【社会人文】药厂与研究者和行医者的暧昧关系

发布日期：2025-01-03 18:56    点击次数：89

药厂与研究者和行医者的暧昧关系 《新英格兰医学杂志》等刊物最近披露的研究表明，制药企业与医生的暧昧关系从未断过，那么，从去年底NIH资深科学家因私下收受药企酬金落马以来，临床研究和实践中的利益冲突和行为规范问题已越来越突出，如何打破美国医药工业界与临床的这种暧昧，保证临床研究的客观性，维护广大公众利益，各方人士正考虑通过政策手段加以规范。 研究人员：心照不宣有默契美国加州大学旧金山分校公共卫生学院的部分教授曾经对学校打算放宽防范利益冲突条款发出严厉警告。他们在校方的公开信中强调：金钱的纽带必然要影响研究项目本身的质量，哪怕是很小的资金数目。来自商业盈利性公司的赞助多少会影响研究项目和成果的可信度。涉及人体试验的项目与基础生物学研究不同，应该以更严谨的方式来规范管理，确保受试对象得到保护，临床研究成果经得起实践考验。 资深科学家落马 去年底，一位NIH（美国国立卫生研究院）的政府资深科学家因为私下接受辉瑞数10万美元的酬金而被检方指控，该科学家是国立卫生研究院下属的精神健康研究分院老年精神病学研究所的某实验室主任，55岁的Pearson Sunderland博士。他在法庭承认了检方对其的部分指控。随后被法官判处两年以内的监禁缓刑以及没收或退还30万美元的非法收入，必须完成400小时的社区服务。 早在1997年底，辉瑞的医药代表就找到Sunderland，探讨与其实验室进行一项课题合作，研究目标是寻找血液或脑脊液中可提示阿尔茨海默病发生发展的生物标记和生理特征。检方称Sunderland参与了这一协作，但没有告知其上司在这项合作中他和辉瑞还有另外的私下交易，即可从辉瑞获得个人报酬。法院文件还证实，在Sunderland担任辉瑞顾问的5年间，他从辉瑞得到了12.5万美元的顾问费、3.5万美元的出席辉瑞会议费和14次参会的额外差旅补贴。Sunderland明知故犯，有意隐瞒了他的顾问身份以及从辉瑞得到的酬金，为此，他付出了沉重的代价。 不止是个案 Sunderland 博士是成百上千名NIH高级科学家中，首位因为隐瞒收入和未经批准擅自与工业界进行交易而被刑事起诉并受到严厉制裁的第一人。这在NIH于1887年成立以来的110年历史上是极为罕见的。作为世界上最重要的高水平医学研究中心，NIH雇有超过1.8万名政府雇员身份的科学家。每年财政拨款数百亿美元，NIH2007财政年度的预算将为286亿美元。尽管研究经费颇为丰厚，但在NIH为政府打工的科学家的待遇远低于在工业界工作的同行们。因为待遇不佳并且限制多多，政府在吸引和挽留优秀科学家方面一直都有麻烦。按照美国联邦政府的规定和相关法律，受雇于NIH和其他国家实验室的科学家们可以收取适当的咨询服务费，但必须事先告知主管部门并获得批准才算合法。但近年来，监管部门发现，许多制药公司与政府雇用的科学家们存在私下非法的协议和现金交易， Sunderland博士被起诉就是其中一例重案。本案发生于1998年，直到2004年因为举报而浮出水面。而Sunderland博士的胆大妄为，也绝非孤立事件。据NIH官员透露，在NIH，据信大约有40多位科学家与工业界各类公司间存在不同程度的顾问和付费关系，他们中除了Sunderland博士外，还没有人被指控犯罪。不过NIH的行为规范准则在此案受调查后，已被从严修订，惩罚和监控力度有所加强。有些违规的科学家已受到内部惩罚或提前从NIH退休。2005年8月，NIH又制定了更严厉的防范利益冲突的规定，禁止员工为药厂工作或拥有合作厂家的股票。 漏洞还是疏忽尽管地区检察官Rosenstein先生拒绝透露他是否以相似的罪名起诉其他科学家，但国会负责调查此事的特别委员会主席，来自密歇根州的民主党资深参议员，国会住房、能源和商务委员会主席John D.Dingell并未对此善罢甘休，他严厉质问NIH有关部门，“像这样被定罪的贪婪科学家还能被政府留用吗？”他认为NIH的内部管理显然有漏洞，需要改进和整顿。 据检方提交到法院的文件显示，NIH有明文规定，像Sunderland这样的资深科学家，不仅要在事先披露并得到批准任何涉外商业服务及合作，每年还要报告他所参与外协活动的所有收入以及在外报销的超过260美元的差旅费。Sunderland不仅违反了上述两项规定，还在这两个项目上都犯有大错。 雇用Sunderland博士的厂商辉瑞在整个事件中似乎没有受到任何影响。辉瑞公司发言人对外声称：“辉瑞没有任何不端行为，公司对Sunderland的学术地位和贡献极为尊重和赞赏，对其被定罪表示遗憾。”也许辉瑞对Sunderland的个人违规毫不知情，也许辉瑞只关心与NIH合作的项目能否顺利进行，并得到其满意结果。但舆论界的质疑是：辉瑞不可能不知道NIH的规矩，即使是Sunderland主动提出要求得到顾问费，顾问协议的签署就不受任何约束？但愿这只是辉瑞律师一时的诚实疏忽！ 靠什么自律 防范利益冲突的政策和条款在国外的政府研究部门和学术机构是相当普遍而严谨的，大学、研究所、政府研究机构和医学研究中心，一旦放松了这方面的监管，就会对科学界的信誉及公众利益造成伤害。确保研究对象的利益受到保护，确保研究者的独立性和创造性，保持公众对研究机构的信任，保护科技界的公开、公平、公正和诚信是制定和实施防范利益冲突条款的主要目的。近几年，国际知名的医学杂志所发表的临床研究论文有80%由药厂赞助，尽管这些论文的发表，作者必须按照杂志和学会规定，披露赞助厂商的名字，说明是否领取企业顾问费、是否拥有相关行业及药厂的股票等财务及个人利益的信息，但这主要靠作者自觉自律，实际情况如何，杂志社和学会很难搞清楚，业内人士对此现状深表担忧。药厂赞助的临床研究，绝大部分是公正、透明、客观和严谨的，但发表论文的题材、时间、重点、方案设计、证明内容、否定内容，在不同程度上是可以人为操纵的。只有很资深的业内专业人士才能看出名堂，普通医生和大众很容易被诱导，甚至误导。 临床医生：大谈免费午餐美国研发型制药企业协会（PRMA）2002年的行业内自律条款曾经规定了医药代表给与医生的礼品规格要限制在100美元以下，同时禁止向医生赠送球票等娱乐运动礼卷。很遗憾，这样的规矩并没有被业内自觉遵守，公众的利益在一定程度上多少会受到侵害。医药行业需要反思，为什么行业自律规则形同虚设，怎样才能规范药品销售推广过程，改善药厂在公众心目中的形象和地位。 80%不拒绝药厂对临床研究人员的诱惑及紧密合作只要不牺牲百姓健康利益、研究客观性和严谨性，这是无可非议的，就怕政府和法规监管不严，利益驱动下总有可能偏离道德底线。基于同样原因，药厂销售代表时常登门拜访握有处方大权的医生，进行产品宣传推广，也经常有披金戴银的嫌疑。 