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PubMed2003

Pharmaceutical firms' generosity and physicians: legal aspects in Belgium.

In this article we will examine the relation between physicians and (representatives of) the pharmaceutical industry. More in particular we want to discuss the appropriateness of some of the gifts that are given to physicians by companies in the pharmaceutical (and medical equipment) industry, since there has been growing concern about the potential negative consequences of these so-called 'gift-giving practices'. Although the relation between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavourable public perceptions, over-consumption and misuse of public money. First of all, a concise factual summary of the different types of gift-giving will be given, since not every gift can automatically be considered as inappropriate: depending on the extent to which the gift serves a function beneficial to patient care and on whether the same benefits can be realised through less costly promotional activities, gifts can be appropriate. In connection with that remark, we will next outline the positive and negative impact pharmaceutical promotion has on patient welfare, according to advocates as well as opponents of 'gift-giving'. We will not take position in the discussion whether 'gift-giving' is appropriate or not. This paper focuses on the position the (Belgian) legislator, following a European Directive of 1992, takes in this controversy. For the answer to that question the following documents are of crucial importance: the Belgian Law on Medicinal Products of 25 March 1964, the European Council Directive 92/28/EEC of 31 March 1992 on the advertising of medicinal products for human use and the Belgian Crown Order of 7 April 1995 on the advertising of medicinal products for human use. To round up, we will examine how the principles laid down in these documents are being interpreted in the Belgian case-law.

Belgium↗
PubMed2025

Cross-species implementation of an innate courtship behavior by manipulation of the sex-determinant gene.

In accepting a courting male, Drosophila subobscura females require nuptial gift giving in which a male gives regurgitated crop contents to her mouth to mouth. No similar behavior is found in D. melanogaster. By clonal activation of neurons expressing the male-determinant FruM, we identified insulin-like peptide-producing cells (IPCs) and their putative postsynaptic targets, proboscis-innervating motoneurons, as those critical for gift giving. We demonstrate that loss of FruM from D. subobscura IPCs abrogates neurite extension and gift giving, whereas FruM overexpression in their D. melanogaster counterparts induces overgrowth of neurites that harbor functional synapses, culminating in increased regurgitation. We suggest that the acquisition of FruM expression by IPCs was a key event occurring in an ancestral D. subobscura that conferred a latent capability to perform nuptial gift giving.

Animals↗
PubMed2000

Sensory exploitation as an evolutionary origin to nuptial food gifts in insects.

Nuptial food gifts given by males to females at mating are widespread in insects, but their evolutionary origin remains obscure. Such gifts may arise as a form of sensory trap that exploits the normal gustatory responses of females, favouring the selective retention of sperm of gift-giving males. I tested this hypothesis by offering foreign food gifts, synthesized by males of one cricket species, to females of three non-gift-giving species. Females provisioned with novel food gifts were 'fooled' into accepting more sperm than they otherwise would in the absence of a gift. These results support the hypothesis that nuptial food gifts and post-copulatory female mating preferences coevolve through a unique form of sensory exploitation.

Animals↗
PubMed2001

Health care professionals and industry: reducing conflicts of interest and established best practices.

The relationship between health care providers and pharmaceutical companies and other commercial interests is ethically complex. The common practice of gift giving takes many forms including free samples, sponsorship of medical education, loan of equipment, and gifts ranging from those of nominal value such as pens to more valuable gifts such as golf outings or dinners. Gift giving is a practice that serves both the recipient and the giver, but, in the medical setting, it raises the question of whether this is to the detriment of patient care. Although health care professionals may believe they are able to ignore influence from commercial interests, human judgment research indicates that decision-makers are generally unaware of biases affecting their decisions. This is an issue of organizational ethics as well. Institutions that allow commercial interests to give some form of gift are allowing the appearance of bias as well as placing the burden of avoiding bias on the individual rather than on the institution. Conflict-of-interest analysis indicates that best practice is to limit or eliminate the influence of commercial interests, ensuring that professionals are better able to exercise their independent objective judgment.

Attitude of Health Personnel↗
PubMed2006

Ethical philanthropy in academic psychiatry.

OBJECTIVE: From an ethical perspective, psychiatrists cannot accept gifts of significant monetary value from their patients. This guideline raises important questions regarding institutional practices related to gift-giving in academic psychiatry. The first aim of this article is to explain the ethical tensions and shared ethical commitments of the professions of psychiatry and philanthropy. The second aim is to outline a series of steps that may be undertaken to assure ethical philanthropic practices within an institution, including the establishment of a committed advisory workgroup and the creation of ground rules and safeguards for gift-giving. Each situation should be evaluated for "ethical risk," and specific measures to safeguard donors should be considered. METHOD: The author outlines methods to manage, minimize, or eliminate conflict of interest issues, including identification and disclosure of conflicting interests, role separation, goal clarification, confidentiality protections, proper timing, and ongoing oversight. Three case illustrations are provided and discussed. RESULTS: The process of institutional engagement, dialogue, and shared problem-solving is especially important. A shared, constructive ethic will be attained only if leaders and diverse stakeholders communicate the value of the new approach through their words, expectations, and actions. CONCLUSIONS: Through these efforts, greater attention will be given to the concerns of people with mental illness, and academic institutions may be better able to fulfill their responsibilities to this important but neglected population now and in the future.

