Pharmaceutical Representatives Research Articles

Turkish Final Year Medical Students' Exposure to and Attitudes Concerning Drug Company Interactions: A Perspective from a Minimally Regulated Environment for Medical Students.

Interactions between drug companies and medical students may affect evidence-based medical practice and patient safety. The aim of this study was to assess drug company–medical student interactions in a medical faculty where limited specific national or institutional regulations apply between drug companies and medical students. The objectives of the study were to determine the exposure and attitudes of final year medical students in terms of drug company–medical student and physician interactions, to identify factors affecting those attitudes and to provide data for policymakers working on the regulation of interactions between drug companies and medical students. This anonymous questionnaire-based study of 154 medical final year medical students at the Karadeniz Technical University Medical Faculty, Trabzon, Turkey, in April and May 2015 attracted a response rate of 92.2% (n/N, 154/164). Exposure to interaction with a pharmaceutical representative was reported by 90.3% (139/154) of students, and 68.8% (106/154) reported experiencing such interaction alongside a resident. In addition, 83.7% (128/153) of students reported an interaction during internship. Furthermore, 69.9% (107/153) of students agreed that interactions influence physicians’ prescription preferences, while 33.1% (51/154) thought that a medical student should never accept a gift from a drug company and 24.7% (38/154) agreed with the proposition that “drug companies should not hold activities in medical faculties”. Students with rational prescription training expressed greater agreement with the statement “I am skeptical concerning the information provided by drug companies during interactions” than those who had not received such training, and this finding was supported by logistic regression [O.R.(C.I), p -3.7(1.2–11.5), p = 0.022]. Acceptance of advertisement brochures was found to significantly reduce the level of agreement with the proposition that “A physician should not accept any gift from a drug company.” (0.3[0.1–0.9], p = 0.030). In summary, exposure to drug companies was widespread among our final year medical students who, like students in both Western and non-Western societies, hold permissive attitudes concerning accepting gifts, and drug advertising brochures may relax those permissive attitudes still further. Rational prescription training was useful in generating rational attitudes. Policies concerning drug company–medical student relationships should be developed in Turkey as well as internationally.

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States

The pharmaceutical industry spends roughly 15 billion dollars annually on detailing – providing gifts, information, samples, trips, honoraria and other inducements – to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone.

Drug Target Identification and Validation: Global Pharmaceutical Industry Experts on Challenges, Best Strategies, Innovative Precompetitive Collaboration Concepts, and Future Areas of Industry Precompetitive Research and Development.

Focused interviews were conducted with global pharmaceutical company representatives in order to derive a consistent view on drug target identification/validation challenges, collaborative strategies, and future developments in a precompetitive space. Analysis revealed translation into clinical utility as a major hurdle of novel drug target validation, originating from lack of biological understanding, irreproducibility of published results, and lack of valid animal models. Direct and close collaborations with academia are the preferred model to tackle basic research on novel drug targets in high-risk projects. Efforts to conduct target identification in large precompetitive consortia are acknowledged with some doubts about the pace of progress and data-sharing policies, while concept to extend the precompetitive space to target validation in phase II trials was curtailed to niche indications together with a revision of current intellectual property (IP) practice. Public-private partnerships in established areas are forecasted to increase. Novel emerging themes are toxicology data sharing, joint genetic patient data analysis, and reimbursement concepts.

U.S. Food and Drug Administration: Review for the Emergency Physician of Approval Process and Limitations.

U.S. Food and Drug Administration: Review for the Emergency Physician of Approval Process and Limitations.

AD-HOC study of pharma companies` willingness to conduct PASS/PAES studies in Bulgaria