尽管美国一些机构和临床中心及诊所在不断限制医生收受药厂礼品和其他小恩小惠，但最新发表在《新英格兰医学杂志》的调查报告显示，80%以上的美国医生接受药厂和器械商销售代表买给他们的食品和饮料。2002年美国医药界提出了非强制性的行业准则，不鼓励药厂对医生进行变相的“感情投资”。此次调查的结果显示：在过去几年中，赠送食品、饮料及球票的行业游戏规则几乎没有发生任何变化。此份报告的研究人员在2003~2004年内分别向3167名医生发出问卷，其中的1662名回应了问卷。接受调查的医生均有至少10年以上至30年的行医经历，他们半数在私人医生诊所，其他来自医院或医学院。调查结果显示： 83%的医生接受食物和饮料；78%的医生接受免费药物样品； 35%的医生接受专业会议报销； 28%的医生收取顾问咨询费和讲课费； 7%的医生接受免费球票和其他节目赠票。 这种医生和医药代表的交往活动和药厂的惠赠举措虽然普遍，但药厂也很有的放矢。心血管专科的医生最受宠，他们得到关照和收取费用的几率一般是家庭医生的2倍，这可能是由于心脏病专家的观点能影响非专科医生的处方；私人诊所医生拿到的免费药品和其他礼品分别是医院医生的6倍和3倍；家庭医生与销售代表每月会晤的次数平均达到16次，每隔1天就有人不请自到，登门拜访。家庭医生受医药代表特别关注的原因，可能与美国百姓诊疗大都（80%）发生在医生私人诊所，而医院和医学院等机构对医生的行为规范和约束强度大于小型私人诊所有关。这项调查研究的报告由麻省总医院、耶鲁大学和澳大利亚Melbourne大学的研究人员完成，该调查报告发表在最新一期的《新英格兰医学杂志》上，调查在纽约医药研究所的支持下完成。 礼轻含义重 前医药代表、制药业内幕人士Shahram Ahari和内科医生Adriane Fugh-Berman在最近由公共科学图书馆出版的《PLoS Medicine》杂志上发表的文章为我们揭示了这样一幅画面。他们估计，大约有10万名经常访问医生的医药代表在不停地活动。他们寻找所联系医生的家庭照片，或打探有望进一步牢固双方关系的医生们的业余爱好。他们利用免费大餐、礼品和现金让经常加班工作的医生感谢有加，使他们更加忠实于这些制药公司的产品。如果医生不愿会见医药代表，他们会极尽谄媚阿谀之态和以免费餐来打动诊室员工。两位作者在《PLoS Medicine》杂志上写道，来自制药业的礼物虽然看上去慷慨，但其中却隐藏着深思熟虑的目的，“许多医生接受钢笔、便笺和咖啡杯，由于这些礼品在办公室里触手可及，这似乎就会时刻提醒医生们想起某个药品来。开药多的医生还会收到高档一点的礼品，比如丝质领带或高尔夫球袋”。制药公司还在通过美国医疗协会的数据库，购买来自药店的处方档案资料，以识别个别医生的开药习惯，并依据开药数量的多少，对医生进行排序。这些做法都在发挥作用。最近《PLoS Medicine》杂志发表的另外一项研究就发现，医药代表的拜访已经促使97名医生中的一半增加了加巴喷丁（gabapentin）的处方量，加巴喷丁被批准用来治疗癫痫症。但研究发现，在许多情况下，医药代表都在大力促销这支药物的标签外用途。 看来，在全球医药和器械销售过程中对医生的“细微关怀”，是药厂和医疗器械商偏好的手段和潜规则。尽管医学伦理专家反复警告，医生收取药厂的礼品，多半会影响医生的处方习惯和临床判断。但药厂坚持，这是医药代表与医生交流沟通的必要途径和方式，谈不上是“行贿”。 今年2月份发表在《普通内科医学杂志》上的一项研究发现，一些受到关注的医生们表示，虽然他们理解这其中可能存在着利益冲突，但他们仍然把与医药代表的见面视为获取信息的一种合适途径。由此看来，2002年出台的那项自律性规则作用有限。麻萨诸塞州综合医院卫生政策研究中心主席David Blumenthal博士则认为，如果医生不能处理好与制药企业的关系，将会受到政府更广泛地限制，他说，“这不是企业的问题，而是职业的问题”。>—— Doctors' Ties to Drug Makers Are Put on Close View - New York TimesDoctors' Ties to Drug Makers Are Put on Close View - New York TimesBy GARDINER HARRIS and JANET ROBERTSPublished: March 21, 2007Dr. Allan Collins may be the most influential kidney specialist in the country. He is president of the National Kidney Foundation and director of a government-financed research center on kidney disease.In 2004, the year he was chosen as president-elect of the kidney foundation, the pharmaceutical company Amgen（注：美国安进公司,EPO(商品名EPOGEN)和G-CSF(商品名NEUPOGEN)生产商）, which makes the most expensive drugs used in the treatment of kidney disease, underwrote more than $1.9 million worth of research and education programs led by Dr. Collins, according to records examined by The New York Times. In 2005, Amgen paid Dr. Collins at least $25,800, mostly in consulting and speaking fees, the records show. The payments to Dr. Collins and the research center appear in an unusual set of records. They come from Minnesota, the first of a handful of states to pass a law requiring drug makers to disclose payments to doctors（注：1997年始，美国明尼苏达州是首个立法要求药厂公布给医生报酬）. The Minnesota records are a window on the widespread financial ties between pharmaceutical companies and the doctors who prescribe and recommend their products. Patient advocacy groups and many doctors themselves have long complained that drug companies exert undue influence on doctors, but the extent of such payments has been hard to quantify.