Party Pooper?

The Annual Education Conference (AEC) of the National Society of Genetic Counselors offers a balanced mix of the academic, the clinical, the professional, and, perhaps most importantly, the social. Some of my most cherished professional relationships were formed at the AEC after I struck up a conversation with a genetic counselor who I had not previously known but who wound up sitting next to me in the audience, joined me on a panel presentation, came up and asked me a question after a talk I gave, or perhaps most commonly, unwinding at a bar after a marathon of lectures and workshops. Professional demeanors discarded, guard down, shoes off at day’s end, sipping an interesting beer or a fine single malt Scotch, you can easily become BGCCF (Best Genetic Counseling Comrades Forever). Sometimes I can’t remember a blessed thing I heard all day at the AEC but that post-plenary bar conversation often opened my mind to new and exciting ideas and warm companionship.

Capitalizing on the social networking aspect of the AEC, some corporate sponsors have taken to hosting evening parties and dinners. Maybe it is just my imagination, but the number of these soirees seem to have increased over the last few years. Free food, a generous open bar, genetic counselors eager to socialize and compare notes – what a great way to live it up on our meager travel budgets, freed from the worry of trying to justify several glasses of wine when you submit your receipts for reimbursement. So who can complain?

Well, me, for one.

Okay, so I admit to being an ethical stick in the mud who can suck all the fun out of the dance hall. But now that we have acknowledged yet another of my social failings, let me pose this question for discussion – Is it appropriate for genetic counselors to accept free fare provided by corporate sponsors at the AEC, particularly at non-educational activities?

Stick In The Mud Bobby

Stick In The Mud Bobby

To be clear – I am not taking the corporate sponsors to task. They are businesses, and doing business is what businesses do. With so many labs competing for our samples, they should and will do whatever ethical actions it takes to keep their genetic counselor customers happy. If we told them they would be more likely to get and keep our accounts if they donated that money to Action Against Hunger instead of catering to slightly hungry genetic counselors who want to party a little, I am sure they would do that (not to split hairs too finely, but, all else being equal, selecting a lab in part because it participates in what you consider to be ethical practices such as donating to charitable organizations based on the company’s ethos is different than using a lab because it donates money to feeding clinicians at a conference). The ethical burden is on us, not the sponsors, who are responding to a demand that we have – silently? – created and fostered.

I can already hear the complaints of “Oh Jeez, Bob, can’t you just let us have a good time? I mean it’s just a few drinks and some good food. I give that lab a lot of business. Why can’t I get an occasional treat out of it? So I am nibbling on shrimp atop a round of fried polenta topped with basil pesto while sipping a glass of Nebbiolo. Enough with your puritanical ethics already. Really, what harm is gonna’ result?”

Puritan Bobby

Puritan Bobby (not my real wife)

Perhaps none. But is a practice ethical until harm results? What would patients think if they knew that the very labs that were analyzing their specimens were also providing us with food and spirits? Maybe many of our patients would not care, and might even be slightly envious. But other patients might be surprised if they learned that the lab where you sent their specimens to be analyzed was also wining and dining you. Or what if one day a lab became embroiled in some financial funny business or God forbid a scandal from sub-standard laboratory practices and word leaked out that the lab was in the practice of courting counselors with culinary baksheesh? We would feel awfully awkward and might appear to be guilty by association.

One could legitimately ask whether an occasional gift of food and wine really affects our decisions about which labs we use. Probably many practitioners would deny it or suggest that it does not affect their decisions but may sometimes affect their colleagues’ choices (“I’m very ethical and would never let a glass of wine stand between me and my patients’ best interests. But maybe that is not so true for a few other genetic counselors.”). On the other hand, it is hard to believe that labs would spend valuable cash on activities that resulted in a loss of business. This stuff must be successful on some level or else they wouldn’t do it. TANSTAAFL. We may not be consciously aware of how these influences work. Vide Blind Spots. Which leads me to pose more uncomfortable questions – Should we include attending a corporate-sponsored after-hours bash in our conflict of interest statements when we publish articles or make professional presentations? Many hospitals and other employers of genetic counselors ban vendor sponsored lunches in our offices, so how is this any different? If the free food and drink is not directly connected to an educational activity, would this be a violation of the Stark Law on the part of the vendor, since  just about all labs receive Medicare and Medicaid reimbursement?

By the way, yes, you can call me Mr. Guilty. I have attended my share of these events, but, after a long discussion with my conscience (who I also met at the bar), over the last few years I have decided to avoid them.

