The influence of direct-to-consumer advertising and physician promotions are examined in this study. We further examine some of the ethical issues which may arise when physicians accept promotional products from pharmaceutical companies. The data revealed that direct-to-consumer advertising is likely to increase the request rates of both the drug category and the drug brand choices, as well as the likelihood that those drugs will be prescribed by physicians. The data further revealed that the majority of responding physicians were (...) either neutral or did not feel that accepting some types of gifts from pharmaceutical companies affected their ethical behaviors. (shrink)

BackgroundThe pharmaceutical market in Bangladesh is highly concentrated. Due to high competition aggressive marketing strategies are adopted for greater market share, which sometimes cross limit. There is lack of data on this aspect in Bangladesh. This exploratory study aimed to fill this gap by investigating current promotional practices of the pharmaceutical companies including the role of their medical representatives.MethodsThis qualitative study was conducted as part of a larger study to explore the status of governance in health sector (...) in 2009. Data were collected from Dhaka, Chittagong and Bogra districts through in-depth interview, observation, and round table discussion.ResultsFindings reveal a highly structured system geared to generate prescriptions and ensure market share instituted by the pharmaceuticals. A comprehensive training curriculum for the MRs prepares the newly recruited science graduates for generating enough prescriptions by catering to the identified needs and demands of the physicians expressed or otherwise, and thus grab higher market-share for the companies they represent. Approaches such as inducements, persuasion, emotional blackmail, serving family members, etc. are used. The type, quantity and quality of inducements offered to the physicians depend upon his/her capacity to produce prescriptions. The popular physicians are cultivated meticulously by the MRs to establish brand loyalty and fulfill individual and company targets. The physicians, willingly or unwillingly, become part of the system with few exceptions. Neither the regulatory authority nor the professional or consumer rights bodies has any role to control or ractify the process.ConclusionsThe aggressive marketing of the pharmaceutical companies compel their MRs, programmed to maximize market share, to adopt unethical means if and when necessary. When medicines are prescribed and dispensed more for financial interests than for needs of the patients, it reflects system’s failed ability to hold individuals and entities accountable for adhering to basic professional ethics, code of conduct, and statutory laws. (shrink)

Constructive leaders highlight elements of motivation to employees to grow in order to achieve goals for their institutions or departments. They do this either through understanding the significance of ethical leadership or servant leadership. However, people who work under toxic environments often have little or no choice but drop their energy levels and be completely demoralised because of the toxicity at their workplace. This includes stories of leaders who ridicule their employees in public, force employees to undergo physical and psychological (...) pains, and promote divisiveness between colleagues. As the article focuses on leadership, and toxic leadership that is destructive not only for the workplace but also for human relationship, it argues for a need of ethical leadership which creates a dynamic relationship and trust between a leader and those led. The article concludes by stating that there is a relationship between ethical leadership and employee performance, and that this is very important for academic institutions.Contribution: Although the article reflects on the notion of leadership and its toxicity in an academic environment, the implications of the outcome are multidisciplinary, as ethical leadership is necessary in all human institutions. (shrink)

BackgroundIn Pakistan, drug promotion practices, ethical or unethical, have rarely been in the spotlight. We aimed to assess the perception and barriers of medical representatives (MRs) and doctors (MDs) regarding ethical promotion of pharmaceuticals in Pakistan.MethodsA cross sectional survey was conducted in seven major cities of Pakistan for 6-months period. Self-administered questionnaire was used for data collection. Logistic regression and five-point Likert scale scoring was used to estimate the perceptions and barriers.ResultsCompared to national companies (NCs), the medical representatives (MRs) of (...) multinational companies (MNCs) strongly believed that their companies follow World Health Organization (WHO) (OR; 5.31, p = 0.0005), International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) (OR; 6.45, p = 0.0005) and national codes of ethics (OR; 5.84, p = 0.0005). MNCs trained their MRs (OR; 6.68, p = 0.0005), provide accurate and valid scientific data (OR; 4.01, p = 0.007) with adequate system of accountability and controls on product samples (OR; 1.96, p = 0.047), while, NCs sponsor social or entertainment activities, seminars and conferences, and all sort of facilitation in form of gifts of their choice and clinic renovation for medical doctors (MDs). MDs perceptions were similar to MRs mentioned above, yet strongly agreed that companies offer cash payments or equivalents to MDs. The MRs of NCs/mncs and MDs agreed/strongly agreed that no external accountability, profiteering, pressure on sale targets, job insecurity, condoning unethical promotion by high-ups’ and business promotion by junior MDs were the predominant barriers.ConclusionIn conclusion, MRs of MNCs and MDs believed that MNCs follow certain codes of ethics in the promotion of pharmaceuticals, while NCs tend to be more profit oriented and even condone unethical promotion. All stakeholders, MRs, MDs and companies, might pose certain barriers, intentionally or unintentionally, in ethical promotion. (shrink)