（由此公众能够看清药厂与医生的联系及其程度）。The Minnesota records begin in 1997. From then through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in the state at least $57 million. Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money. The median payment per consultant was $1,000; more than 100 people received more than $100,000. (美国的现状看来也很惊人：据明尼苏达州1997-2005年的记录，医生、护士或其他卫生从业人员总共接受了5700万美元，医院、研究中心和其他相关机构得到4000万美元)。超过20%的执业的医生得到过现金。平均每人1000美元，有100人超过100万美元！）Doctors receive money typically in return for delivering lectures about drugs to other doctors. Some of the doctors receiving the most money sit on committees that prepare guidelines instructing doctors nationwide about when to use medicines（收钱最多的人往往也执指南撰写之牛耳！）. Dr. Collins, who received more money than anyone else in the state, is among a limited number whose payments financed research. In dozens of interviews, most doctors said that these payments had no effect on their care of patients. Dr. Collins said his sole focus was the health and well-being of patients. “Just because I might do consulting work doesn’t mean I don’t press the agenda of the public health,” he said.Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, said interactions between drug companies and doctors were beneficial. “In the end, patients are well-served when technically trained pharmaceutical research company representatives work with health care professionals to make sure medicines are used properly,” he said.There is nothing illegal about doctors’ accepting money for marketing talks, and professional organizations have largely ignored the issue.(法律管不了，专业组织更是无视)But research shows that doctors who have close relationships with drug makers tend to prescribe more, newer and pricier drugs — whether or not they are in the best interests of patients. (这句话够损的也够直接的！)“When honest human beings have a vested stake in seeing the world in a particular way, they’re incapable of objectivity and independence,” said Max H. Bazerman, a professor at Harvard Business School. “A doctor who represents a pharmaceutical company will tend to see the data in a slightly more positive light and as a result will overprescribe that company’s drugs.”In an e-mail message, Dr. Collins said he personally received in 2004 less than $10,000 from Amgen for educational presentations. “The contract amount of $1.9 million from Amgen was paid to the Minneapolis Medical Research Foundation (MMRF) for the research contract, on which I am the designated senior researcher,” Dr. Collins wrote. He wrote that he did not work for or serve on the board of directors of the foundation. Dr. Collins discloses on his Web site and research papers that he is a consultant to Amgen, among other companies.