http://bmj.com/cgi/content/full/325/7363/511
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Updated guidelines setting out boundaries for relationships between hospital doctors and healthcare firms are contained in a new paper from the Royal College of Physicians.
First produced in 1986, the advice defines the current position of the college on hospitality for meetings, gifts, grants, research, declarations of interest, and doctors acting as consultants to industry. It extends the coverage of guidance beyond pharmaceutical companies to include all biomedical firms.
The report, in the July-August edition of the college's journal Clinical Medicine (2002;2: 320-2), sees a danger that money from biomedical firms might be used to interfere with a physician's independent professional judgment.
Dr John Collins, medical director at the Chelsea and Westminster Hospital NHS Trust, is joint author of the paper with treasurer of the Royal College of Physicians, Dr John Bennett.
Dr Collins said, "We are widening the guidelines to other organisations and probably being more prescriptive in terms of third party handling of funds. Always have your financial arrangements done through a third party."
He believes that inappropriate relationships with business are much less likely than in the 1980s but adds: "I suspect that the vast majority of practising clinicians do not prescribe medicines because a company has funded them to go to a conference. However, if you were a non-medically qualified individual looking at a doctor you might wonder whether they might be influenced in any way."
The rules in other countries differ considerably, as BMJ correspondents report below.
France: The French medical association has tightened its rulings on
the receipt of gifts from pharmaceutical companies, writes
Alexander Dorozynski. A doctor should not accept gifts in cash or
otherwise, except small gifts not exceeding 
30 (£19;
$29) in value.
Contributions to a doctor's attendance at scientific meetings or congresses and "hospitality" are authorised if they are reasonable and if the selection of a remote (and therefore costly) site is justified.
Spain: Earlier this year the body representing all Spanish drug
companies issued a code of practice stating that drug companies'
representatives can offer medical related gifts to doctors worth up
to only 19, writes Xavier Bosch. Expenses for
meetings cannot include those of social or cultural events or
expenses to accommodate the spouses of doctors attending the meeting.
These guidelines come into effect this month.
Netherlands: The marketing code for prescription only drugs has already resulted in legal cases against pharmaceutical companies and individual doctors, writes Tony Sheldon.
In 2001 Merck Sharp and Dohme was fined £27000 ($41000; 43000)
for events promoting its antimigraine drug rizatriptan (Maxalt) that
included dry ski slope and go-kart contests.
Next month up to 15 doctors are due to appear in court for refusing to pay
fines for accepting excess hospitality. The doctors went on a car
anti- skid course, offered by German pharmaceutical company
Boehringer-Ingelsheim as entertainment after an event promoting its
drugs against blood pressure and rheumatism. Another 50 doctors have
already paid fines of up to 250.
Australia: Drug companies have just agreed to end the lavish wooing of doctors with free lunches and resort seminars, writes Christopher Zinn. Under reforms to the pharmaceutical industry's code of conduct, all non-essential hospitality will be axed. The Australian Medical Association has welcomed the code but says the perks for prescriptions were vastly exaggerated and that more politicians than doctors enjoyed the largesse.
Nigeria: The Nigeria Medical Association frowns at physicians accepting gifts with conditions from drug companies, writes Abiodun Raufu. According to the association's vice president, Dr Kayode Obembe, "the commonest gift from drug companies to physicians is sponsoring doctors to conferences abroad, but such trips are often linked to research issues which affect the products of the drug companies."
A senior pharmacist with Pfizer Nigeria said the most unusual request by a doctor was for a television set for the waiting room of his private clinic.
United States: In 1990 the American Medical Association and the
American College of Physicians each issued guidelines on gifts from
pharmaceutical companies, writes Charles Marwick. Last year
the American Medical Association mounted an educational campaign to
alert its members to its guidelines
evidence
that nobody had been paying them much attention. Companies are
reported to spend up to $5bn a year on "health promotion
services."
Among the rules set out by the association, presenting scientific information is permitted, but entertainment is not. Gifts, if less than $100 in value and intended for patients' benefit, are allowed. The Food and Drug Administration monitors promotional activities. It says action would be taken if any activities were false or misleading. But gifts do not violate the law.
India: "The practice of giving gifts, offering foreign trips, and even direct cash incentives to doctors by drug companies is rampant in India," says Dr Puneet Bedi, gynaecologist and an independent health activist, writes Sanjay Kumar. It is much more so in areas such as cardiology where the big money is involved, he says.
The Medical Council of India, in its new Code of Ethics Regulation, March
2002, does not prohibit doctors from accepting gifts or cash
incentives from drug companies (see
www.mciindia.org/know/rules/ethics.htm).
| New recommendations on
receiving gifts
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Collections under
which this article appears:International
health Competing
interests / conflicts of interest |
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