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'We owe it to society to give the wealth back'. Gates tops annual 100 Most Powerful list, spotlighting growing role of philanthropy in fighting healthcare's ills.

Modern Healthcare's fifth annual listing of the 100 Most Powerful People in Healthcare spotlights executives, providers and other insiders who have their fingers on the pulse of the biggest industry trends, such as electronic health records, health savings accounts and rising numbers of uninsured patients. Who's the most influential person in healthcare? One hint: It's not the president.

Altruism↗

To give or sell human gametes--the interplay between pragmatics, policy and ethics.

The ever-growing acceptance and use of assisted human reproduction techniques has caused demand for "donated" sperm and eggs to outstrip supply. Medical professionals and others argue that monetary reward is the only way to recruit sufficient numbers of "donors". Is this a clash between pragmatics and policy/ethics? Where monetary payments are the norm, alternative recruitment strategies used successfully elsewhere may not have been considered, nor the negative consequences of commercialism on all participants thought through. Considerations leading some countries to ban the buying and selling of sperm, eggs and embryos are outlined and a case made that the collective welfare of all involved parties be the primary consideration in this, at times heated, debate.

Adult Children↗

Interactions between emergency medicine programs and the pharmaceutical industry.

OBJECTIVES: To examine the beliefs and practices of emergency medicine program directors regarding interactions with the pharmaceutical industry. The authors also sought to study the prevalence of program policies and the desire for organizational policies. METHODS: The Board of the Council of Emergency Medicine Residency Directors (CORD) requested and approved a member survey. An institutional review board-approved, Web-based, 30-item survey was sent to all CORD members subscribed to the organization's listserv in May 2002 and was completed by June 2002. Program director respondents were surveyed as to their beliefs and practices regarding industry sponsorship of speakers, social events, drug samples, travel to conferences, and the educational value of marketing representatives. Subjects were queried about their awareness of existing guidelines and whether they desired policy development by CORD. RESULTS: Surveys were returned from 106 programs (85%). The majority of program directors (72%) "never" or "very rarely" allowed unrestricted interactions between pharmaceutical representatives and residents at work. However, only 52% of program directors said they "never" or "very rarely" allowed pharmaceutical representatives to give residents free drug samples at work. Only 46% said they "never" or "very rarely" allowed pharmaceutical representatives to teach residents. Two thirds of program directors desired CORD guidelines regarding interactions with the pharmaceutical industry. Program directors seeking guidelines were less likely to allow pharmaceutical representatives to teach residents (p = 0.001). They were also less likely to allow pharmaceutical representatives unrestricted interactions with residents (p = 0.05). CONCLUSIONS: A wide range of practices exist among emergency medicine residency program directors, and most desire organizational guidelines regarding interactions with the pharmaceutical industry.

Attitude of Health Personnel↗

The competitive advantage of corporate philanthropy.

When it comes to philanthropy, executives increasingly see themselves as caught between critics demanding ever higher levels of "corporate social responsibility" and investors applying pressure to maximize short-term profits. In response, many companies have sought to make their giving more strategic, but what passes for strategic philanthropy is almost never truly strategic, and often isn't particularly effective as philanthropy. Increasingly, philanthropy is used as a form of public relations or advertising, promoting a company's image through high-profile sponsorships. But there is a more truly strategic way to think about philanthropy. Corporations can use their charitable efforts to improve their competitive context--the quality of the business environment in the locations where they operate. Using philanthropy to enhance competitive context aligns social and economic goals and improves a company's long-term business prospects. Addressing context enables a company to not only give money but also leverage its capabilities and relationships in support of charitable causes. The produces social benefits far exceeding those provided by individual donors, foundations, or even governments. Taking this new direction requires fundamental changes in the way companies approach their contribution programs. For example, philanthropic investments can improve education and local quality of life in ways that will benefit the company. Such investments can also improve the company's competitiveness by contributing to expanding the local market and helping to reduce corruption in the local business environment. Adopting a context-focused approach goes against the grain of current philanthropic practice, and it requires a far more disciplined approach than is prevalent today. But it can make a company's philanthropic activities far more effective.

Charities↗

A marketer's take on practice building.

This article proposes a new method for increasing new patients in a dental practice. It augments the practice externally by increasing the dentist's presence in the local community through the following ways: (1) distributing a consumer dental product to local community groups such as emergency rooms, ambulances, and kids sports teams, (2) lecturing about dental trauma at local organizations, and (3) creating positive press about the dentist and his or her practice. The practice is also built internally by giving out CDPs to selected patients. By initiating this program, a dentist can substantially increase the number of new patients in his or her office. With the increase in new patients, the dentist will be able to raise fees, be more selective in the parts of dentistry he would like to perform, and become free from third-party payment. The dentist who appears focused on providing the best care to everyone in the community will shortly see new patients entering his or her practice. With this program, a dentist can focus on marketing and building the practice without the stigma frequently associated with these activities. The dentist now appears altruistic instead of driven to make more money by building the practice. This image, along with the contacts initiated in the program, will provide the dentist with a strong, very public image that will attract new patients.

Gift Giving↗

Gift authorship.

Explore the source record for details and available documents.