（这个教授还是清廉的典范！）Dan Whelan, an Amgen spokesman, said the company paid the Minneapolis Medical Research Foundation “to conduct sophisticated research and data analyses that have enhanced the understanding of health care delivery” for kidney patients.But Dr. Daniel Coyne, a kidney specialist at Washington University, said he was troubled by the payments. “Amgen’s funding for Dr. Collins’s MMRF is another huge financial connection to individuals at the National Kidney Foundation,” Dr. Coyne said. “The foundation’s recent pro-industry anemia guidelines — and the revisions due next month — have to be viewed with great skepticism.”Dr. Coyne recently wrote an editorial in an influential journal decrying guidelines written last year by the kidney foundation that encourage doctors to use more of Amgen’s drugs to treat anemia in kidney patients despite studies showing that increased use led to more deaths.（和活性蛋白C怎么如此雷同？！）Ellie Schlam, a spokeswoman for the National Kidney Foundation, said the foundation sought out the world’s foremost experts. “These are the same people that are wanted by government and industry,” she said. “We really work hard to separate the financing from the content.”Drug makers listed Dr. Collins and the research group as the recipient of payments totaling more than $2 million between 1997 and 2005. Most doctors on the list are far less prominent than Dr. Collins. Ten doctors and one dentist in Minnesota received more than $500,000. Because the records are incomplete, these sums likely underestimate the providers’ earnings. Device makers and Wall Street firms tracking medical research were not required to report, although consulting arrangements between such companies and doctors are common..（倒霉的总是只要公司，实际上医疗器材生产商以及其他以医学研究有关的上市公司则不需要上报，漏洞！）More than 250 Minnesota psychiatrists together earned $6.7 million in drug company money — more than any other specialty. Seven of the last eight presidents of the Minnesota Psychiatric Society have served as consultants to drug makers, according to the Times examinationAfter psychiatrists, doctors who specialized in internal medicine garnered the most money, followed by cardiologists, endocrinologists and neurologists. 这段最精彩！我们终于知道明尼苏达州哪些医生好做！原来是精神科医生，排在其后的心脏医生、内分泌医生和神经科医生。Unknown to Most PatientsDoctors in Minnesota said they generally did not tell their patients about these arrangements. Indeed, few patients are aware of the financial connections between those prescribing drugs and the companies making them.A New York Times/CBS News poll last month found that 85 percent of respondents thought it “not acceptable” for doctors to be paid by drug companies to comment on prescription drugs. Eighty-five percent also said such payments would influence the decisions that doctors made about patient care.