Pharmaceutical sales representatives (PSRs) are one of the most frequently used drug information sources for physicians in both the United States and China. During face-to-face interactions, PSRs use various promotional strategies to impact the prescribing behavior. In the United States, PSRs provide physicians small gifts, free drug samples, and “sincere friendships”, whereas in China, they played an indispensable role in medical corruption over the past three decades. To cope with the undue influence of PSRs, both these countries (...) have taken positive but insufficient measures to eliminate the effect thus far. By comparing the strategies of American and Chinese PSRs, it was found that building a friendly personal relationship with physicians in a relatively closed private environment (such as physician’s office) is a key factor to exert an individualized influence on physicians, even in different social backgrounds and healthcare contexts. Therefore, this essay suggests that it is necessary to limit the establishment of personal relationships and maintain a more professional interaction to reduce the personalized psychological and emotional influences on physicians’ professional judgment. To achieve this goal, it is proposed to transfer the physician-PSR interaction to a professional public space as a supplement to current countermeasures and suggestions. The presence of others and the possibility of third party participation will stimulate more ethical and reputational concerns. It is hoped that the increased transparency of the interaction will promote participants to consider more professional norms and mitigate the undue influence of PSRs’ individualized strategies. (shrink)

Post-industrial societies confront common problems in pharmaceutical industry-physician relations. In order to promote sales, drug firms create financial relationships that influence physicians' prescriptions and sometimes even reward physicians for prescribing drugs. Three main types exist: kickbacks, gifts, and financial support for professional activities. The prevalence of these practices has evolved over time in response to changes in professional codes, law, and markets. There are certainly differences among these types of ties, but all of them can compromise physicians' independent (...) judgment and rational prescribing.Drug firms have paid kickbacks for prescribing drugs, purchasing drugs, switching brands prescribed, adding a drug to a hospital formulary, enrolling patients in post-marketing clinical trials, and writing practice guidelines that encourage the use of certain drugs. (shrink)

Physician-pharmaceutical industry interactions continue to generate heated debate in academic and public domains, both in the United States and abroad. Despite this, recent research suggests that physicians and physicians-in-training remain ignorant of the core issues and are ill-prepared to understand pharmaceutical industry promotion. There is a vast medical literature on this topic, but no single, concise resource. This book aims to fill that gap by providing a resource that explains the essential elements of this subject. The text makes (...) the reader more aware of the key ethical issues and allows the reader to be a more savvy interpreter of industry promotion, have a heightened awareness of the public and medical legal consequences of some physician-pharmaceutical industry interactions, and be better equipped to handle real-life encounters with industry. (shrink)

In 2008 pharmaceutical companies spent over $12 billion on product promotion and detailing aimed at U.S. health care practitioners. Drug and device manufacturers rely on a workforce of detailers and physician speakers to reach health care practitioners and nudge their prescribing habits. To prevent undue influence and protect the public fisc, a number of states began regulating these marketing practices, requiring companies to disclose all gifts to practitioners, prohibiting the commercialized sale of prescription data, and prohibiting certain (...) class='Hi'>gifts altogether. The 2010 enactment of the Physician Payment Sunshine Act marks the first Congressional involvement in the regulation of disclosure related to pharmaceutical marketing. Overall, the Act improves transparency in pharmaceutical marketing to physicians and expands the regulation of disclosure of pharmaceutical marketing activities in important substantive ways. (shrink)

A training physician has his first interaction with a pharmaceutical representative during medical school. Medical students are often provided with small gifts such as pens, calendars and books, as well as free lunches as part of drug promotion offers. Ethical impact of these transactions as perceived by young medical students has not been investigated in Pakistan before. This study aimed to assess the association of socio-demographic variables with the attitudes of medical students towards pharmaceutical companies and their (...) incentives. (shrink)

Pharmaceutical promotion is a negative influencing force for prescribing. However, very few regulatory initiatives are taken to overcome this unwarranted influence. The present research was conducted in such context with an attempt to review the regulatory documents related to pharmaceutical promotion in Bangladesh including Code of Pharmaceutical Marketing Practices (CPMP), and to compare CPMP with different global guidelines. The studied guidelines demonstrate effort to regulate promotion, though that varies to a great extent, particularly in enforcement aspects. Clearly (...) defined ethical and legal prohibitions, provisions of punishment for violations and entrusted agency with defined authority are crucial. (shrink)

The international pharmaceutical industry has made significant efforts towards ensuring compliant and ethical communication and interaction with physicians and patients. This article presents the current status of the worldwide governance of communication practices by pharmaceutical companies, concentrating on prescription-only medicines. It analyzes legislative, regulatory, and code-based compliance control mechanisms and highlights significant developments, including the 2006 and 2012 revisions of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Code of Practice.

Much attention has been focused in recent years on the ethical acceptability of physicians receiving gifts from drug companies. Professional guidelines recognize industry gifts as a conflict of interest and establish thresholds prohibiting the exchange of large gifts while expressly allowing for the exchange of small gifts such as pens, note pads, and coffee. Considerable evidence from the social sciences suggests that gifts of negligible value can influence the behavior of the recipient in ways the (...) recipient does not always realize. Policies and guidelines that rely on arbitrary value limits for gift-giving or receipt should be reevaluated. (shrink)

Aim To ascertain the quantity and nature of gifts and items provided by the pharmaceutical industry in Australia to medical specialists and to consider whether these are appropriate in terms of justifiable ethical standards, empirical research and views expressed in the literature.

