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MEDICAL CONFERENCE PERSONAL EXPENSES "SHOULD NOT BE ACCEPTED" from industry, the American Medical Association's Council on Ethical and Judicial Affairs recommended in a draft report to be reviewed at the association's yearly Interim Meeting, scheduled for Dec. 2-5 in Orlando, Fla. "Subsidies from industry should not be accepted to pay for the costs of travel, lodging or other personal expenses of physicians attending conferences or meetings, nor should subsidies be accepted to compensate for physicians' time," according to guidelines contained in the report. The prohibition against gifts would not cut off all honoraria. "It is appropriate," AMA said, "for faculty at conferences or meetings to accept reasonable honoraria and to accept reimbursement for reasonable travel, lodging and meal expenses." The opinion warns against "token consulting or advisory arrangements . . . used to justify compensating physicians for their time or their travel, lodging and other out-of-pocket expenses." The report does not define "faculty" or "token" arrangements. The council added that "subsidies for hospitality should not be accepted outside of modest meals or social events held as a part of a conference or meeting." The opinion has been referred to AMA's Reference Committee on Amendments to the Constitution and Bylaws, which will consider the report before forwarding it to the delegates. If adopted, the report becomes official AMA policy ("The Pink Sheet" Nov. 12, T&G-2). Gifts, such as funds for educational seminars and conferences, "serve an important and socially beneficial function," the council acknowledged. However, it noted, "there has been growing concern about certain gifts from industry to physicians." Both FDA and Congress have questioned the industry practice of providing gifts to prescribers. Sen. Kennedy (D-Mass.) is currently conducting an investigation into such practices, particularly with regard to the relationship between scientific symposia and product promotion ("The Pink Sheet" Nov. 19, p. 5). One proposed guideline in the report would recommend against accepting so-called "frequent prescriber" incentives, which tie gifts to prescribing of promoted drug products. "No gifts should be accepted if there are strings attached," the council said. "For example, physicians should not accept gifts if they are given in relation to the prescribing practices. In addition, when companies underwrite medical conferences or lectures other than their own, responsibility for control over selection of content faculty, educational methods and materials should belong to the organizers of the conferences or lectures." Regarding continuing medical education conferences, the report states that "subsidies to underwrite" their costs "can contribute to the improvement of patient care and therefore are permissable." However, payments should be accepted only by the organization sponsoring the conference. "Since the giving of a subsidy directly to a physician by a company's sales representative may create a relationship which could influence the use of the company's products, any subsidy should be accepted by the conference's sponsor, who in turn can use the money to reduce the conference's registration fee," the guidelines state. Industry gifts to doctors are acceptable only if they are "of minimal value," the council said, and even then restrictions apply. "Individual gifts of minimal value are permissible as long as the gifts are related to the physician's work (e.g., pens and notepads)." Individual doctors may accept such gifts if they "primarily entail a benefit to patients," the guidelines state. "Accordingly, textbooks, modest meals and other gifts are appropriate if they serve a genuine educational function. Cash payments should not be accepted.

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