(民意调查显示：民众普遍不满)In addition to Minnesota, legislators in Vermont, Maine, West Virginia, California and the District of Columbia have passed laws requiring some level of disclosure of drug company marketing efforts. In Vermont, the state has collected three years of data on payments to doctors, but drug makers are allowed to keep the records private by declaring them trade secrets.In the 2005 fiscal year, the most recent year for which figures are available, drug makers declared 73 percent of payments to doctors in Vermont as trade secrets. The Journal of the American Medical Association today is publishing data summarizing physician payments from drug makers in Minnesota and Vermont. The study concludes that many payments exceeding $100 were made but that the records were difficult to decipher and all but impossible for individuals in either state to interpret. Dr. David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital, said, “We have given physicians a lot of freedom and self-governance because of their professional reputation and a sense that they know how to help their patients.”Doctors said their lectures about drugs to other doctors in return for the payments were gentle marketing pitches that adhered strictly to messages approved by drug makers and federal drug regulators.Drug companies “want somebody who can manipulate in a very subtle way,” said Dr. Frederick R. Taylor, a headache specialist in Minneapolis who earned more than $710,000 between 1997 and 2005, much of that from GlaxoSmithKline, the maker of the migraine drug Imitrex. Dr. George Realmuto, a psychiatrist from the University of Minnesota, said most of the marketing associated with his lectures was packaged around his talks. “It’s at a wonderful restaurant, the atmosphere is very conducive to a positive attitude toward the drug, and everyone is having a good time,” said Dr. Realmuto, who compared the experience to that of buying a car in a glitzy showroom. He earned at least $20,000 between 2002 and 2004 from drug makers. Doctors said that lectures were highly educational, and that drug makers hired them for their medical expertise and speaking skills. But former drug company sales representatives said they hired doctors as speakers mostly in hope of influencing that doctor’s prescribing habits.“The vast majority of the time that we did any sort of paid relationship with a physician, they increased the use of our drug,” said Kathleen Slattery-Moschkau, a former sales representative for Bristol-Myers Squibb and Johnson & Johnson who left the industry in 2002. “I hate to say it out loud, but it all comes down to ways to manipulate the doctors.”