Sunita Sah and George Loewenstein of Carnegie Mellon in Pittsburgh authored a paper in this week's JAMA that nicely fills in a gap in our knowledge. (Subscription required to access paper; several popular press accounts are circulating)
They surveyed around 300 pediatrics and family medicine residents, using survey forms that differed in the degree to which they 1) suggested personal sacrifice as a possible rationale/rationalization for accepting gifts (aka bribes) from the pharmaceutical industry, and 2) reminded the residents of their high debts, low pay, and sleepless nights. As we might have expected, by substantial margins, residents who were either reminded more forcefully of poor working conditions, or who had the rationalization suggested to them, were more likely to view accepting gifts as appropriate.
One perhaps unexpected finding was the relatively low rate of acceptance of the rationalization when it was baldly presented to the residents. A majority of the residents rejected the argument that just because they had made various personal sacrifices, therefore accepting gifts was justified. The authors suggested that the rationalization works better at the subconscious level. But at any rate it does seem as if more recent surveys are showing us a decreased level of acceptance of the old habits of profligate bribe-taking among recent trainees.
Readers of HOOKED know that I have always been persuaded that rationalization plays a huge role in this area and is a prime subverter of ethical reflection. We have known for a long time that drug reps are carefully trained to provide their physician targets/dupes, not only with various gifts, but with a steady stream of rationalizations designed to make accepting the gifts seem the right thing to do. And we docs have (at least till recently) generally proven very accepting of both of the diets being fed to us.
Sah S, Loewenstein G. Effect of reminders of personal sacrifice and suggested rationalizations on residents' self-reported willingness to accept gifts. JAMA 304:1204-11, Sept. 15, 2010.