Implicit Cognition and Gifts: How Does social Psychology help Us Think Differently about Medical Practice?

This article takes the following two assumptions for granted: first, that gifts influence physicians and, second, that the influences gifts have on physicians may be harmful for patients. These assumptions are common in the applied ethics literature, and they prompt an obvious practical question, namely, what is the best way to mitigate the negative effects? We examine the negative effects of gift giving in depth, considering how the influence occurs, and we assert that the ethical debate surrounding gift-giving practices must be reoriented. Our main claim is that the failure of recent policies addressing gift giving can be traced to a misunderstanding of what psychological mechanisms are most likely to underpin physicians' biased behavior as a result of interaction with the medical industry. The problem with gift giving is largely not a matter of malicious or consciously self-interested behavior, but of well-intentioned actions on the part of physicians that are nonetheless perniciously infected by the presence of the medical industry. Substantiating this claim will involve elaboration on two points. First, we will retrace the history of policies regarding gift giving between the medical profession and the medical industry and highlight how most policies assume a rationalistic view of moral agency. Reliance on this view of agency is best illustrated by past attempts to address gift giving in terms of conflicts of interest. Second, we will introduce and motivate an alternate view of moral agency emerging from recent literature in social psychology on implicit social cognition. We will show that proper consideration of implicit social cognition paints a picture of human psychology at odds with the rationalistic model assumed in discussions of COIs. With these two pieces on the table we will be able to show that, without fully appreciating the social-psychological mechanisms (both cognitive and affective) of implicit cognition, policy-makers are likely to overlook significant aspects of how gifts influence doctors.