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In Reply: We agree with Dr Katz and colleagues that reciprocity constitutes an additional mechanism through which gifts influence physicians. As they note, the research findings they summarize reinforce several of our points, including the conclusion that even small gifts are influential. Reciprocity is especially important for gift-giving, but the self-serving bias, which was our focus, plays a role in nearly all conflicts of interest that physicians face, such as being paid for referring patients to clinical trials or profiting from procedures that they recommend.

Dr Goldrich cites the AMA policy statement that gifts "should primarily entail a benefit to patients," implying that an effective policy for dealing with conflict of interest already exists. But the research we cited found that gifts lead to prescription practices that may harm patients.

In response to Dr Tarshis, we argued that most physicians are well intentioned but, like everyone else, subject to self-serving . . . [Full Text of this Article]

Jason Dana, MS; George Loewenstein, PhD
Department of Social and Decision Sciences
Carnegie Mellon University
Pittsburgh, Pa

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