In this essay, we argue that the acceptance of gifts by health professionals from the pharmaceutical industry is morally problematic. We conclude that whether physicians view the receipt of items from drug detailers as entitlements or gifts, this practice is unacceptable, as it constitutes a conflict of interest. In addition, we argue that these gifts are particularly problematic in academic hospitals. Physicians-in-training are inculcated with the belief that receiving gifts is morally acceptable. The cumulative effect (...) of these worries should be sufficient to warrant the serious attention of medical associations worldwide. (shrink)

The pharmaceutical industry and drugs advertisements are sometimes accused of “creating diseases”. This article assesses and describes the role of that industry in fostering medicalization. First, the notions of medicalization and pharmaceuticalization are defined. Then, the problem of distinguishing between harmful overmedicalization and well-founded medicalization is presented. Next, the phenomenon of disease mongering is explained and illustrated by the case analysis of medicalizing pain and suffering in three contexts: (1) the general idea of medicalizing physical pain, (2) the medicalization (...) of grief and (3) disease mongering of pseudoaddiction—a condition promoted in order to increase the demand for opioid pain relievers. (shrink)

Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver educational talks to groups of physicians in the community to help market the company's brand-name drugs. These speakers receive substantial compensation to lecture at events sponsored by pharmaceutical companies, a practice that has garnered attention, controversy, and scrutiny in recent years from legislators, professional associations, researchers, and ethicists on the issue of whether it is appropriate for academic physicians to serve in a promotional role. (...) These relationships have become so contentious that three years ago the pharmaceutical industry trade association, the Pharmaceutical Research and Manufacturers of America, adopted voluntary guidelines stating that drug companies should stop giving doctors free pens, calendars, sports bags, or tickets to entertainment events. Further, numerous medical associations, such as the Association of American Medical Colleges, the American Board of Internal Medicine and the Institute on Medicine as a Profession, and government bodies such as the Institute of Medicine have recommended that medical schools and teaching hospitals prohibit or strongly discourage faculty from participating in so-called industry Speakers Bureaus — promotional events designed solely to market pharmaceutical products. (shrink)

Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver “educational” talks to groups of physicians in the community to help market the company's brand-name drugs.Although presented as educational, and even though they provide educational content, these events are intended to influence decisions about drug selection in ways that are not based on the suitability and effectiveness of the product, but on the prestige and persuasiveness of the speaker. A number of state legislatures and most academic (...) medical centers have attempted to restrict physician participation in pharmaceutical marketing activities, though most restrictions are not absolute and have proven difficult to enforce. This article reviews the literature on why Speakers' Bureaus have become a lightning rod for academic/industry conflicts of interest and examines the arguments of those who defend physician participation. It considers whether the restrictions on Speakers' Bureaus are consistent with principles of academic freedom and concludes with the legal and institutional efforts to manage industry speaking. (shrink)

Should we be concerned about financial conflicts of interest (COI) between doctors and the pharmaceutical industry? Some people will say no as there are clearly doctors who celebrate the relationship. Others say that it does not matter to patients, but the evidence says otherwise. Financial COI is different from other types of conflicts because it is voluntary and can be refused. Finally, it is not just the large gifts that are a problem, the small ones also create a (...) "gift relationship." Drug companies know about this and spend billions on promotion with good effect from their point of view. Companies also woo doctors who honestly hold pro-industry points of view to speak on behalf of the companies. There are still multiple examples of financial COI, and although there are isolated examples of improvement, this is still an area of deep concern. (shrink)

Relationships between physicians and pharmaceutical sales representatives (PSRs) often create conflicts of interest, not least because of the various benefits received by physicians. Many countries attempt to control pharmaceutical industry marketing strategies through legal regulation, and this is true in Poland where efforts are underway to eliminate any practices that might be considered corrupt in medicine. The present research considered Polish medical students’ opinions about domestic laws restricting doctors’ acceptance of expensive gifts from the industry, the idea (...) of compulsory transparency, and the possibility of introducing a Polish Sunshine Law. A qualitative, focus group-based, interview method was used. Data were gathered from nine focus groups involving 92 medical students from three universities located in major Polish cities. The article presents a classification of opposing student views with regard to the consequences of introducing different legal solutions; this should be useful for policy makers deliberating on how to optimally regulate pharmaceutical marketing. The study’s results are discussed in the context of the public bioethical debate in Poland. (shrink)

Pharmaceutical and medical device companies apply social psychology to influence physicians' prescribing behavior and decision making. Physicians fail to recognize their vulnerability to commercial influences due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias. Six principles of influence — reciprocation, commitment, social proof, liking, authority, and scarcity — are key to the industry's routine marketing strategies, which rely on the illusion that (...) the industry is a generous avuncular partner to physicians. In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias and have both the motivation and means to resist industry influence. A culture in which accepting industry gifts engenders shame rather than gratitude will reduce conflicts of interest. If greater academic prestige accrues to distant rather than close relationships with industry, then a new social norm may emerge that promotes patient care and scientific integrity. In addition to educating faculty and students about the social psychology underlying sophisticated but potentially manipulative marketing and about how to resist it, academic medical institutions should develop strong organizational policies to counteract the medical profession's improper dependence on industry. (shrink)

