel that the rules are necessary. While it is nice to thank a collaborator and talk business over a dinner or conclude a deal with a gift, it is influencing the other party in a way that has nothing to do with the actual business. Gifts, dinners and other gestures distract from the main business and can lead to biased decision making that can, in turn, harm the patient. This is almost like bribing the physician. Even if the gesture isn't very large, there can be a preference towards a company that provides gifts which is a dangerous situation for a healthcare provider.

As has been mentioned in previous posts, there needs to be a clear line between work and family. But I do not believe that is the primary issue. The primary issue is a matter of ethics and conflicts of interest. It is unethical and a source of a potential conflict of interest if gifts are given to a physician who is being asked to participate in a study. The source of this conflict is that gift giving can be seen as a way to influence results. In the classic example of a pharmaceutical rep and an attending physician, if the rep provides gifts to the physician with the "understanding" that the physician will enroll more of his/her patients in a clinical trial using an experimental drug, there can be a potential conflict when the physician has to decide between what is best for a given patient and what is his "obligation" (implied or otherwise) to the corporation that provided him/her with a gift. As such, gifting should be limited if not all together eliminated to avoid conflicts of interest and ethical issues.

I believe the list of gifts a company can and can’t give is extremely necessary for this day in age where money is very influential. If people are out discussing business; 1. The conversations should be business related 2. People should be bringing a significant other to this business “dinners” (wife, husband, child,…) 3. And I also feel that any time a company has a business “dinner” or meeting it should all be recorded. 4. Anything given to a company or physician should be recorded, and no direct money should be given.
I feel that money, vacations, cars, or extravagant gifts shouldn’t be allowed because these are things that can easily change the opinion of people. While a fruit or muffin basket, in my opinion, is more appropriate, because it shows appreciation, but isn’t overkill or seem as if you are trying to buy the physician.
All these regulations are there in order to protect physicians, companies, and especially the patients.

I believe that this type of regulation is necessary in order to achieve a certain level of fairness. In general, we don't want the company to buy the doctor so I believe that this is fair to have this limit on spending. Ideally, people should be fair and honest in heir day to day tradings, however, that is not the case. There are a lot of people who are greedy and unethical who will take advantage of a situation to personally benefit from it. I think there should be some leeway, in terms of gifts, where some are permissible and it can be a whole discussion on its own.

I think that is little absurd that physician's wife meal is not getting paid off. But then again why is physician's wife in the meeting? I mean usually these meetings are highly confidential so personally I don't understand the whole point of bringing your spouse to the meeting. Also, I do understand that gifts should be of certain amount only, specifically $100. Sometimes, gifts might be seen as a bribe and I guess to not come across like that, that amount is fixed.

I think that these restrictions are necessary because there is always someone trying to abuse their privileges or power to better themselves even though they will be hurting other people. If the market can be controlled by persuasion through expensive gifts and accommodations then the market will become one sided and will hurt smaller companies who may not have the money and resources yet, but have one of the best products on the market. This also ensures that the physician is making his decision based on the quality of the device and the quality of the person they are interacting with. That way the best product will be given to patients, and the rep will be the best representation for the company as someone who is reliable and trustworthy. The rep will now have to sell the product to the best of his ability on an even playing field, which I think is not an over reaction.

The gift triggers a human instinct to reciprocate; even if the reciprocation involves nothing more than giving the detail person a few moments of your time.  It may be entirely reasonable to accept a small token of appreciation from a patient. In fact, refusing it may cause embarrassment that could unnecessarily harm the relationship between a doctor and a patient. Doctors should try to understand the reasons behind a patient’s gift. Doctors should never accept a gift if there is any risk that it may influence their professional decision making. Physicians should also take into account factors such as the cost of the gift in proportion to the patient’s means, the appropriateness of the gift, and whether there are particular circumstances, such as the patient being vulnerable, that may attract criticism. Transparency and accountability are essential when considering an offer of a gift from a patient. Doctors should keep a record of any gifts they receive for their appraisal and revalidation. Patients should donate money to the hospital charity rather than to an individual. A ‘thank you,’ a letter recounting the family’s joy, or a photo of the patient enjoying a moment of life that medical care allowed him to experience. Patients should donate cash gifts that they have received from patients to charity or buy practice equipment that will benefit patients.

