Monday, May 07, 2007

Guidelines for Gifts to Patients

Some time ago, I suggested that pharma sales reps should bring free lunch to patients as well as physicians and their staffs (see "Free lunch for patients! Why not?").

I never thought that a pharmaceutical company would actually implement my idea, but it seems that at least one -- AstraZeneca -- has. Well, it really wasn't lunch. It was cupcakes for chemotherapy patients. I believe this was first reported by Peter Rost over at Question Authority Blog (see "AstraZeneca's Secret Oncology Plans: Sell Cancer Drugs to Patients with Pink Cupcakes").

This issue has generated some heat in between some members of the Pharma BlogosphereTM and the pharma trade press, especially "Pharma Blogs: Week in Review," published by Engel Publishing Partners and written by Christiane Truelove, editor of MedAdNews. Black Kitty -- a rare women blogger member of the Pharma Blogosphere -- in particular has taken exception to Truelove's view that there is nothing wrong with giving cancer chemotherapy patients cupcakes (see "SIN = MedAdNews 'Pharma Blogs: Week in Review'").

We may not yet have seen the end of this "True Love Kitty Fight," but the incident suggests that if pharmaceutical companies are going to get into giving gifts to patients -- including serving food to patients in doctor's offices -- then PhRMA needs to come up with "Guidelines for Gifts to Patients" similar to AMA's "Ethical Guidelines for Industry Gifts to Physicians." Here's my draft of the guidelines that should help PhRMA get started.
1. Any gifts accepted by patients individually or as a group should primarily entail a benefit to patients and should not be of substantial value. [My interpretation of substantial value: no more than 2-5 cupcakes per patient depending upon body mass index (BMI). Of course, cupcakes are verboten altogether (see Guideline # 3).]

2. Individual gifts of minimal value are permissible as long as the gifts help patients pass the time while waiting in the office. [My interpretation: crossword puzzle books are OK as are patient education materials, and even iPods if they are the cheap Shuffle versions (load 'em up with audio from ads)].

3. Free lunches should be healthy and appropriate for the medical condition of the patient. [My interpretation: Cupcakes, pizza and Italian hoagies are generally not appropriate for patients, although OK for physicians who often eat this kind of crap. Lunch for patients should be limited to veggie platters containing no fatty dips. Or tuna salad. NOTE: Sales reps should not query physicians about the medical conditions fo their patients in the waiting room in order to determine what kind of lunch is appropriate (see Guide;ine #5).]

4. No gifts should be offered with strings attached. [My interpretation: Soap on a rope is out. Just kidding! Reps shouldn't offer gifts to patients to entice them to visit your favorite high-prescribing with a practice down the block.]

5. Giving gifts to patients should not violate HIPAA privacy regulations. suggested that giving cupcakes to cancer chemotherapy patients in treatment rooms might be a violation of Peter RostHIPAA (see "AstraZeneca's Pink Cupcakes May Violate AMA Guidelines and HIPAA law"). [My interpretation: If pharma reps keep their patient gift giving activity isolated in the waiting room outside the treatment area, that's perfectly HIPAA compliant. Peter and I both agree, however, that only the doctor is in danger of violating HIPAA, not the reps. The covered entity is responsible for protecting the personal/protected health information (PHI) of his/her patients and only the doctor can be prosecuted under HIPAA.
Anyway, these are just suggestions for guidelines and I welcome any additional ideas from readers of this blog.


  1. "True Love Kitty Fight"? Yeesh, John. Can you make us sound any more like we're going to don cutesy bikini costumes and wrestle in a pit of jello?

    Seriously, I am glad I provoked some reaction from someone out there. You know how it is, write something and it disappears into the great beyond without any comment. I can't say I completely disagree with some of the things Dr. Black Kitty says, just the all-caps way that she expressed herself.

    As far as your guidelines, I agree it's a good idea to have something in place. Confronted with an excess of food (this happens around Christmas, usually, although there have been other times), there is one doc's office of my acquaintance that has in the past set out stuff for patients. Usually this stuff is of the sweet variety. The office workers just share the largesse. And I'll have a tale for you this week about that.

  2. Chris,

    Thanks for your comments.

    Re: Kitty fight. How could I resist! -- see my post over at Pharma Blogosphere:

    At least I refrained from posting any R-rated images of women, which is becomming more common amongst pharma bloggers, especially those who emulate Peter Rost and PharmaGossip! Speaking of whom, did you see the image PharmaGossip used to illustrate your story about a sales rep who stripped down to her bikini in a doc's office!

    These are the guys that women bloggers and editors should go after.

    [In defense of my male colleagues, if you put meat in front of lions, you've got to expect them to feast! In other words, you could have chosen not to describe the bikini rep incident, since it is anecdotal anyway and does no good for the image of women reps!]

    I admit that I have included some sexy images in my blog and even made a lot of sexual innuendos. Buit not all were at women's expense. What about the All-Pharma (MALE) Lobbying Lineup! See

  3. John,

    I must admit my last name does get a lot of laughs, and the gooiness factor increases when I tell folks it's my married name.

    But by casting the verbal disagreement between Dr. Black Kitty and me as a "kitty fight," you've implied a bimbo-tastic tone that's hard for folks to get past and take us seriously. It's an attitude that is satired in this classic Harry Enfield piece:


  4. Ms. Truelove,

    Thank you so much for your comment on my blog. I was wrong to use caps, and I didn't interpret those big letters as others do. But I won't make that mistake again. Because rather than attack the *content* of my post, the *tone* of my post was commented on. And that was valid, in my mind.

    Now, however, I would like comments on the content. I am work, and can not respond with the respect Dr. Mack and Ms. Truelove deserve.

    I think this should be a positive, supportive discussion, that has the goal of improving consumer-pharma relations.

    I love the pictures, and especially *the movie!!!!* I can't wait to put it on my blog. I will credit you of course - thanks.

    More later,

    Peace and Love to you both (and Peter),


  5. Thanks a ton for the post! I have actually heard of patients giving their doctor gifts, but not doctors giving gifts to patients. Unless, of course you count the little plastic fishes that are sometimes available in a little drawer at the end!


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