Objective: To identify factors that predict physicians’ intent to comply with the American Medical Association’s ethical guidelines on gifts from the pharmaceutical industry.Methods: A survey was designed and mailed in June 2004 to a random sample of 850 physicians in Florida, USA, excluding physicians with inactive licences, incomplete addresses, addresses in other states and pretest participants. Factor analysis extracted six factors: attitude towards following the guidelines, subjective norms , facilitating conditions , profession-specific precedents , individual-specific precedents and intent. (...) Multivariate regression modelling was conducted.Results: Surveys were received from 213 physicians representing all specialties, with a net response rate of 25.5%. 62% of respondents were aware of the guidelines; 50% had read them. 48% thought that following the guidelines would increase physicians’ credibility and professional image; 68% agreed that it was important to do so. Intent to comply was positively associated with attitude, subjective norms, facilitators and sponsorship of continuing medical education events, while individual-specific precedents had a negative relationship with intent to comply. Predictors of intent were attitude, subjective norms, the interaction term , sponsorship of CME events and individual-specific precedents.Conclusions: Physicians are more likely to follow the AMA guidelines if they have positive attitudes towards the guidelines, greater subjective norms, fewer expectations of CME sponsorship and fewer individual-specific precedents. Physicians believing that important individuals or organisations expect them to comply with the guidelines are more likely to express intent, despite having fewer beliefs that positive outcomes would result through compliance. (shrink)

Many factors contribute to the inappropriate use of medicines, including not only a lack of information but also inaccurate and misleading promotional information. This review examines how the promotion of pharmaceuticals directly affects the prescribing and use of medicines. We define promotion broadly as all actions taken directly by pharmaceutical companies with the aim of enhancing product sales. We look in greater detail at promotion techniques aimed at prescribers, such as sales representatives, pharmaceutical advertisements in medical journals (...) and use of key opinion leaders, along with the quality of information provided and the effects thereof. We also discuss promotion to the public, through direct-to-consumer advertising, and its effects. Finally, we consider initiatives to regulate promotion that come from industry, government and nongovernmental organizations. (shrink)

We all know that doctors accept gifts from drug companies, ranging from pens and coffee mugs to free vacations at luxurious resorts. But as the former Editor-in-Chief of The New England Journal of Medicine reveals in this shocking expose, these innocuous-seeming gifts are just the tip of an iceberg that is distorting the practice of medicine and jeopardizing the health of millions of Americans today. In On the Take, Dr. Jerome Kassirer offers an unsettling look at the pervasive (...) payoffs that physicians take from big drug companies and other medical suppliers, arguing that the billion-dollar onslaught of industry money has deflected many physicians' moral compasses and directly impacted the everyday care we receive from the doctors and institutions we trust most. Underscored by countless chilling untold stories, the book illuminates the financial connections between the wealthy companies that make drugs and the doctors who prescribe them. Kassirer details the shocking extent of these financial enticements and explains how they encourage bias, promote dangerously misleading medical information, raise the cost of medical care, and breed distrust. Among the questionable practices he describes are: the disturbing number of senior academic physicians who have financial arrangements with drug companies; the unregulated "front" organizations that advocate certain drugs; the creation of biased medical education materials by the drug companies themselves; and the use of financially conflicted physicians to write clinical practice guidelines or to testify before the FDA in support of a particular drug. A brilliant diagnosis of an epidemic of greed, On the Take offers insight into how we can cure the medical profession and restore our trust in doctors and hospitals. (shrink)

Over the last few years, the pharmaceutical industry intensified marketing activity in Poland. One of the most important ways of promotion are visits by pharmaceutical sales representatives in physicians’ offices. Representatives during those meetings are using different sorts of tactics to manipulate physicians such as: gift-giving, free meals, travel subsidies, “fake” research, ‘white Saturdays’, sponsored teaching and conferences. An ethical ambiguity can be easily find in this work. The paper describes briefly the results of the research concerning the (...) influence of the relationship between physicians with the pharmaceutical companies on prescribing habits which were conducted in other countries. The article presents law regulations and ethical codes present in Poland, but it concentrate on describing the results of 31 in-depth interviews with pharmaceutical sales representatives conducted between the June – November 2007. The main aim of this paper is to show how important are ethical and law standards for the pharmaceutical sales representative. Do they know it? Does companies take care about proper training and information in the area for their employees? Work ethics of the pharmaceutical sales representative is very important, and should be discussed. Drugs are special kind of goods which can influence people health and sometimes even lives so we should pay attention to the ways medicaments are advertise and promote. (shrink)

