Should Gifts to Prescribers be Proscribed? The Ethics of Industry Gifts to U.S. Healthcare Professionals

To everything there is a season, and for many, the winter holidays are a peak season for giving – and receiving – gifts.  Gift exchanges among family members and friends, or between businesses and customers, are so common that we rarely question them.  But in some industries, like healthcare, gift-giving is viewed very differently by different stakeholders.  For decades, the US Congress, federal agencies, various state legislatures, professional associations, patient groups, and pharmaceutical and medical device companies have discussed whether doctors and other US healthcare professionals (“doctors”)2 should accept gifts from pharmaceutical and medical device companies (“PMCs”).  There is no national ethical – or legal – consensus.  

Some say gifts are an acceptable part of an ethical PMC-doctor relationship unless/until proven otherwise.  Others say gifts are inherently unethical because they can compromise integrity, damage trust, jeopardize safety, and increase healthcare costs. 

Whether you think PMC gifts should be permitted or proscribed may depend on your view of human nature.  What does this mean?  Studies show that a person who receives a gift usually feels a need to reciprocate – to return the kindness by doing something the gift-giver will appreciate.3  Doctors know what PMCs would appreciate most:  prescriptions for their products.  Most people – doctors included – would agree that it is unethical to allow PMC gifting to drive prescribing decisions.  But can doctors resist the pull of reciprocity when they prescribe medications?  Or should gifts be proscribed for the good of the healthcare system?  

Let’s look at some of the concerns that are expressed about PMC gifting through a bioethical lens.  

Professional Responsibility.  On the one hand, supporters of PMC gifting note that doctors are medical professionals who swear an oath to conscientiously provide patients with expert medical care. They know their prescribing decisions should be free from outside influences. On the other hand, critics of PMC gifting may say that although most doctors are – try to be – ethical, they are human. Humans are fallible, and therefore, some will compromise their integrity by choosing treatments for patients based on outside influences. 

Non-Maleficence.  Non-maleficence requires doctors to avoid or minimize potential harm to patients.  Those who support PMC gifting might say that laws and regulations that require PMC gifts to be publicly disclosed reduce potential harms, by providing patients with information. Patients can consult the Open Payments System, a national, government-sponsored database, for information about many PMC financial interactions with doctors (including most gifts).  They can see for themselves when or if their doctors have had financial interactions with the companies that make or sell the medicines they take, and they can ask their doctors if they have questions or concerns.  

Justice.  Often, PMCs that engage in gifting make or sell brand-name drugs that may be relatively newer and/or more expensive than other treatment options.  Uninsured or underinsured patients may not be able to obtain these medications at all, or only if they take on significant medical debt.  Prescribing decisions influenced by PMC gifts may adversely affect health equity and result in disparate treatment of otherwise similarly situated patients.  This is inconsistent with the bioethical principle of justice.  

Giving and receiving holiday offerings is gratifying, but good health – and respectful collaboration among PMCs, doctors and patients that helps everyone receive high-quality, ethical healthcare – is a priceless gift we can all appreciate year-round.  

Happy Holidays and we’ll see you in 2026!

1. This note greatly oversimplifies a complex topic and does not contain legal advice.  If you are looking for more information on this topic, the cited resources may be helpful.  

2. For convenience, this note addresses PMC gifts to “doctors.”  Some state laws and other regulations address gifts to other healthcare professionals. 

3. Interestingly, the pull of reciprocity is not necessarily influenced by the cost or value of the gift.  One group of commentators has noted that “[w]hen a gift or gesture of any size is bestowed, it imposes…a sense of indebtedness…. The…rule of reciprocity imposes…an obligation to repay for favors, gifts and invitations…. Feelings of obligation are not related to the size of the initial gift or favor.”  Katz D, Caplan AL, Merz JF. All gifts large and small: toward an understanding of the ethics of pharmaceutical industry gift-giving. Am J Bioeth. 2003;3(3):39-46, quoted in Sierles FS, “Case and Commentary:  The Gift-Giving Influence,” AMA J. Ethics (June 2006) (accessed December 9, 2025).