WO

OtqcAspgnttpsr“tsatsittrbweasd

GWAA

1

from the associationETHICS IN ACTION

Accepting Gifts: Let ADA’s Professional Code ofEthics Be Your Guide

Dianne Killebrew, MEd, RD, LDN

JfslcvRGtpsstIfappfstaigncpidtp

dbcttmhjtscaschq

STYApay

omsiypsmtd

SRMYwqwtfta

bitmtsfipi

STYaa

HY IS THERE INCREASED ATTENTIONN THE ETHICS OF ACCEPTING GIFTS?

n the surface it might seemharmless to accept a gift fromindustry. However, it’s impor-

ant to consider the long-term conse-uences of short-term thinking. Prin-iple 18 from the American Dieteticssociation’s (ADA’s) Code of Ethicspeaks to the responsibilities of therofession with regard to acceptingifts: “The dietetics practitioner doesot invite, accept, or offer gifts, mone-ary incentives, or other considerationshat affect or reasonably give an ap-earance of affecting his/her profes-ional judgment” (1). In 2002, Coyleeported on studies surroundingindustry influence on physician objec-ivity and behavior, particularly pre-cribing practices, formulary choices,nd assessment of medical informa-ion,” in which research showed “atrong correlation between receivingndustry benefits (gifts) and favoringheir products” (2). For registered die-itians (RDs) and dietetic technicians,egistered (DTRs), there is a need toe mindful of potential biases andhether a gift-giving relationship isthically appropriate. Professionallynd ethically, clinical judgment deci-ions must be based on scientific, evi-ence-based guidelines.

IFTS DON’T ALWAYS ARRIVE WRAPPEDITH A PRETTY BOWccording to the American Medicalssociation’s Council on Ethical and

D. Killebrew is an educationalcoordinator and packaging inno-vation specialist for the DieteticInternship Program at VanderbiltUniversity, Nashville, TN.0002-8223/$36.00

cdoi: 10.1016/j.jada.2010.06.017

242 Journal of the AMERICAN DIETETIC ASSOCIATI

udicial Affairs, “even when giftsrom industry have no effect on phy-icians’ practices, there may be a pub-ic impression of impropriety, espe-ially if the gifts are substantial inalue” (3). Analogous to physicians,Ds and DTRs face similar challenges.ifts from industry range in value from

rivial (eg, pens, notepads, calculators,enlights, or tape measures) to sub-tantial (eg, textbooks, equipment,taff celebrations, gift certificates,rips). In 1998, the Journal of Generalnternal Medicine reported findingsrom Gibbons and colleagues, who ex-mined and contrasted attitudes ofhysicians and patients toward 10harmaceutical industry gifts, rangingrom a pen to a trip. Study findingsuggested “patients are more likelyhan their physicians to believe thatcceptance of pharmaceutical gifts maynfluence prescribing behavior” (4). Ineneral, dietetics practitioners shouldot accept gifts from industry if the cir-umstances would compromise or ap-ear to diminish their objectivity andntegrity, and/or undermine their fun-amental ethical commitment to puthe interest of the client, customer, oratient first (5).The ADA Code of Ethics follows

ietetic practitioners into manyusiness settings: private practice,orporate boardrooms, online, na-ional/affiliate/district/dietetic prac-ice groups/member interest groups,edical centers, universities, publicealth, and private corporations,

ust to name a few. The nonaccep-ance of industry gifts has becometandardized language in businessontracts, employee evaluations,nd policy manuals. The followingcenarios are meant to stimulateonversations, raise awareness, andelp you be prepared to answer theuestion: Is accepting this gift ethi-

ally appropriate? c

ON © 2010

cenario #1: What Would My Clienthink?ou work in a corporate fitness center.representative for a nutrition sup-

lement company leaves a coffee mugnd mouse pad on your desk. Shouldou accept these small gifts?Gifts carry an implied expectation

f reciprocity. While accepting theseay not consciously affect your deci-

ion-making, the presence of thetems in your office is likely to makeou think positively of the donor orroduct. The risk is there for subcon-cious or conscious bias in decisionaking. From your client’s perspec-

ive, it may be seen as a product en-orsement.