Introduction: According to the contemporary data very little part of the developed and clinically tested molecules reach the market. Before being authorized for human use, during the clinical trials, the medicinal product is tested in many different ways. Bulgaria is one of the most preferred countries for conducting clinical trials. According to the current regulation the post-authorization studies are divided into two types - PASS (safety studies) and PAES (studies of efficacy) - also known as phase 4 of the clinical trials, taking place in the real clinical practice with patients. Their aim is identification, quantifying and assessment of the importance of the risks, linked to the use of a medicinal product in the clinical practice. Methodology: A questionnaire composed with the aim to assess the willingness of the pharmaceutical companies in Bulgaria to conduct PASS/PAES has been carried out. Subjects of the study were pharmaceutical companies and representatives of marketing authorization holders (MAH) in Bulgaria - innovative companies, members of the Association of the research-based pharmaceutical manufacturers in Bulgaria (ARPharM) and generic companies, members of the Bulgarian generic pharmaceutical association (BgPharmA). Results: Currently in international perspective half of the questioned pharmaceutical companies and two of the generic ones conduct PASS with total number of studies varying between 1 and 20 studies per company. Only one of the innovative companies conducts PAES. Nowadays only one of the questioned innovative companies has current PASS and PAES in Bulgaria. Conclusion: The results of the conducted study show that from regulatory and logistic point of view in Bulgaria all the required conditions for conduction of PASS and PAES are present. Although this legal tool is not yet widely popularized in the activities of the regulatory authority and MAHs, the existing conditions have the potential to speed up the development of this sector of the pharmaceutical industry.

Évaluer le temps de travail hors les murs. Incertitudes et tensions chez les visiteurs médicaux de l’industrie pharmaceutique

This article focuses on a common situation, that of employees working away from their business premises, usually salespeople meeting clients. Combining ethnography, statistics and archival research, it questions the social effects of working hours that are not directly measurable — and therefore approximate — through the example of pharmaceutical sales representatives. These effects arise from two distinct types of uncertainty. First, measuring the working hours of sales representatives by counting tasks creates a mismatch between actual working time and statutory working time. This gap opens up the possibility of collective protests against this measurement and of power struggles between employers and trade unions to alter it in their best interests. In return, the method of estimating hours structures working time, which proves to be both highly unequal across the profession and on average higher than statutory working hours. Second, the work that pharmaceutical representatives do leaves few traces, generating both uncertainty about the tasks reported and leeway in this measurement process. The power of reps to control their working hours is subject to a range of forms of regulation by employers and by peers, which manifest themselves by trials and tensions in the working collective.

The relationship between the physician and pharmaceutical industry: background ethics and regulation proposals.

Pharmaceutical funding plays an important role in medical progress. Thus, clinical and academic research has been significantly commercialized (1). There are data to suggest that economic interest from industry may have a negative influence on the objectivity of science, research publication, and even patient management (2,3). For example, a manufacturing company has been engaged “… in misleading practices to promote the prescription and usage of rofecoxib, including ‘fake’ journals and guidelines to ‘drug reps’ that minimised the adverse cardiovascular risks” (4). Industry-sponsored reports are up to four times as likely to favor a pharmaceutical company’s product compared to independently published data (5).

An Empirical Model of Drug Detailing: Dynamic Competition and Policy Implications

The practice of detailing in the marketing of prescription drugs is undergoing significant changes. For instance, in September 2013, the Physician Payment Sunshine Act went into full effect. The accompanying transparency requirements have prompted physician practices and hospitals to severely restrict pharmaceutical sales representatives’ direct access to their physicians. Despite all the attention in the popular press, scant scholarly research has investigated how these restrictions on physician access impact physician prescription behavior and competitive detailing to physicians. To analyze the impact of these restrictions, we develop a structural model of how pharmaceutical firms compete dynamically to schedule detailing to physicians. Detailing activities are known to have significant carryover effects that are captured in a first-stage model of physicians’ demand for prescription drugs. We also specify detailing policy functions that describe each firm’s observed detailing actions. In a second stage, we estimate a model that describes costs of detailing, assuming that the observed detailing levels are consistent with a Markov perfect Nash equilibrium. The estimated structural model is used to examine the implications of restrictions on the amount of detailing via counterfactual simulations. We find that restriction policies would increase the market share of a nondrug-treatment-only option but impact firms asymmetrically; firms that are strong in detailing and/or rely more on detailing would be hurt more. Unexpectedly, a policy that imposes a ceiling on detailing frequency could significantly reduce detailing of all firms in the market, including those firms with average detailing levels below the ceiling, and effectively would soften competition between firms and enhance their profits. This paper was accepted by J. Miguel Villas-Boas, marketing.

Conflicts about Conflict of Interest.