（部分医生和医药代表的心态）Jamie Reidy, a drug sales representative for Pfizer Inc. and Eli Lilly & Company who was fired in 2005 after writing a humorous book about his experiences, said drug makers seduced doctors with escalating financial inducements that often start with paid trips to learn about a drug.If a doctor says that he got flown to Maui, stayed at the Four Seasons — and it didn’t influence him a bit? Please,” Mr. Reidy said.‘A Silent Quid Pro Quo’The lectures earn doctors more than cash.“You’re making him money in several ways,” said Gene Carbona, who left Merck as a regional sales manager in 2001. “You’re paying him for the talk. You’re increasing his referral base so he’s getting more patients. And you’re helping to develop his name. The hope in all this is that a silent quid quo pro is created. I’ve done so much for you, the only thing I need from you is that you write more of my products.”For many doctors, marketing lectures are also a welcome diversion.“It beats talking to little old ladies about their bowels,” said Dr. Eric Storvick of Mankato, Minn., who made more than $174,000 between 1998 and 2005 from drug makers.The number of drug marketing presentations delivered by doctors across the United States rose nearly threefold between 1998 and 2006, according to Verispan, a company that tracks drug marketing efforts. In some cases, consulting doctors are so well recognized that they offer drug makers far more than the chance to influence their own prescriptions. For drug makers, among the most prized consultants are those who write guidelines instructing their peers about how to use drugs.Drug Companies'NatureThis list of top doctors in Minnesota includes Dr. Richard Grimm of the Berman Center for Outcomes and Clinical Research in Minneapolis, who has twice served on government-sponsored hypertension panels that create guidelines about when to prescribe blood pressure pills. Last year, he served on a National Kidney Foundation panel that wrote guidelines about when kidney patients should be given cholesterol pills. (看看收入榜的老大是什么来历！)Between 1997 and 2005, Dr. Grimm earned more than $798,000 from drug companies, according to records. In 2003 alone, Pfizer paid Dr. Grimm more than $231,000. Pfizer markets Lipitor, a cholesterol drug that last year had $12.9 billion in sales, more than any other drug in the world. It also markets Norvasc, a hypertension drug that last year had $4.9 billion in sales. Guidelines that suggest greater use of these drugs would be a huge boon to Pfizer.“Drug companies are like lions,” Dr. Grimm said of his sponsored talks. “For lions, it’s their nature to kill zebras and eat them. For drug companies, it’s their nature to make money. They’re not really trying to improve anybody’s health except if it makes them money.