Los médicos y la industria farmacéutica: impacto sobre actitudes y hábitos de prescripción / Physicians and the pharmaceutical industry: impact on prescription attitudes and habits

Resumen Introducción: La relación médico-industria farmacéutica (IF) se ha identificado como un problema ético por favorecer conflictos de interés derivados de los beneficios que reciben los médicos y que pueden afectar su juicio clínico. Objetivo: Identificar la frecuencia de participación de médicos en actividades financiadas por la IF, las actitudes de estos profesionales hacia los representantes de la IF, su conducta prescriptiva y la asociación de sus características y del trabajo con la participación en actividades financiadas por la IF. Método: Encuesta transversal a médicos internistas y cardiólogos. El cuestionario incluyó características de los médicos y centro de trabajo, participación en actividades financiadas por la IF, actitudes hacia los representantes y conducta de prescripción. Resultados: Se analizaron 455 cuestionarios, 78.5 % de los encuestados tuvo conocimiento de la relación médico-IF, la mayoría respondió reunirse con representantes de la IF, 30 % indicó haber recibido subsidios financieros y 10 % consideró que los obsequios afectan su prescripción. Tener conocimiento previo de la relación médico-IF se asoció con menor participación en actividades educativas financiadas por por la IF. Conclusión: Las prácticas y preferencias hacia la IF muestran la necesidad de diseñar estrategias para evitar la prescripción inapropiada.

Abstract Introduction: The physician-pharmaceutical industry relationship has been identified as an ethical problem, due to conflicts of interest motivated by the benefits that doctors receive and that can affect their clinical judgment. Objective: To identify the frequency of physicians participation in activities financed by the pharmaceutical industry (PI), their attitudes towards PI representatives (PIRs), their prescriptive behavior and the association between their characteristics and their workplace with their participation in activities financed by the PI. Method: Cross-sectional survey to internists and cardiologists. The questionnaire included characteristics of the doctors and their workplace, participation in activities financed by the PI, attitudes towards PIRs, and prescription behavior. Results: 455 questionnaires were analyzed; 78.5 % of surveyed subjects were aware of the physician-PI relationship, the majority acknowledged meeting with PIRs, 30 % indicated having received financial subsidies and 10 % considered that gifts affect their prescription. Having prior knowledge of the physician-PI relationship was associated with less participation in PI-financed educational activities. Conclusion: Practices and preferences towards the PI show the need to design strategies to avoid inappropriate prescription.

A review of the possibility of adopting financially driven live donor kidney transplantation

ABSTRACT Kidney transplantation for end-stage renal disease remains the preferred solution due to its survival advantage, enhanced quality of life and cost-effectiveness. The main obstacle worldwide with this modality of treatment is the scarcity of organs. The demand has always exceeded the supply resulting in different types of donations. Kidney donation includes pure living related donors, deceased donors, living unrelated donors (altruistic), paired kidney donation and more recently compensated kidney donation. Ethical considerations in live donor kidney transplantation have always created a debate especially when rewarding unrelated donors. In this paper, we examine the problems of financially driven kidney transplantation, the ethical legitimacy of this practice, and propose some innovative methods and policies that could be adopted to ensure a better practice with accepted ethical guidelines.

Gifts and conflicts of interest: in shades of gray? / Los regalos como conflicto de interés: ¿una zona gris? / Presentes e conflitos de interesses: uma área cinza?

Abstract: 15. Gifts are a regular practice within the relationships established by business world stakeholders with the professionals that may be instrumental in promoting their sales. Consequently, gifts are a potential source of conflicts of interest. This article is the result of a bibliographic study of papers addressing gifts, published in scientific journals which was carried out with the aim of identifying what kinds of professions address the issue and in what ways, in order to reach conclusions that may enhance reflection and contribute to professional training. The research was carried out using the SciELO, PsychNet, IEEE, and Proquest databases and yielded 59 publications that span the period between 1998 and 2015. Results show a remarkable concentration in health-related professions, mainly in their relationships with the pharmaceutical industry. Nevertheless, an emerging presence is being observed in other professional fields. Starting from a philosophical conceptualization of the gift as a present, the results suggest that it is not this conception of gift but rather the exchange rationality that is reflected in these practices, thus becoming an ethically gray, i.e., uncertain area, that cannot be disregarded when it comes to training in professional ethics.

Resumen: 19. Los regalos son una práctica habitual en las relaciones que establecen los actores del mundo empresarial con aquellos profesionales que pueden potencialmente promover sus ventas. Por ello, constituyen fuente de eventuales conflictos de interés. Este artículo es el resultado de un estudio bibliográfico de artículos publicados en revistas científicas acerca de los obsequios con el propósito de identificar en qué tipos de profesiones el tema es tratado y de qué maneras, para arribar a conclusiones que enriquezcan la reflexión y contribuyan en la formación profesional. La pesquisa se efectuó a través de las bases SciELO, PsychNet, IEEE y Proquest, dando como resultado 59 publicaciones que abarcan el período comprendido entre 1998 y 2015 y que muestran una notoria concentración en las carreras de la salud, principalmente en sus relaciones con la industria farmacéutica. A pesar de ello, se aprecia una presencia emergente en carreras de otros campos profesionales. Partiendo de una conceptualización filosófica del regalo en cuanto don, los resultados inducen a concluir que no es esta concepción de regalo la que se expresa en estas prácticas sino la racionalidad del intercambio, constituyéndose en una zona éticamente gris, es decir, incierta, que resulta insoslayable en la formación en ética profesional.

Resumo: 23. A troca de presentes é uma prática regular dentro das relações estabelecidas no mundo de negócios, o que pode ser um instrumento na promoção de vendas. Consequentemente, os presentes são uma fonte potencial de conflitos de interesses. Este artigo é o resultado de um estudo bibliográfico de trabalhos que abordam presentes, publicados em revistas científicas, que foi realizado com o objetivo de identificar quais os tipos de profissões que abordam essa questão e de que maneira, a fim de chegar a conclusões que possam reforçar a reflexão e contribuir para a formação profissional. A pesquisa foi realizada usando os bancos de dados da SciELO, PsychNet, IEEE e Proquest e foram encontradas 59 publicações que abrangem o período entre 1998 e 2015. Os resultados mostram uma notável concentração nas profissões relacionadas com a área da saúde, principalmente relacionadas com a indústria farmacêutica. No entanto, uma presença emergente está sendo observada em outros campos profissionais. A partir de uma conceituação filosófica do presente como um regalo, os resultados sugerem que não é essa concepção de presente, mas sim o intercâmbio de racionalidade que é refletida nestas práticas, tornando-se um ponto de vista ético cinza, ou seja, uma área incerta, que não pode ser ignorado no âmbito do ensino da ética profissional.