But enough of my thoughts. This is about all of us, not just me. What do the Good Readers of The DNA Exchange think about this? Are there better ways to foster collegial and professional relationships with labs that are transparent and ethical, and that allow labs to maintain and grow their volumes? Complete the admittedly unscientific poll below and also share your thoughts in the Comments.

Voodoo Bobby Doll

Voodoo Bobby Doll

And please, be gentle with your Bob Resta voodoo dolls.

 

Thanks to Emily Singh for realizing the graphics and to Maureen Flynn for a thoughtful discussion that sparked and helped shape this posting.

10 Comments

Filed under Robert Resta

10 responses to “Party Pooper?

  1. Jon Weil

    Thanks for another thought-provoking post, Bob. I am answering your pole with a fourth choice.

    X Should be discontinued because of the conflict of interest, however large or small, apparent or disguised it may be.

    Jon Weil

  2. Kami Schneider

    I do not have an answer, but I wonder where we draw the line. If it is a conflict to accept food and wine, is it also a conflict to collect candy, pens, pedigree templates, foam toys for our children, other gadgets and prizes, etc. from all the vendors in the exhibitor suite?

    • William Pirjamali

      A very good point you make, Kami. Some of the paper’s cited in this blog suggest that gifts as small as pens might have an influence on the recipient’s perception of the business. So where do we draw the line? I personally feel that if we have objective criteria for selecting lab for genetic testing then attending these events should not be a problem. Unless of course you feel that eating free food will compel you to order from that particular lab.

  3. Philip Reilly

    Hello Robert,

    I am a clinical geneticist who is a regular reader of your column. I wonder if you would be interested in reading and reviewing on your blog my new book, Orphan: The Quest to save Children with Rare Genetic Disorders.” As I was writing it, I often thought that genetic counselors were its perfect audience. You can check it out on Amazon. If you are interested I will have a copy sent to you. For that I will need your land address. Thanks for your consideration.

    Phil Reilly

  4. Jennifer Siettmann

    I too have wondered about accepting things from vendors, be it food, drinks, or marketing items. What I found comforting is that this is not a problem unique to genetic counselors, and so most hospitals will have a policy for conflict of interest and will specify what and how much in monetary goods you’re allowed to accept from vendors. Some hospitals dictate that you cannot accept any, whereas others (like mine) have a quarterly dollar limit per vendor, and that dollar limit is not very high either. Now, I still feel like each of us in turn should decide for ourselves what we feel comfortable accepting because we (theoretically) should be able to assess what can influence our biases, but I found looking at my hospital’s policy comforting to know that there a policy that I can hold myself to and that I won’t be called out on conflicts of interest within my hospital system so long as I remain within their guidelines.

  5. Sara Riordan

    Bob,
    Next year you should attend our Wine SIG meeting. No corporate sponsorships, no COI, just GC’s getting together at the AEC to enjoy some good wine and discourse. Open to all – we even have a Twitter handle.🙂 https://twitter.com/Wine_SIG
    Hope you’ll join us next year!
    Sara Riordan

  6. We as genetic counselors should consider a position statement or an update to our code of ethics that addresses this issue. The AMA addresses this issue in their code of ethics in more specific detail. We also would benefit from a more detailed discussion of the legal and ethical issues surrounding the relationship to industry and I think our profession would benefit if this was a topic at the next AEC; it should also be discussed in training programs.

  7. Robert Resta

    Thanks to everyone for your thoughtful comments. Perhaps I am tempesting in a teapot, but I think it is too easy to dismiss the possible – and most importantly, subconscious – influences of food, wine, and small giveaways. But at the end of the day, do we really need a couple of glasses of pinot noir, mini-crabcakes, cool little bendy toys with corporate logos, or wind-up sperm toys (no, I am not making that up)? Why accept them? Why not just keep as clean a separation line as possible? As Jon points out, conflicts of interest, be they large or small, are still conflicts of interest. Little baksheesh, big baksheesh – it’s all baksheesh.

    I very much agree with Wendy that an update to the NSGC Code of Ethics and further collegial and frank discussions are much needed. If the poll included with this blog post has even a remote measure of reliability and validity, two thirds of genetic counselors think it is acceptable to accept free wine and food.

    OWW – I think a couple of genetic counselors just stuck a pin very hard into their Bob Resta VooDoo Dolls.

  8. Heather Douglas

    I pick up pens from vendors at the AEC but immediately cover up the logos. I encourage you to do the same – it works. I am still using the pens but I can’t remember which companies I got them from. I generally pass on the other marketing freebies.
    Thanks for this thoughtful post🙂

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