“On your side, you’re making a bit of money, but you’re also trying to educate the doctors. And in my view, the doctors need a lot of educating.”这位收入老大看来也是人精，分析药厂的本性够透彻的，不过医生，或者人的本性又是什么呢？Dr. Grimm said that he contributed more than $50,000 between 1997 and 2005 to the Minneapolis Medical Research Foundation, and that his lectures were not biased.Dr. Donald Hunninghake served on a government-sponsored advisory panel that wrote guidelines for when people should get cholesterol-lowering pills. The panel’s 2004 recommendations that far more people get the drugs became controversial when it was revealed that eight of nine members had financial ties to drug makers. The full extent of those ties have never been revealed.In 1998 alone, Pfizer paid Dr. Hunninghake $147,000, and he earned at least $420,800 from drug makers between 1997 and 2003. He left the University of Minnesota in 2004 to become a full-time industry consultant. He is now retired.“Most of my talks did not relate to drugs but the guidelines for treatment,” Dr. Hunninghake said. He said his consulting practice included a variety of activities, including lectures.A 2002 survey found that more than 80 percent of the doctors on panels that write clinical practice guidelines had financial ties to drug makers.“It is critical that the experts who write clinical guidelines be prohibited from having any conflicts of interest,” said Dr. Marcia Angell, a former editor of The New England Journal of Medicine. “Since they have no data themselves but are just making judgments based on their expertise, they absolutely must be impartial or it undermines the whole enterprise.”其实最后一段讲的主要还是指南与公共健康，看来指南制定中委员会成员的筛选以及相关制度的强制执行是必需的。可见这个问题不光是在中国有本月的《mayo clinic proceeding》刊登了Mayocamilleri.michael等两位医生的文章——《Managing Conflict of Interest in Clinical Practice》，为临床科室与医生个人识别利益冲突并规避风险提供了有益的建议，全文免费：?AID=4370&UID= ging Conflict of Interest in Clinical Practice.pdf (53.8k)医生的案头摆满了来自药企的小物件。 （缩略图，点击图片链接看原图）一名医生在易趣网上拍卖医药代表赠送的各色圆珠笔。 （缩略图，点击图片链接看原图）全球一盘棋传播健康本来是很神圣的一件事情！ RMB , U.S.$, EUR, etc面前，人人平等.呵呵，本人当年在柏林的危重病于麻醉年会上就没有少拿，惭愧。 （缩略图，点击图片链接看原图）上面的笔还只是当时收获的1/3，以下是在会上收集的厂商多媒体资料，现在看来，这些都是我道德水平不高的表现呀...在自己的Blog上还写了关于如何获取免费医学多媒体资料的连载，看来也要暂停一下了。 （缩略图，点击图片链接看原图）huangwei98 wrote:上面的笔还只是当时收获的1/3，以下是在会上收集的厂商多媒体资料，现在看来，这些都是我道德水平不高的表现呀...在自己的Blog上还写了关于如何获取免费医学多媒体资料的连载，看来也要暂停一下了。呵呵，本人当年在柏林的危重病于麻醉年会上就没有少拿，惭愧。 huangwei98医生的这点小礼品, 算不上什么. 药厂, IT公司都这么干,不必惭愧自责. 需要注意的是: 如果药厂付你顾问费, 要你写软文,或作会议报告宣传, 而你丝毫不告诉读者和听众你是受雇于别人, 涉嫌做托(也许不是) 那是不合适的. 因为代言人身份所叙述的信息和材料客观性准确性是要打折的, 没有厂家愿意雇人去贬低自己的技术和产品, 做托成份居多, 只是巧妙程度不同而以.我也想做托呀，也要人家看得上。一句话, 说不清啊感情国外的乌鸦也是一般黑啊！实习的时候感觉那些老师都可好了，从没见过哪个老师收红包，还想着还是大医院的医生，道德水准就是不一样，后来才知道，原来只是自己太单纯而已，老师收红包那有学生看到的道理啊。病人的红包都可以毫无愧色地收下，更何况是药商的礼品呢？感情国外的乌鸦也是一般黑啊！实习的时候感觉那些老师都可好了，从没见过哪个老师收红包，还想着还是大医院的医生，道德水准就是不一样，后来才知道，原来只是自己太单纯而已，老师收红包那有学生看到的道理啊。病人的红包都可以毫无愧色地收下，更何况是药商的礼品呢？电视上那么多药品广告,黑也黑不过明星啊,医生多捞点有什么不好,捞也捞不过明星啊.反正病人多被忽悠几次也会变得耐忽悠了