Pharmaceutical representatives use detailing, gift giving, and the donation of free samples as a means to gain access to and influence over physicians. In biomedical ethics, there has been an ongoing debate as to whether these practices constitute an unethical conflict of interest (COI) on the part of the physician. Underlying this debate are the following antecedent questions: (1) what counts as a conflict of interest, (2) when are such conflicts unethical, and (3) how should the ethical physician respond to conflicts? This article distinguishes between two perspectives that have been developed on these issues: a reliable performance model (PM) and a trustworthiness model (TM). PM advocates argue that a conflict of interest can only be established by demonstrating that a particular influence is undermining the reliability of the physician's judgment, and this requires empirical evidence of negative patient outcomes. TM advocates, on the other hand, argue that because of the fiduciary nature of the patient-physician relationship, physicians have an obligation to develop and be worthy of patient trust. A COI, on this view, is a condition that undermines the warrant for patients to judge a physician as trustworthy. Although there is much that is right in the PM, it is argued that the TM does a better job of responsibly addressing the unique vulnerabilities of the patient. The TM is then applied to the practices of detailing, gift giving, and sample donation. It is concluded that these practices constitute an unethical conflict of interest.

Empathy, nonverbal immediacy, and salesperson performance: the mediating role of adaptive selling behavior

Purpose Previous studies that examined the role of empathy and nonverbal immediacy on business-to-business (B2B) salesperson performance is limited in scope and yielded inconclusive evidence. Grounded in Plank and Greene’s (1996) framework of salesperson effectiveness, this paper aims to empirically investigate the mediating role of adaptive selling behavior through which empathy and nonverbal immediacy influence sales force performance and the form of empathy (cognitive or affective) that has the most beneficial role in improving relationship (versus outcome) salesperson performance. Design/methodology/approach Using cross-sectional data that were collected from 422 pharmaceutical sales representatives, this study used structural equation modeling to test the hypothesized relationships. Findings Adaptive selling behavior mediates the effect of perspective taking empathy and empathic concern on relationship performance. However, the impact of empathy on outcome performance is not significant through adaptive selling behavior, but perspective taking empathy has a direct influence on outcome performance. Contrary to expectations, nonverbal immediacy is not mediated by adaptive selling behavior but has a direct and positive impact on relationship performance. Research limitations/implications The results of this study have several implications for recruitment, training and assessment of salespeople in a B2B context. Based on the empirical evidence, it is highlighted that firms may use different forms of empathy and nonverbal cues to promote adaptive selling behavior that impact sales force performance (i.e. outcome or relationship). Originality/value To the authors’ knowledge, this is the first study which simultaneously examines the mediating role of adaptive selling behavior in the relationship between three antecedent variables that relate to sales force empathy and nonverbal communication (i.e. perspective taking empathy, empathic concern and nonverbal immediacy) and two aspects of B2B sales performance (relationship and outcome).

Pharmaceutical Representatives' Opinion about Pharmacists' Drug Dispensing Practices in Romania and Factors that Influence them

The objective of the research is to identify pharmaceutical representatives’ opinions on some practices of drug dispensing amongst community pharmacists in Romania. Material and methods: 70 pharmaceutical representatives working with different pharmaceutical companies in Romania answered questions regarding practices of drug dispensing. Different variables were taken into account: age, gender, type of education, and length of employment time. Collected data were analyzed with SPSS 17.0. Results: over 70% of the pharmaceutical representatives consider that pharmacists counsel the patient regarding other drug brand names and take into consideration patient financial contribution when dispensing a certain drug. Regarding the relationship of the pharmacist with doctor and rep, 65% of pharmaceutical representatives consider the relationship with the doctor, and 40% the relationship with the rep, important when dispensing a drug. No important differences were identified in relation to the gender or type of education. Conclusion: the study provides information regarding pharmaceutical representatives’ opinions on practices of drug dispensing. More than 2/3 of the reps consider that pharmacists are counseling the patient regarding a drug to a high level.