Advocates, activists, and academics have criticized pharmaceutical intellectual property ("pharma IP") rights as obstacles to access to medicines for the global poor. These criticisms of pharma IP holders are frequently exceptionalist: they focus on pharma IP holders while ignoring whether others also bear obligations to assist patients in need. These others include holders of other lucrative IP rights, such as music copyrights or technology patents; firms, such as energy companies and banks, that do not rely on IP; and wealthy (...) private individuals. Their resources could be used to aid patients by providing direct medical assistance, funding prizes or biomedical research, or purchasing pharmaceutical patents and granting rights to the disadvantaged. -/- After identifying this exceptionalism, this Article evaluates several arguments in its defense. These are that pharma IP holders are unique in (1) owning what poor patients need, (2) being in special proximity to these patients, (3) being able to assist at low cost to themselves, (4) having a professional duty to help these patients, or (5) being implicated by their past conduct in these patients' plight. It concludes that none of these arguments are compelling: while IP holders have a duty to help, this duty is not fundamentally different from the duties others owe. -/- Even though this project criticizes exceptionalism, it does not absolve pharma IP holders of duties to help the sick. Rather, it argues that spreading the costs of aiding patients in need across a greater number of market actors, via publicly funded "pull" programs like prizes and patent buyouts or "push" programs like grants, would be preferable. So would allowing pharmaceutical firms to seek contribution from others who are able to help. However, if others cannot be held to account, imposing burdens on pharma IP holders can be justified in order to promote global health: treating wealthy firms arbitrarily is preferable to ignoring the urgent needs of the global poor. (shrink)

The study examines the attitudes among physicians regarding acceptance of gifts, sponsorships, and drug samples in response to marketing efforts of pharmaceutical companies in India. The research also attempts to study physicians’ perceptions of the Medical Council of India (MCI) guidelines on the code of conduct for pharmaceutical marketing practices and the influence of these guidelines on physicians’ actions. A structured questionnaire was developed for collecting primary data regarding exposure of physicians to promotional tools and physicians’ (...) attitudes and practices with regard to various professional ethical issues. One thousand physicians from private and government hospitals located in a metropolitan area were approached personally or through email for getting the questionnaire filled. A total of 189 completed and usable questionnaires could be obtained which is a response rate of approximately 20 %. Respondents in the study indicate being offered samples, sponsorship, and gifts by pharmaceutical companies with a frequency of at least once a month. Thus, many pharmaceutical firms are not following the code of conduct issued by the Department of Pharmaceuticals, Govt. of India. Further, though almost all physicians report being aware of the guidelines issued by the MCI, yet as many as 69 % of the sample admitted to be accepting gifts and sponsorships offered by the pharmaceutical firms. Educational programs were found to be influencing physician prescription behavior to a greater extent when compared with gifts. Frequency of offers made for gifts and sponsorships were found to be dependent upon physicians’ practice (number of prescriptions written) and the type of hospital they are associated with (private or government). The study focuses on sensitive yet critical ethical issues related to the promotional practices of pharmaceutical firms in India and physicians’ responses with regard to these promotional practices in the context of the guidelines of the Medical Council of India and the Department of Pharmaceuticals. (shrink)

Pharmaceutical advertising is one of the most important kinds of advertising that can have a direct impact on the health of a consumer. Hence, this necessitates the fact that it is essential for advertisers of such products to take special care and additional responsibility when devising the promotional strategies of these products. In reality, it has been observed that pharmaceutical product advertisers often promoted their products to achieve their own goals at the potential risk of having an (...) adverse effect on the consumerÕs health. This type of advertising is most often seen in over-the-counter drug product advertisements, and not as often in the case of prescription drug advertisements, which is relatively new. This article analyzes various purposes of advertising pharmaceutical products and also the potential problems that arise from the way pharmaceutical products have quite frequently been promoted. (shrink)

This article compares the means that the United States, France, and Japan use to oversee pharmaceutical industry-physician financial relationships. These countries rely on professional and/or industry ethical codes, anti-kickback laws, and fair trade practice laws. They restrict kickbacks the most strictly, allow wide latitude on gifts, and generally permit drug firms to fund professional activities and associations. Consequently, to avoid legal liability, drug firms often replace kickbacks with gifts and grants. The paper concludes by proposing reforms that (...) address problems that persist when firms replace kickbacks with gifts and grants based on the experience of the three countries. (shrink)

This paper promotes a philosophy derived from the direct distribution of goods to needs that occur in mothering and invisibly in many other aspects of life. Such a philosophy is suggested as an alternative to market based values, which currently permeate society. It is important to bring alternative values to consciousness and validate them for both teachers and children so that the orientation towards the other that characterizes the gift paradigm will not be lost in the fight for survival endemic (...) to a market society. The hope is that we can find solutions that are viable for all. After presenting this philosophy, we show how it already exists among educators and children, and we suggest ways in which it may be validated and promoted in early childhood education. (shrink)

This paper promotes a philosophy derived from the direct distribution of goods to needs that occur in mothering and invisibly in many other aspects of life. Such a philosophy is suggested as an alternative to market based values, which currently permeate society. It is important to bring alternative values to consciousness and validate them for both teachers and children so that the orientation towards the other that characterizes the gift paradigm will not be lost in the fight for survival endemic (...) to a market society. The hope is that we can find solutions that are viable for all. After presenting this philosophy, we show how it already exists among educators and children, and we suggest ways in which it may be validated and promoted in early childhood education. (shrink)

Article 3.4 of EC directive 89/381 requires member states to take "all necessary measures to promote Community self-sufficiency in human blood or human plasma" and, for this purpose, to "encourage the voluntary unpaid donation of blood and plasma". This paper presents an ethical case in support of the policy of voluntary, unpaid donation.