cenario #2: How Would I Feel if this Giftelationship Was Disclosed through theedia?ou work at the health department,here legislation is being proposed re-uiring restaurants to label foodsith nutritional information. A res-

aurant owner offers to provide lunchor your committee meetings wherehis topic will be discussed. Do youccept the gift of free meals?While this gift relationship would

e budget friendly, it could place youn a binding personal relationshiphat may generate vague, open-endedoral obligations. The importance of

he gift lies in the personal relation-hip it generates, sustains, and signi-es. Accepting gifts can give the ap-earance of impropriety—especiallyn the court of public opinion.

cenario #3: What Would My Employerhink?ou attend a professional conferencend receive product samples, pens,nd notepads. Is this considered ac-

epting gifts?

by the American Dietetic Association

ecpnuistBctswatfap

WPTTptaeip

PFGovcabait

TOTrisTatytAt

Ct

R1

2

3

4

5

ETHICS IN ACTION

The Code of Ethics provides a gen-ral guide in Principle 18 c: “The prin-iple shall not preclude a dieteticsractitioner from accepting gifts ofominal value, free samples of prod-cts, or similar items, as long as such

tems . . . do not result in conduct orervices that are contrary to the prac-itioner’s professional judgment” (1).efore taking these items to work,

onsult your employer’s conflict of in-erest policy. Many companies havepecific guidelines banning itemsith brands or logos in client carereas. If you or your employer acceptshese products, it would be prudent toully disclose to your client that it was

gift and you are not endorsing theroduct.

HAT SHOULD DIETETICSRACTITIONERS DO NOW?une inhings are changing in the market-lace. Use ADA/Commission on Die-etic Registration’s Code of Ethicsnd your employer’s conflict of inter-st polices as organizational anchorsn your business relationships andatient/client/customer interactions.

ay Attentionood and nutrition are big business.ifts in the form of activities oftenffer important opportunities to ad-ance knowledge and improve patientare or services, but they also createn opportunity for the introduction ofias. From the public’s perspective,voiding the appearance of conflict ofnterest or commitment is as impor-ant as avoiding the actual conflict.

alk about Itur workplace culture has changed.here is heightened awareness sur-ounding the acceptance of gifts fromndustry. Something you never con-idered a “gift” is now labeled a gift.alk about it with your colleaguesnd be prepared to handle situationshat will test your code of ethics. Asou develop alliances and collabora-ions in the marketplace, make theDA Code of Ethics regarding accep-

ance of gifts part of your discussions.If you have questions regarding theode of Ethics or acceptance of indus-

ry gifts, contact ethics@eatright.org.

eferences. American Dietetic Association/Commission

on Dietetic Registration. Code of ethics for theprofession of dietetics and process for consid-eration of ethics issues. J Am Diet Assoc.2009;109:1461-1467.

. Coyle SL. Physician-industry relations. Part1: Individual physicians. Ann Intern Med.2002;36:396-402.

. Council on Ethical and Judicial Affairs. Opin-ion Report: Gifts to physicians from industry;G–I-90. American Medical Association. Ameri-can Medical Association Web site. http://www.ama-assn.org/ama1/pub/upload/mm/369/ceja_gi90.pdf. Accessed February 23, 2010.

. Gibbons RV, Landry FJ, Blouch DL, JonesDL, Williams FK, Lucey CR, Kroenke K. Acomparison of physicians’ and patients’ atti-tudes toward pharmaceutical industry gifts.J Gen Intern Med. 1998;13:151-154.

. Woteki C. Ethics opinion: Conflicts of inter-est in presentations and publications anddietetics research. J Am Diet Assoc. 2006;106:27-31.

August 2010 ● Journal of the AMERICAN DIETETIC ASSOCIATION 1243