Dara Gantly on the complex issue of doctor-industry links and the ethical considerations involved.
When the Seventh Edition of the Ethical Guide was published in November 2009, the Medical Council clarified a number of matters involving doctors and their patients, including consent, confidentiality, end-of-life care, provision of information to the public, prescribing practices and referral of patients.
Two key areas, however, that were not examined — but which the Council promised to in due course — were human-assisted reproduction and doctors’ relationship with industry. “The process of developing an Ethical Guide is really a rolling agenda,” the Council President stated at the time. I guess some things roll slower than others.
Nearly three years later, the Council has published guidance clarifying its position on the relationships between doctors and industry, in the form of ‘frequently-asked questions’ (FAQs) that stipulate the standards expected of doctors in their dealings with the pharmaceutical and medical device industries.
The 13-page document is indeed clear and concise (hats off to the Council for getting the National Adult Literacy Agency’s Plain English Mark), and won’t surprise many doctors. Among its recommendations is that drug samples are probably okay to accept, but only if they are used as emergency medication.
Accepting gifts, including hospitality, is a general no-no (Paragraph 59.9 of the Guide), however a reasonable fee for any work done as part of a contractual arrangement with a commercial company is okay. But here is where it gets less clear. As the FAQs are based not only on the Ethical Guide, but also on the Medicinal Products (Control of Advertising) Regulations 2007 and the Irish Pharmaceutical Healthcare Association (IPHA) Code of Marketing Practice, 2007, elsewhere it states that “reasonable hospitality and gifts” may be accepted, as long as this happens at sales promotions or scientific events and is limited to the main purpose of the event.
The new document goes on to state that promotional meetings do not give objective educational information and doctors should not use them for continuing professional development (CPD) points, “unless the event has been approved by a professional body”.
Interestingly, the Council accepts its Guide does not specifically deal with doctors charging a fee for a visit by a sales representatives. However, it points to the industry’s own Code (par 12.6), which says sales reps must not use any “incentive or ploy” to gain an interview with a doctor.
“It is likely that the Medical Council would view the charging of fees for visits by sales representatives as wrong,” the new document somewhat indefinitely states, perhaps because a test case has yet to confirm this view.
The patient-doctor relationship is a privileged one that depends on the patient’s trust in the doctor’s professionalism, and anything that detracts from that — including any hint that their judgement might be affected by the influence of industry — must be guarded against. Recent revelations in the US — much due to the ‘Dollars for Doctors’ investigation by ProPublica (propublica.org) — has renewed calls for full disclosure and regulation of financial and other relationships between industry and doctors. Is this one pill too far?
Of course, given the significant influence of the media on the health of individuals and populations, we should probably also be alert to the potential impact of industry–journalist relationships on healthcare, health policy and public health. But that’s for another day.