A study out of Carnegie Mellon University in JAMA tested whether reminding pediatric and family medicine residents of their personal sacrifices might make them more willing to accept a gift from industry. In the online survey, if the residents where asked about their sacrifices, such as work hours, hours of sleep, salary and education related debt, prior to questions about the acceptability of gifts, then 48% found the gifts acceptable vs 22% in the control group who were asked about the gifts first.
Interestingly, if the residents were also read this: "Some physicians believe that the stagnant salaries and rising debt levels prevalent in the medical profession justifies accepting gifts and other forms of compensation and incentives from the pharmaceutical industry. To what extent do you agree or disagree that this is a good justification?" then 60% found the gifts acceptable. So reminding residents of their sacrifices, especially if they are provided a rationalization really changes their perceived acceptability of industry-sponsored gifts. Pretty scary. But what can be done?
An accompanying editorial by Pauker and Wong from Tufts discusses, among many things, the lack of training medical students receive in managing their many conflicts "regarding ethical principles about personal economic behavior, the ethics of patient care (eg, beneficence vs autonomy), or multifaceted loyalties (eg, to patients, institutions, society, or third-party payers)." They highlight the 'theory of constraints thinking process" (TOCTP) and it's core conflict resolution diagram, the evaporating cloud. This 'dark cloud' can be evaporated when subjected to logic techniques. The example they provide might take a few readings to understand, but seems to make sense on paper. I'm not sure how such techniques could be implemented, however.
Sah and Loewenstein JAMA RCT
Pauker and Wong JAMA editorial
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