BackgroundThe International Committee of Medical Journal Editors Recommendations set ethical and editorial standards for article publication in most leading medical journals. Here, I examine the strengths and weaknesses of the Recommendations in the prevention of commercial bias in industry-financed journal literature, on three levels – scholarly discourse, article content, and article attribution.DiscussionWith respect to overall discourse, the most important measures in the ICMJE Recommendations are for enforcing clinical trial registration and controlling duplicate publication. With respect to article content, the ICMJE (...) promotes stringent author accountability and adherence to established reporting standards. However, the ICMJE accepts the use of commercial editorial teams to produce manuscripts, which is a potential source of bias, and accepts private company ownership and analysis of clinical trial data. New ICMJE guidance on data sharing will address but not eliminate problems of commercial data access. With respect to attribution, the Recommendations oppose guest authorship and encourage clear documentation of author contributions. However, they exclude writers from coauthorship; provide no specific advice on the attribution of commercial literature, for instance with respect to company authorship, author sequence or prominent commercial labeling; and endorse the use of fine print and euphemism. The ICMJE requires detailed author interest disclosures, but overlooks the interests of non-authors and companies, and does not recommend that interests most salient to the publication are highlighted. Together, these weaknesses facilitate “advocacy”-based marketing, in which literature planned, financed and produced by companies is fronted by academics, enabling commercial messages to be presented to customers by their respected clinical peers rather than companies themselves.ConclusionsThe ICMJE Recommendations set important research and reporting standards, without which commercial bias would likely be a significantly greater problem than it is today. However, they also support practices of commercial data control, content development and attribution that run counter to science’s values of openness, objectivity and truthfulness. These weaknesses could be addressed with appropriate modifications to the Recommendations. The ICMJE should also disclose its own commercial interests and funding – not least because publishing organizations that finance it and pay the salaries of some member editors derive substantial revenues from industry. (shrink)

ABSTRACTThe analogy between gift‐giving and organ donation was first suggested at the beginning of the transplantation era, when policy makers and legislators were promoting voluntary organ donation as the preferred procurement procedure. It was believed that the practice of gift‐giving had some features which were also thought to be necessary to ensure that an organ procurement procedure would be morally acceptable, namely voluntarism and altruism. Twenty‐five years later, the analogy between gift‐giving and organ donation is still being made in the (...) literature and used in organ donation awareness campaigns. In this paper I want to challenge this analogy. By examining a range of circumstances in which gift‐giving occurs, I argue that the significant differences between the various types of gift‐giving and organ donation makes any analogy between the two very general and superficial, and I suggest that a more appropriate analogy can be found elsewhere. (shrink)

I will discuss the prospect of pharmaceutically enhancing human morality and decision making in such a way as to eliminate morally unjustifiable choices and promote desirable ones. Our species in the relatively short period since it has emerged has enormously advanced in knowledge, science, and technical progress. When it comes to moral development, the distance it has covered is almost negligible. What if we could medically accelerate our moral development? What if we could once and for all render our species (...) totally immune to certain vices? I will examine whether pharmaceutically intervening in human morality would compromise the autonomy of moral agents. I will argue that the argument from the autonomy of the moral agent is neither stable nor convincing. In the light of Kantian ethics we might consider moral enhancement by pharmaceutical means to be a perfect duty for moral agents. (shrink)

Globalized in 1995 through the TRIPs Agreement, humanity’s dominant mechanism for encouraging innovations involves 20-year product patents, whose monopoly features enable innovators to reap large markups or licensing fees from early users. Exclusive reliance on this reward mechanism in the pharmaceutical sector is morally problematic for two main reasons. First, it imposes a great burden on poor people who cannot afford to buy patented treatments at monopoly prices and whose specific health problems are therefore neglected by pharmacological research. Second, (...) it discourages pharmaceutical firms from fighting diseases at the population level with the aim of slashing their incidence. These problems can be alleviated by establishing a supplementary alternative reward mechanism that would enable pharmaceutical innovators to exchange their monopoly privileges on a patented product for impact rewards based on the actual health gains achieved with this product. As such, an international Health Impact Fund would create powerful new incentives to rapidly develop remedies against diseases concentrated among the poor, provide such remedies with ample care at very low prices, and deploy them strategically to contain, suppress, and ideally eradicate the target disease. By promoting innovations and their diffusion together, the HIF would greatly enlarge the benefits, and thereby also the cost-effectiveness, of the pharmaceutical sector, especially in favor of the world’s poor. (shrink)

