Be wary of starter packs and medicine support schemes, says RACP


Physicians should think carefully before giving patients starter packs or signing them up to industry-run medication support schemes, according to new RACP guidelines on ethical interactions with industry.

In its fourth edition of Guidelines for Ethical Relationships Between Physicians and Industry, the College has updated and reaffirmed its 2006 advice for avoiding conflicts of interest in areas including sample and starter packs, product familiarisation schemes and medical education.

It also offers new advice pertaining to industry players across complementary medicine, biotechnology and devices and expands the definition of industry beyond the for-profit sector.

The RACP says it has repeatedly been shown that health practitioners are influenced by contact with industry and that accepting gifts, sponsorship for travel and attendance at scientific meetings, and appointment to advisory boards increases demand for specific products.

But while physicians “generally accept that there are negative effects from certain interactions with industry” many believe they are “personally immune to the influence”.

Noting there is no universal consensus about how to assess the influence of industry or manage conflicts of interest from industry interactions, the RACP says its document is a guide to help physicians consider the implications posed by various scenarios.

“While some relations with industry are inescapable or desirable, the Guidelines provide clear advice on avoiding interactions that do not further patient care or population health activities and which have the potential to bias professional judgment.”

Off-label prescribing: The advice for practitioners – to proceed with caution – remains the same as 2006 edition, but the RACP voices new concerns over off-label prescribing which it says can be  “the outcome of the promotional activities of pharmaceutical companies anxious to extend the market for their products”. “While industry promotion of off-label prescribing of their products is prohibited in Australia and elsewhere, such practices are common and are known to have significant effects on prescribing behaviour”.

Gifts: All gifts, even items of small value, have the potential to exert influence and create conflicts of interest. Therefore, “the simplest, and most defensible, approach is for health professionals to err on the side of rejection of gifts, even those of trivial value”.

Entertainment and hospitality: Acceptance of industry hospitality can create conflicts of interest. Individuals should consider the context, potential implications and available alternatives before deciding on their personal courses of action. For the most part hospitality should be provided by employers or its costs should be covered by the health professionals themselves.

Drug samples and starter packs: Consider carefully before accepting these from industry pharmaceutical representatives because they are often not in the best interests of patients. “The provision of samples is primarily a marketing exercise that is intended to create relationships of reciprocity between clinicians and industry representatives, to accustom clinicians to prescribing particular products, and to establish cohorts of patients on long-term treatment with newer and often more expensive drugs”;

Industry patient support programs: Consider if the program will really support the patient, and whether the information being offered is reliable before enrolling [patients] or providing them with information. “Although such programs may facilitate optimal use of a drug as well as a measure of support to patients, clinicians should bear in mind that they also often function as promotional devices. As such, they have the ability to influence the attitudes of patients and health practitioners.” Healthcare teams should carefully monitor to conduct of ‘support’ programs and physicians should not facilitate direct contact between industry representatives and patients.

Meetings and conferences: Industry support (financial and in-kind) for a formal contribution to scientific meeting or conference should be given indirectly through an independent organising committee, not tied to the promotion of anything, and should be fully disclosed. Practitioners should not accept sponsorship to cover the cost of travel, attendance for meals of family or friends. Most hospitality should be provided by employers or costs should be covered by health professionals themselves.

Continuing Professional Development: Privately funded educational institutions are “an increasing part of the CPD landscape”, and clinicians and clinical organisations making use of these offerings should be aware that they may be funded by industry.

Grand Rounds should be funded by the clinical organisation but where no alternative is available industry supporters should have no part in determining the speakers, subject or content.

Complementary medicines, therapeutic devices and other health products: The arguments around conflict of interest pertaining to the pharmaceutical industry “apply equally” to the complementary medicines, devices and food industries, the latter continuing to “exert considerable influence over public health policies and clinical guidelines”.

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