It is a tricky subject. On one hand kickbacks are an obviously bad thing. However small gifts are good ways to start/improve relationships. I think that $100 is a good cap, and limiting it to the physician only seems to be a good idea. I'd want to learn more about what people actually do in terms of business relationship-building but a small cap seems okay. With the dinner example if it was a "double date" or a family with family event then I don't see as much of an issue. Having a wife/husband be the only other person seems a bit odd and harder to pass off as a friendly get-together. There's a lot of grey areas. Most people factor in personal like-ability when doing business, so as long as it's a fair playing field and not too excessive I'd be fine with gifts.

In my opinion, I understand why this may seem pretty awkward and I don't think it's a problem at all to pay for the physician's wife but I do see the reasoning behind it. The physician could bring more colleagues and family members (e.g. brothers and sisters involved in the field) and try to exploit the company's generosity. I think that this is just a way for the company to make sure that they don't overspend or "waste" money. Paying for only the doctor's meal makes sense because he is the one who is involved in the work, not the wife or relatives. I think that it is reasonable for the company to refuse to pay for the physician's wife. If companies allowed this, then the case could be made as to why it can't extend to other people such as relatives and other doctors that the physician may be friends with. It may not be a bid deal to pay for the physician's wife but in that same argument, it wouldn't be a big deal for the doctor to pay if it's such a small price. Companies should pay for large expenses (e.g. hotel reservations, flights) if the physician is required to travel, but if they don't want to pay for meal for people that are not employees, then that's very understandable.

I do think these restrictions are a bit too harsh. Sure expensive steak and wine dinners are not the most useful allocation of resources but I also do not think someone is swayed into a huge business agreement just because they were treated to some good food. Cars, vacations, and expensive watches may be a different story since those are more lasting and have the potential to make deals happen. While it is obviously a frowned upon way to conduct business, many companies are discovered each week to engage in scandalous activities. Under Armour was just exposed as having spent extravagantly on strip club visits for top executives and athletes. College scandals break out with sports coaches throwing parties for recruits and taking them to strip clubs. Since these practices are going on all over the country across many industries, I feel it is a bit trivial to put prices on lunches and give categories for acceptable gifts. Until then, I believe people will continue to participate in unethical activities behind closed doors no matter what.

I do believe this is too restricted, but it is also for good reason. Getting gifts worth more, even if it is health based, can seem as a bribe and could be used against the doctor in the future. Or let’s say if they use this gift and something goes wrong, this could become a legal case as well. I do believe, however, that if the doctor and their spouse are out at dinner for a business event, that he spouse’s dinner should be paid for as well. Dinner without the spouse is still a social, more causal event so having the wife or husband there will not change the business aspect of the evening. It is another thing if it is a social event and not a business event. I believe if the spouse is there for a business-related event, then this should be included in the expenses but if its more than that, such as kids or other people, than it should not be covered.

I think most of these regulations mentioned regarding gift giving to physician are reasonable. The first topic I do feel a little bit rigid because it is not consistent with basic courtesy, which in normal situation, people would at least buy their friend a meal along with his/her family. However, this meal is also purposeful because it's interest involved. So I think the aim of this regulation is to restrict the salesperson who sell produce to the physician via bribing the physician's spouse. The only way to improve this situation is to try to disprove people who actually think you are bribing. This is to say, the networking between you and the physician is built on a healthy and reasonable friendship and that is all.

I think it makes perfect sense that there are rules and laws that prevent these things from continuing to happen. As Dr. Simon mentioned in this week's lecture, there are products out there that could give better results for patients and morally the doctors should choose to work with whatever product they think will provide the best treatment for his/her patients rather than using another product that isn't as good but the reps are bribing you into using it. Safety of people always comes first and if restricting the amount of gift is what needs to be done, then it should be enforced.

I think the restrictions are not out of place. You are attending a business discussion and family members should not be involved. It should be understood in the doctor's side that only his meal will be covered and therefore he or she will not bring their partner or another family member to avoid any awkward situation. Other regulations involving gifts seem also reasonable.

As much as having a rule such as this sucks, it is a necessary rule that is enforced. Without a limit on the gifts we can give to our physicians, not only can they be influenced by the money/gifts that are given to them, they can abuse them to their advantage for personal gain. From an outside perspective, gifts like this could be seen as a form of bribery. All in all, while you feel like the physician may deserve more and there is no harm in paying for the wife's meal the fact of the matter is that rules like this help both sides maintain credibility should something arise.