Academic Medical Centers↗
PubMed1997

The gift relationship between pharmaceutical companies and physicians: an exploratory survey of physicians.

The purpose of this exploratory study was to survey physicians' attitudes surrounding the 'gift relationship' between pharmaceutical companies and physicians. A survey was mailed to 1000 randomly selected West Virginia physicians, of which 283 (28.3%) responses were received. The most commonly received gifts reported by the study physicians were trinkets (77.4%), followed by books (41.7%) and meals (41%). Principal component analysis and varimax rotation identified seven physician belief constructs. The mean ratings of the constructs indicated that the physicians slightly agreed that pharmaceutical companies give gifts to physicians to influence their prescribing, moderately disagreed that they do so as a form of professional recognition of physicians, and strongly disagreed that their prescribing behaviour could be influenced by the gifts they receive. Physicians slightly disagreed that pharmaceutical companies' sponsoring of CME programmes are only promotional gimmicks. Although the study physicians slightly disagreed that it may be inappropriate for them to accept gifts from pharmaceutical companies, they seemed slightly averse to having 'gift relationships' between pharmaceutical companies and physicians made public. Correlation analysis suggested that physicians who have a large number of patients in their practice, see a larger number of patients per day, or write a large number of prescriptions per day are more likely to be offered gifts by pharmaceutical companies, and they are also more likely to condone the practice of gift giving and receiving.

Attitude of Health Personnel↗
PubMed1994

Gender socialization of adolescents in the home: research and discussion.

While gender socialization and practice have been investigated in education, work, and children within the family, there has been minimal research on adolescents and parents. The present research focused on male and female adolescents' perceptions of their mothers' and fathers' behavior in six common family routines: allowances, gifts, use of the family car, curfew, and chores inside and outside the home. Data were gathered from 448 senior high school students, Gender-equal behavior toward sons and daughters was clearly evident in the parental practice of allowances and gift giving, and less evident in permission to use the family car. Traditional behavior was strongly evident in sons' performing outside chores and, to a lesser degree, in daughters' keeping an earlier curfew and doing more inside chores. Fathers were more traditional than mothers in allowance and gift giving to sons, and less traditional than mothers in giving sons permission to use the car. It is evident from the perspective of the teenager, that stereotypical gender roles are being perpetuated in North American home life.

Adolescent↗
PubMed2006

Death feigning in the face of sexual cannibalism.

Pre-copulatory sexual cannibalism by females affects male and female reproductive success in profoundly different ways, with the females benefiting from a meal and the male facing the risk of not reproducing at all. This sexual conflict predicts evolution of traits to avoid cannibalism and ensure male reproductive success. We show that males of the nuptial gift-giving spider Pisaura mirabilis display a remarkable death feigning behaviour--thanatosis--as part of the courtship prior to mating with potentially cannibalistic females. Thanatosis is a widespread anti-predator strategy; however, it is exceptional in the context of sexual selection. When the female approached a gift-displaying male, she usually showed interest in the gift but would sometimes attack the male, and at this potentially dangerous moment the male could 'drop dead'. When entering thanatosis, the male would collapse and remain completely motionless while retaining hold of the gift so it was held simultaneously by both mates. When the female initiated consumption of the gift, the male cautiously 'came to life' and initiated copulation. Death feigning males were more successful in gaining copulations, but did not have prolonged copulations. We propose that death feigning evolved as an adaptive male mating strategy in conjunction with nuptial gift giving under the risk of being victimized by females.

Animals↗
PubMed1994

Gift Exchange Theory: a critique in relation to organ transplantation.

Organ transplantation is becoming more important as a viable method of treatment for certain severe medical conditions. It is a complex and demanding process for all involved. Nursing as a developing science must respond to cultural and economic changes. Therefore, a need exists to develop a body of empirically based knowledge to understand and support the process of organ transplantation. This paper will argue that as trading in organs is unacceptable to the moral standards of western society and outlawed in many countries, an alternative framework must be considered for understanding the mechanisms through which organs are donated and utilized. The donating and receiving of organs may be equated with gift-giving, as there is no barter of commodities involved. Therefore, a useful framework to explore this phenomenon will be one that underpins the process of giving and receiving of gifts. Gift Exchange Theory will be evaluated and critically examined in relation to organ transplantation and the role of nurses in this process.

Anthropology, Cultural↗
PubMed2004

Gifts to give yourself for the new year.

Dentistry can offer its dedicated practitioners a wonderful, productive, service-oriented life, with an acceptable income. However, numerous circumstances can turn what could be a happy life into a nightmare of frustration and negative feelings. This article has identified several of the challenges facing practitioners. If these challenges are faced and solutions implemented, the possibility of the practitioner's maintaining a happy life is greatly improved.

Attitude of Health Personnel↗