Authorship↗

Patient perceptions of physician acceptance of gifts from the pharmaceutical industry.

OBJECTIVE: To examine patient perceptions of professional appropriateness and the potential impact on health care of physician acceptance of gifts from the pharmaceutical industry. DESIGN: A random-digit dialing telephone survey. SETTING AND PARTICIPANTS: A sample of 649 adults (> or = 18 years old) living in Kentucky. MAIN OUTCOME MEASURES: Patient awareness of office-use gifts (eg, pens, notepads) and personal gifts to physicians from the pharmaceutical industry, patient exposure to office-use gifts, and attitudes toward physician acceptance of both office-use and personal gifts. RESULTS: The survey had a response rate of 55%. Eighty-two percent of the respondents were aware that physicians received office-use gifts, while 32% were aware that physicians received personal gifts. Seventy-five percent reported receiving free samples of medication from their physicians. Compared with office-use gifts, more respondents believed that personal gifts to physicians have a negative effect on both health care cost (42% vs 26%) and quality (23% vs 13%). After controlling for demographic variables, as well as awareness and exposure to physician gifts, individuals with at least a high school education were 2.4 times as likely to believe that personal gifts have a negative effect on the cost of health care and 2.3 times as likely to believe that personal gifts would have a negative effect on the quality of health care. CONCLUSIONS: These results suggest that the public is generally uninformed about personal gifts from pharmaceutical companies to physicians. If public perception regarding the objectivity of the medical profession is to serve as a guide, these findings suggest a reevaluation may be in order for guidelines regarding physician acceptance of gifts from the pharmaceutical industry.

Adult↗

Looking a gift horse in the mouth: corporate gifts supporting life sciences research.

CONTEXT: Throughout the last decade a number of studies have been conducted to examine academic-industry research relationships. However, to our knowledge, no studies to date have empirically examined academic scientists' experience with research-related gifts from companies. OBJECTIVE: To examine the frequency, importance, and potential implications of research-related gifts from companies to academic life scientists. DESIGN: A mailed survey conducted in 1994 and 1995 of 3394 faculty who conduct life science research at the 50 universities that received the most research funding from the National Institutes of Health in 1993. SETTING: Research-intensive universities. PARTICIPANTS: A total of 2167 of the 3394 faculty responded to the survey (response rate, 64%). MAIN OUTCOME MEASURES: The percentage of faculty who received a research-related gift from a company in the last 3 years, the perceived importance of gifts to respondents' research, and what, if anything, the recipient thought the donor(s) expected in return for the gift. RESULTS: Forty-three percent of respondents received a research-related gift in the last 3 years independent of a grant or contract. The most frequently received gifts were biomaterials (24%), discretionary funds (15%), research equipment and trips to meetings (11% each), support for students (9%), and other research-related gifts (3%). Of those who received a gift, 66% reported the gift was important to their research. More than half of the recipients reported that donors expected the following in return for the gift: acknowledgment in publications (63%), that the gift not be passed on to a third party (60%), and that the gift be used only for the agreed-on purposes (59%). A total of 32% of recipients reported that the donor wanted prepublication review of any articles or reports stemming from the use of the gift, 30% indicated the company expected testing of their products, and 19% indicated that a donor expected ownership of all patentable results from the research in which a gift was used. However, what recipients thought donors expected differed by the type of gift received. CONCLUSIONS: Research-related gifts are a common and important form of research support for academic life scientists. However, recipients frequently think that donors place restrictions and expect returns that may be problematic for recipients as well as institutions.

Academic Medical Centers↗

Physicians and the pharmaceutical industry: is a gift ever just a gift?

CONTEXT: Controversy exists over the fact that physicians have regular contact with the pharmaceutical industry and its sales representatives, who spend a large sum of money each year promoting to them by way of gifts, free meals, travel subsidies, sponsored teachings, and symposia. OBJECTIVE: To identify the extent of and attitudes toward the relationship between physicians and the pharmaceutical industry and its representatives and its impact on the knowledge, attitudes, and behavior of physicians. DATA SOURCES: A MEDLINE search was conducted for English-language articles published from 1994 to present, with review of reference lists from retrieved articles; in addition, an Internet database was searched and 5 key informants were interviewed. STUDY SELECTION: A total of 538 studies that provided data on any of the study questions were targeted for retrieval, 29 of which were included in the analysis. DATA EXTRACTION: Data were extracted by 1 author. Articles using an analytic design were considered to be of higher methodological quality. DATA SYNTHESIS: Physician interactions with pharmaceutical representatives were generally endorsed, began in medical school, and continued at a rate of about 4 times per month. Meetings with pharmaceutical representatives were associated with requests by physicians for adding the drugs to the hospital formulary and changes in prescribing practice. Drug company-sponsored continuing medical education (CME) preferentially highlighted the sponsor's drug(s) compared with other CME programs. Attending sponsored CME events and accepting funding for travel or lodging for educational symposia were associated with increased prescription rates of the sponsor's medication. Attending presentations given by pharmaceutical representative speakers was also associated with nonrational prescribing. CONCLUSION: The present extent of physician-industry interactions appears to affect prescribing and professional behavior and should be further addressed at the level of policy and education.

Attitude↗