The analogy between gift‐giving and organ donation was first suggested at the beginning of the transplantation era, when policy makers and legislators were promoting voluntary organ donation as the preferred procurement procedure. It was believed that the practice of gift‐giving had some features which were also thought to be necessary to ensure that an organ procurement procedure would be morally acceptable, namely voluntarism and altruism. Twenty‐five years later, the analogy between gift‐giving and organ donation is still being made in the (...) literature and used in organ donation awareness campaigns. In this paper I want to challenge this analogy. By examining a range of circumstances in which gift‐giving occurs, I argue that the significant differences between the various types of gift‐giving and organ donation makes any analogy between the two very general and superficial, and I suggest that a more appropriate analogy can be found elsewhere. (shrink)

This article argues that the misalignment of private profit-maximizing objectives with public health needs causes institutional corruption in the pharmaceutical sector and systematically leads firms to act contrary to public heath. The article analyzes how financial incentives generate a business model promoting harmful practices and explores several means of realigning financial incentives in order to foster therapeutic innovation and promote the rational use of medicines.

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 23 (2003) 183-186 [Access article in PDF] Zen Gifts to Christians. By Robert Kennedy. New York: Continuum, 2000. 131 pp. Though Robert Kennedy's recent book Zen Gifts to Christians (2000) is intended for Christian readers who may be "temperamentally inclined" (i) to learn about Zen to spiritually augment their lives, it also succeeds as a work that defines the Western Buddhist community and as an (...) introductory text for those interested in Zen Buddhism. Drawing on his experiences as a Catholic priest and Zen master, Kennedy's work contributes much to the ideals expressed in the Second Vatican Council's conciliar decree Nostra Aetate (as well as the Thirty-fourth General Congregation of the Society of Jesus): to preserve and promote those universal elements of truth that manifest themselves in different cultures and societies, through dialogue and collaboration with followers of other religions. Kennedy achieves this monumental goal by organizing the book around the ten ox-herding pictures of Zen Buddhism (also known as the ten bulls) so as to better illustrate to Christians what Zen Buddhism has to offer through the narrative of spiritual growth common to all Zen Buddhists. Each ox-herding picture (or "bull") is elegantly expanded into a chapter detailing each step in the path of the spiritual quest. Kennedy richly supplements the lessons and ideas contained in each bull with references to Western poetry and prose, making the bulls more accessible to the reader by presenting the information in different ways.For both Christian and non-Christian readers, Kennedy's introduction to Zen may come as somewhat of a surprise, because he begins with the lived components of Zen Buddhism: discipline and practice. Though Zen does have speculative features and theories (as evidenced by koans), it is primarily concrete in its approach. Unlike Christianity, Zen is also a physical skill: it must be attentively practiced for enlightenment to occur. As Kennedy notes, if it is practiced sporadically or by rote, the student cannot make any spiritual progress, thus destroying the goal of the exercise. Moreover, Kennedy indirectly echoes a Platonic critique when he warns the [End Page 183] prospective student that time alone will not produce results, let alone Enlightenment! As with the perfection of any skill, discipline requires that the student give up strengths to concentrate on weaknesses. Kennedy's anecdotes and citations beautifully illustrate the points he wishes to make. However, he is cognizant of the fact that failure is part of any spiritual growth (in fact, it is the hallmark of discipline!) and is careful not to paint Zen in overly rosy colors.While the first chapter (Kennedy's commentary and explanation of the first bull) introduces readers to the concrete aspects of Zen, the second chapter on "not-knowing" explores the application of the abstract or mental component of Zen in one's attitude toward daily circumstances. Kennedy skillfully builds on the lessons he presented in the first chapter to express several ideas, many with implications for Christianity today.Two of these ideas are "letting go" and "the loss of God."Though Zen Gifts to Christians was written well before September 2001, these twin themes have become applicable to the contemporary situation for Christians and Buddhists alike. The theme of"letting go" allows Kennedy to subtly explore how old habits (characteristic of rigidness and inflexibility) not only prevent students from realizing their Buddha-nature, but also destroy the possibility for spiritual growth and progress of any sort. This serves to highlight the second theme: the loss of God. Though the book is open and inclusive, the reader is reminded anew that Kennedy wrote the book with a Christian audience in mind. While Kennedy holds that the experience of "losing" God is common to fervent Christians (30), the student, rather than focusing on how distressing that can be, should take it as a reminder of the most primal Christian belief—namely, that a person need not adhere to any single doctrine to be able to accept God. Moreover, such an experience should jar students out of their complacency and allow them to grow further.This point... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 23 (2003) 183-186 [Access article in PDF] Zen Gifts to Christians. By Robert Kennedy. New York: Continuum, 2000. 131 pp. Though Robert Kennedy's recent book Zen Gifts to Christians (2000) is intended for Christian readers who may be "temperamentally inclined" (i) to learn about Zen to spiritually augment their lives, it also succeeds as a work that defines the Western Buddhist community and as an (...) introductory text for those interested in Zen Buddhism. Drawing on his experiences as a Catholic priest and Zen master, Kennedy's work contributes much to the ideals expressed in the Second Vatican Council's conciliar decree Nostra Aetate (as well as the Thirty-fourth General Congregation of the Society of Jesus): to preserve and promote those universal elements of truth that manifest themselves in different cultures and societies, through dialogue and collaboration with followers of other religions. Kennedy achieves this monumental goal by organizing the book around the ten ox-herding pictures of Zen Buddhism (also known as the ten bulls) so as to better illustrate to Christians what Zen Buddhism has to offer through the narrative of spiritual growth common to all Zen Buddhists. Each ox-herding picture (or "bull") is elegantly expanded into a chapter detailing each step in the path of the spiritual quest. Kennedy richly supplements the lessons and ideas contained in each bull with references to Western poetry and prose, making the bulls more accessible to the reader by presenting the information in different ways.For both Christian and non-Christian readers, Kennedy's introduction to Zen may come as somewhat of a surprise, because he begins with the lived components of Zen Buddhism: discipline and practice. Though Zen does have speculative features and theories (as evidenced by koans), it is primarily concrete in its approach. Unlike Christianity, Zen is also a physical skill: it must be attentively practiced for enlightenment to occur. As Kennedy notes, if it is practiced sporadically or by rote, the student cannot make any spiritual progress, thus destroying the goal of the exercise. Moreover, Kennedy indirectly echoes a Platonic critique when he warns the [End Page 183] prospective student that time alone will not produce results, let alone Enlightenment! As with the perfection of any skill, discipline requires that the student give up strengths to concentrate on weaknesses. Kennedy's anecdotes and citations beautifully illustrate the points he wishes to make. However, he is cognizant of the fact that failure is part of any spiritual growth (in fact, it is the hallmark of discipline!) and is careful not to paint Zen in overly rosy colors.While the first chapter (Kennedy's commentary and explanation of the first bull) introduces readers to the concrete aspects of Zen, the second chapter on "not-knowing" explores the application of the abstract or mental component of Zen in one's attitude toward daily circumstances. Kennedy skillfully builds on the lessons he presented in the first chapter to express several ideas, many with implications for Christianity today.Two of these ideas are "letting go" and "the loss of God."Though Zen Gifts to Christians was written well before September 2001, these twin themes have become applicable to the contemporary situation for Christians and Buddhists alike. The theme of"letting go" allows Kennedy to subtly explore how old habits (characteristic of rigidness and inflexibility) not only prevent students from realizing their Buddha-nature, but also destroy the possibility for spiritual growth and progress of any sort. This serves to highlight the second theme: the loss of God. Though the book is open and inclusive, the reader is reminded anew that Kennedy wrote the book with a Christian audience in mind. While Kennedy holds that the experience of "losing" God is common to fervent Christians (30), the student, rather than focusing on how distressing that can be, should take it as a reminder of the most primal Christian belief—namely, that a person need not adhere to any single doctrine to be able to accept God. Moreover, such an experience should jar students out of their complacency and allow them to grow further.This point... (shrink)

