Ethics Statements

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Doctor & Pharmaceutical/Medical Device Industry Relationships Position Statement

Introduction

Doctors appreciate the contribution that the pharmaceutical and medical device industries make to the practice of medicine. Without the discoveries made by industry, many of the medical advances and products of recent decades would never have been possible. However, there must be appropriate boundaries between practicing doctors and industry. Industry viability understandably requires fiscal integrity and a margin of profit. Doctors’ primary motive should be to promote the welfare of their patients. The resultant conflict of interest requires that a doctor deliberately evaluate the ethics of receiving gifts from industry. There are many published standards for appropriate relationships between industry and doctors. Many academic medical institutions and the US Government have adopted policies on these issues. CMDA, in an effort to give guidance to its members, addresses the question, “What is the appropriate responsibility of a doctor when offered incentives from industry?”

The Current Situation

The choice of what pharmaceutical or medical device to use is largely made by the doctor though this choice is often influenced by institutional or insurance company constraints and incentives. Therapeutic choices must be individualized with due consideration of the best scientific evidence available and costs involved. Industries seek to promote the use of their product to the doctor by providing, among other things, free educational opportunities, gifts, and services. Studies demonstrate that incentives from industry influence recipients more than doctors realize.

Biblical Foundation

A Christian’s response must consider several Biblical principles:

  • The two great commandments are to love God and neighbor.
    • Jesus warns of the danger of being motivated by a love of money or other things of this world.
    • Jesus directs that our motives be pure and undivided.
    • Christians must “guard their hearts” against undue influence.
  • The behavior of a Christian must be “above reproach.”
    • Christians should avoid any form of inappropriate behavior.
    • A reputation for doing what is right is of value.
  • Solomon warned that receiving gifts could place people under the influence of others. Even with our best intentions, we may be inappropriately biased toward those who give us gifts.

Ethical Principle

Doctors should consider carefully the basis of their therapeutic decisions to assure that they are made in accordance with best possible evidence applied to the welfare of the patient. Personal gain must never be the compelling reason for our decisions. Incentives from industry, intended to influence therapeutic choices, can compromise doctor integrity and behavior.

Recommendations:

Categories of receiving gifts from industry:

  1. Unethical practices:
    1. Contracts that obligate the doctor to prescribe a particular pharmaceutical for reasons of personal gain.
    2. Failure to disclose the degree to which the industry or institution controls the content of presentations, recommendations, or product placements.
    3. Failure to disclose to the patient any financial relationships with the industry or institution.
    4. Selling materials that were gifts, including samples.
    5. Receiving greater compensation from a company than would be fair and reasonable for services rendered.
  2. Practices requiring extreme caution:
    1. Receiving incentives from industry or institutions to build rapport or promote exposure to their products, e.g., free meals (including staff), entertainment, etc.
    2. Personal use of product samples.
  3. Practices requiring caution:
    1. Accepting product samples: Product samples are distributed to doctors as a large part of the industry’s advertising budget. These are intended to bring attention to the products and allow the doctor some experience in using them. They should be received by the doctor with “no strings attached.”
      1. Appropriate uses include distribution to indigent patients and as a means to introduce a patient to a new product to assess efficacy and side effects before requiring their purchase. Product samples may also be used for dose titration.
      2. Inappropriate uses: Product samples must never be given in a way that doctors promote themselves as benefactors.
    2. Accepting information from Industry. A discerning doctor is wise to look for independent sources of information. One must exercise caution in allowing the following sources to become the basis for therapeutic decisions:
      1. Sales promotional literature. This material is biased to promote the product. In the United States these materials are regulated by the FDA but are not always in compliance.
      2. Industry sponsored studies. When using studies that are financed and published by the manufacturer, the doctor must keep in mind that though the work may be done with integrity, the conclusions may be subject to bias. Negative studies may not be readily available and only favorable outcomes emphasized.
  4. Generally ethical practices:
    1. Attending or sponsoring educational activities that have received support from industry where it is clearly stated that industry has no control over the content and any conflict of interest on the part of the faculty is clearly revealed.
    2. Receiving reprints from peer reviewed journals.
    3. Requesting industry contribution to charitable efforts.
  5. Situations in which it is difficult to refuse gifts from industry.
    1. Training on certain medical devices provided only by the manufacturer. This is often provided in a setting that involves travel, lodging, meals, etc. as a part of the educational experience. In this context, there may be limited options and the recipient must discern the appropriate response.
    2. Industry employees may leave incentives for a doctor without giving an opportunity to decline. In this situation, it is imperative that the doctor not allow these incentives to affect their practice.

Conclusion

Christian doctors must be wary of any inappropriate influence industry has over their prescribing behaviors and assure that their practices are guided by what is best for their patients and in accord with biblical principles.

Approved by the House of Representatives
Passed Unanimously
April 29, 2010. Ridgecrest, North Carolina

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