The use of social media among business-to-business sales professionals in China

Purpose– The purpose of this study is to explore the role of social media usage among business-to-business sales professionals in China. Specifically, the authors seek to define and explore the unique ways in which Chinese salespeople use social media, with a special emphasis on the role ofguanxi.Guanxiis a complex cultural construct that revolves around the exchange of favors to build trust and connection for business purposes.Design/methodology/approach– Three in-depth interviews of sales managers from two industries along with survey data from 42 pharmaceutical sales representatives were collected to gain an understanding of the general usage and attitudes toward social media in the sales process in China.Findings– Results indicated that virtually all the salespeople in the sample were highly familiar with social media and integrated it into the sales process. Furthermore, all participants indicated that their companies were highly supportive of the use of social media with their customers. More importantly, salespeople in China view social media as a critical tool in buildingguanxiwith their customers. Findings from this exploratory study are used to create a conceptual framework for understanding the important role of social media in buildingguanxiin China.Research limitations/implications– While the sample is limited to three managerial interviews and 42 survey responses, the data indicated a near universal acceptance and use of social media among Chinese salespeople. Most importantly, social media appears to be the modern gateway to the ancient and culturally unique construct ofguanxithat is absolutely indispensable to successful business-to-business sales performance in China.Practical implications– The structural challenges within China make trust and emotional connection essential to any potential business relationship. Trust is at the core ofguanxi. Any firm hoping to succeed in China must understandguanxiand the use of Chinese social media to help build it. This study adds to the knowledge and understanding ofguanxiand begins to elucidate the uses of social media as a tool to build and maintain it.Social implications– Social media appears to be the modern gateway to the ancient and culturally unique construct ofguanxithat is absolutely indispensable to successful business-to-business sales performance in China. This study deepens our understanding of not onlyguanxibut also how the modern phenomenon of social media is affecting it.Originality/value– This is one of very few studies to investigate the use of social media among salesforces in China. More importantly, the authors know of no other study linking social media withguanxi.

Evidence-based medicine and life-long learning competency requirements in new residency teaching standards

The objective of this study is to compare accreditation standards across medical and surgical specialties in the USA to determine the requirements for evidence-based medicine (EBM) and information management (life-long...

Effects of Physician-directed Pharmaceutical Promotion on Prescription Behaviors: Longitudinal Evidence.

Spending on prescription drugs (Rx) represents one of the fastest growing components of US healthcare spending and has coincided with an expansion of pharmaceutical promotional spending. Most (83%) of Rx promotion is directed at physicians in the form of visits by pharmaceutical representatives (known as detailing) and drug samples provided to physicians' offices. Such promotion has come under increased public scrutiny, with critics contending that physician-directed promotion may play a role in raising healthcare costs and may unduly affect physicians' prescribing habits towards more expensive, and possibly less cost-effective, drugs. In this study, we bring longitudinal evidence to bear upon the question of how detailing impacts physicians' prescribing behaviors. Specifically, we examine prescriptions and promotion for a particular drug class based on a nationally representative sample of 150,000 physicians spanning 24months. The use of longitudinal physician-level data allows us to tackle some of the empirical concerns in the extant literature, virtually all of which have relied on aggregate national data. We estimate fixed-effects specifications that bypass stable unobserved physician-specific heterogeneity and address potential targeting bias. In addition, we also assess differential effects at both the extensive and intensive margins of prescribing behaviors and differential effects across physician-level and market-level characteristics, questions that have not been explored in prior work. The estimates suggest that detailing has a significant and positive effect on the number of new scripts written for the detailed drug, with an elasticity magnitude of 0.06. This effect is substantially smaller than those in the literature based on aggregate information, suggesting that most of the observed relationship between physician-directed promotion and drug sales is driven by selection bias. We find that detailing impacts selective brand-specific demand but does not have any substantial effects on class-level demand. The increase in brand-specific demand appears to crowd out demand for the substitute branded drug although not for the generic alternative. Results also indicate that most of the detailing response may operate at the extensive margin; detailing affects the probability of prescribing the drug more than it affects the number of prescriptions conditional on any prescribing. We draw some implications from these estimates with respect to effects on healthcare costs and public health. Copyright © 2016 John Wiley & Sons, Ltd.

Knowledge, beliefs and attitudes of physicians in low and middle-income countries regarding interacting with pharmaceutical companies: a systematic review.

