The industry ties that bind

Dr Muiris Houston

Dr Muiris Houston examines the firm message beneath the Medical Council’s velvet glove on the appropriate links between doctors and the pharmaceutical and medical devices industries.

The Medical Council’s decision to flesh-out its guidelines on doctors’ relationships with the pharmaceutical industry suggests some concern may have arisen at its ethics committee about the matter.

Could the issue of medics jetting off to conferences with the bill picked up by a drug company have something to do with it? On the other hand, the Council’s Ethics Working Group flagged that issues such as this would be part of a routine mid-cycle review.

Of its new document, the Council says, “this document clarifies the ethical guidance that the Medical Council gives in relation to doctors’ interactions with pharmaceutical and medical device companies”.

The fresh advice is in the form of questions and answers; in some parts, the Q and A goes beyond the still-current 2007 Guide to Professional Conduct and Ethics for Registered Medical Practitioners. It is based on three documents: the current Medical Council Ethics Guide; the Medicinal Products (Control of Advertising) Reg-ulations 2007; and the IPHA code of marketing practice.

Main responsibility
At the outset, the document reminds practitioners that their main responsibility is to act in the best interests of their patients and that they should not be influenced by any personal consideration. But questions 2 and 3 are likely to attract the most interest.

Question 2 asks: ‘Is it right for doctors to accept gifts and hospitality from pharmaceutical, medical devices or other commercial companies?’
Paragraph 59.9 of the current Ethics Guide says that doctors should not accept gifts (including hospitality) from pharmaceutical, medical devices or other commercial companies. In this latest clarification, the Council says doctors may accept “reasonable hospitality and gifts… as long as this happens at sales promotion or other professional or scientific events” and provided the hospitality is limited to the main purpose of the event.

It continues: “The reasoning for the Medical Council’s advice to doctors is because of the risk that the doctor’s professional judgement might be affected by accepting gifts or hospitality. Doctors have a professional obligation to obey the Medical Council’s guidance.”

Is it acceptable for doctors to attend promotional or sponsored educational meetings, the latest document then asks. It goes on to clarify a sponsored educational meeting as “a professional educational meeting or conference sponsored in whole or in part by commercial companies”.

“The Medical Council advises doctors not to accept direct hospitality from pharmaceutical, medical devices or other commercial companies so that their professional judgement is not affected by the hospitality.

The Medical Council accepts that payment of travel and accommodation expenses for doctors to attend meetings, either as participants or speakers, supports the aim of continuing professional development. “However, the Council says that these payments should go through unrestricted Education and Development Funds made available by the sponsoring company to the institution which is hosting the meeting or the conference organiser” (All italics mine).

“Unrestricted Education and Development Funds are not linked to or controlled by the organisations that contribute to them and healthcare institutions can choose to spend the funds any way they see fit.”

In my opinion, the Council’s use of the word ‘direct’ is a game-changer. It suggests that doctors should not accept invitations to international medical meetings from individual companies. Instead, the medical devices or drug company places money for this purpose in a fund administered by the conference organiser, which then disburses the funds as it sees fit.

In practice, this may not stop doctors being supported to attend major meetings; however, it means they can no longer be direct guests of a particular company at a particular event.

At present, there doesn’t appear to be a formal mechanism by which the Council could check on doctors’ behaviour following this clarification. Nonetheless, should an alleged breach of the guideline come to its attention, it could decide it warranted an investigation.

Independent evidence
Meanwhile, a separate Q and A advises doctors not to rely solely on promotional literature distributed by pharmaceutical companies for information about particular drugs or medical devices. “Instead, you should seek independent evidence-based sources of information on the benefits and risks of all medication and medical devices before prescribing,” it says, before specifically recommending the websites of the Irish Medicines Board and the National Medicines Information Centre.

Council President Prof Kieran Murphy offered the following observations in connection with the clarified guidelines: “The public need to be confident that their doctor’s professional opinion is not influenced by marketing or promotional activities. This supplementary guidance provides clarification for both the medical profession and patients on the standards expected of doctors in their dealings with the pharmaceutical and medical device industries.”

The velvet glove
So, something for us doctors to reflect on. The language of the clarification is facilitatory and there is likely to be a step-wise approach to enforcement. But there is no doubting the firm message that lies beneath the velvet glove.