In this article I examine two basic questions: first, what constitutes a gifted person, and secondly, is there justification in making special educational provision for gifted children, where special provision involves spending more on their education than on the education of ‘normal’ children? I consider a hypothetical case for allocating extra resources for the gifted, and argue that gifted children are generally denied educational justice if they fail to receive an education that adequately challenges them. I further argue that an (...) adequately challenging education is essential to human flourishing, but that most children can be adequately challenged in schools in ways that promote flourishing without doing so at the expense of other children. (shrink)

Family-focused community education implies a relational pedagogy, whereby people of different ages and experiences, including children, engage interdependently in the education of selves and others. Educational projects grow out of lived experiences and relationships, evolving in dynamic conditions of community self-organisation and self-expression, however partial and approximate, as opposed to habitual and repetitive actions. In developing educational activities through radical listening, community educators aim to reflect the character of the neighbourhood and build on local knowledge and expertise. The paper reports (...) on ways in which one community school invited, encouraged and supported children as co-educators through projects that promoted collaborative leadership and unfolded, rather than being delivered through planned and scripted lessons. These were creative projects of cultural significance, characterised by attentive listening and aiming to promote intergenerational conversation. Through such transformative projects children emerged as educators by acting as catalysts of change, as cultural producers and as conversationalists, as did their parents and other members of the school community. The paper concludes that community co-education ideas should be re-visited to breathe new life into educational and social actions today. (shrink)

ABSTRACT:Giving without the expectation of reward is difficult to understand in organizational contexts. In opposition to a logic based on self-interest or a sense of duty, a “logic of gift” has been proposed as a way to understand the phenomenon of free, unconditional giving. However, the rationale behind, and effects of, this logic have been under-explored. This paper responds by first clarifying the three logics of action—the logic of exchange, the logic of duty, and the logic of gift—and then explains (...) how their balanced integration promises to enhance organizational life and outcomes. Having explicated the unique character and contributions of the logic of gift, the paper further suggests practical implications for management. Encouraging the logic of gift fosters more humane relationships within organizations and to enable individuals to be generous in ways that inspire trust and promote creativity. (shrink)

An anonymous survey distributed to doctors in Poland revealed the troublesome relationship between physicians and pharmaceutical sale representatives in terms of the frequency of visits, the trust of physicians in information supplied by sales reps, gifts accepted, and the general influence of marketing strategies on physician decisions. Challenges remain, despite laws enacted to address the problem.