BackgroundUnderstanding the perceptions and attitudes of physicians is important. This knowledge assists in the efforts to reduce the impact of their interactions with the pharmaceutical industry on clinical practice. It appears that most studies on such perceptions and attitudes have been conducted in high-income countries. The objective was to systematically review the knowledge, beliefs and attitudes of physicians in low and middle-income countries regarding interactions with pharmaceutical companies.MethodsEligible studies addressed any type of interaction between physicians and pharmaceutical companies. The outcomes of interest included knowledge, beliefs and attitudes of practicing physicians. The search strategy covered MEDLINE and EMBASE databases. Two reviewers completed in duplicate and independently study selection, data abstraction, and assessment of methodological features. The data synthesis consisted of a narrative summary of the findings stratified by knowledge, beliefs and attitudes.ResultsWe included ten reports from nine eligible studies, each of which had a number of methodological limitations. Four studies found that the top perceived benefits of this interaction were receiving information and rewards. In five out of eight studies assessing the perception regarding the impact of the interaction on the behavior of physician prescription, the majority of participants believed it to be minor. In one of these studies, participants perceived that impact to be lesser when asked about their own behavior. The attitudes of physicians towards information and rewards provided by pharmaceutical company representatives (PCRs) (assessed in 5 and 2 studies respectively) varied across studies. In the only study assessing their attitudes towards pharmaceutical-sponsored Continuing Medical Education, physicians considered local conferences to have higher impact. Their attitudes towards developing policies restricting physicians’ interactions with PCRs were positive in two studies. In one study, the majority of participants did not mind the public knowing that physicians were receiving gifts and awards from drug companies.ConclusionsThis review identified few studies conducted in low and middle-income countries. While physicians generally perceived the impact of interactions on their behavior to be minor, their attitudes toward receiving information and rewards varied across studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1299-4) contains supplementary material, which is available to authorized users.

Effect of Promotional Literature on the Prescribing Habits of Practitioners

Pharmaceutical companies are the manufacturing units of drugs, with established conformity for dispersal into the public. To increase their sales and hence, their shareholder value, these corporations need to make their product have earmarks of a better formulation than those already available and stand out from their adversaries. This is achieved with the help of rigorous promotion of the drug to the prescribers. Medical Representatives (MRs) or Pharmaceutical Sales Representatives (PSRs) advertise to the doctors with the help of eye catching visual presentation, citing various benefits and advantages. These presentations are accompanied by leave-behind brochures, pamphlets, drug guides, drug samples etc. for the doctor to read, and are consistently full of points featuring the promoted drug as an advancement with better effectiveness, supported with various research works, colorful pictures, graphs and diagrams that make a physician take notice of the advertised drug. This raises the question of the ability of a GP to critically appraise the information presented to him/her and segregate the fact from fraud. Too often aid is tied to the trade, and any practicing physician should be aware of the tricks being played on him/her and be able to wring the quality of the information presented from the vast quantity of information and assess it for its accuracy.

Urologists’ experiences with treatment of castration-resistant prostate cancer.

315 Background: Urologists are at the forefront of treating prostate cancer. Since 2010 four non-chemotherapy drugs have been approved for castration-resistant prostate cancer (CRPC). We aimed to ascertain Society of Urologic Oncology (SUO) members’ practices, training, and barriers as they relate to the treatment of CRPC. Methods: An IRB approved nine item REDCap survey was emailed to 697 SUO members (440 US urologists) without a financial incentive. Urologists were asked whether they should and/or have treated men with CRPC, what barriers they experience and how these barriers may be overcome. Results: Eighty-four surveys were completed. 86% definitely or somewhat agreed that it was within the purview of urologists to prescribe therapy for CRPC. Abiraterone, enzalutamide, sipuleucel-T, or Radium-223 were prescribed by 51% and out of those, 44% personally prescribed them to > 50% of their CRPC patients; 52% were aware of other urologists who prescribed these drugs. Education on the use of these drugs was most commonly via self-study (19%), national meetings (19%), pharmaceutical representatives (17%), and informal discussions with colleagues (16%). Although some did not see barriers (27%), side-effects management (23%), the time it takes to counsel patients on these therapies (14%), and their practice’s time and energy costs (14%) were the greatest obstacles to using these medications. 34% felt that more educational sessions at national meetings or greater support by professional organizations would help them increase drug administration. 53% see the recent changes in the management of CRPC as increasing the collaboration between urologists and medical oncologists and 30% believe there are increasing opportunities for urologists to strengthen their relationship with their CRPC patients. Conclusions: The majority of SUO respondents agreed that it is within the scope and practice of urologists to prescribe therapy for CRPC. Half have prescribed these therapies themselves and/or were aware of other urologists who had done the same. Some would be encouraged to increase their use of therapies for CRPC via greater support by professional organizations and education at national meetings.

Public Relations as Part of Integrated Communication of an Enterprise-Consumer Oriented On

Pharmaceutical Representatives and Prescription Decisions by Physicians in Saudi Arabia Ishak Abubakar Y. Ibrahim, Charles H. Bélanger Abstract Purpose: This research aims to identify key factors that influence physicians’ drug selection decisions as well as the main sources of information for physicians about new drugs and the most effective “reminder methods” used by pharmaceutical sales representatives. This study fills a gap within the existing literature by identifying the most important factors that affect physicians’ drug selection decisions in Saudi Arabia Design/methodology/approach: A survey was conducted in the Western region of Saudi Arabia using a convenience sample. A total of 106 physicians who met with pharmaceutical sales representatives filled out a questionnaire identifying the factors that influenced their prescribing decisions, as well as determining their main sources of information about new drugs, and the most effective “reminder methods” used by pharmaceutical representatives. Data were analyzed using SPSS. Findings: The results indicate that pharmaceutical sales representatives are the most commonly mentioned main source of new drugs information. Moreover, the factors identified as most impacting physicians’ drug selection decisions include in order, the patient’s financial situation and prevailing hospital policies, followed by media advertising and frequent visits from pharmaceutical sales representatives. Finally, leaflets were identified as the most effective ‘reminder method’ used by pharmaceutical sales representatives. Originality/value: The study findings are relevant because they can help pharmaceutical sales representatives to focus their efforts on the most effective marketing methods to boost their sales revenue, increase their market share, reduce marketing expenses, and potentially pass on the savings to patients. Full Text: PDF DOI: 10.15640/jmm.v3n2a7

Management of pharmaceutical sales representatives: A literature review

This paper reports literature review in the field of pharmaceutical marketing emphasizing problems faced by medical representatives. India after globalization and being the second highest populated country has emerged as major pharmaceutical market in the world. Pharmaceutical marketing in India is highly relied on personal relationship between medical representatives and doctors. In the last decade, many foreign companies have entered in Indian market. This has posed highly competitive and challenging work environment for medical representatives. Therefore, it is indispensable to study the challenges faced by medical representatives in this dynamic environment. Keywords: Job satisfaction, Medical representatives, Pharmaceutical marketing, Pharmaceutical sales representatives, Sales management, Turnover intention CLC number: R952 Document code: A Article ID: 1003-1057(2016)1-73-06

Understanding the degree of awareness among medical professionals regarding the ethics of pharmaceutical marketing activities in context of revised medical council of India code of ethics

Background: Pharmaceutical marketing activities are regarded as ethically challenging by most medical professionals. This study was planned to understand the extent of the interaction of pharmaceutical companies with healthcare providers & to determine the level of awareness about the ‘Medical Council of India (MCI) Code of Ethics’. Methods: A questionnaire based survey was conducted among 100 consultants and residents. The questionnaire mainly dealt with ethical issues about accepting free gifts, medicines and other sponsorships from pharmaceutical representatives, interactions and expectations from representatives of pharmaceutical companies by doctors and ascertaining among them the level of awareness about the MCI’s code of ethics. Results: 59.4% residents and 58.8% consultants do not consider small gifts (stationery/books/drug samples) as ethically problematic. 88% residents and 85% consultants felt that offers should be limited. 72% of consultants were aware of the revised MCI code of ethics as compared to 28% of residents. Conclusions: Most physicians do maintain a code of ethics with regards to accepting gifts and they felt that inexpensive gifts do not influence clinical judgment. Consultants were of the view that amended MCI code of ethics would not affect their clinical practice significantly.