Ethical reflections: to achieve true transparency, doctors need to play their part

Claire Nicholson

Red Health

In recent years the pharmaceutical industry has been making a concerted effort to try and address its public image issue and become more transparent and open in its dealing with the medical profession, not least by updates to the ABPI Code.

However, the image of the pharmaceutical industry continues to be an uphill battle as the recent article in the Independent on Sunday shows only too well. The article states that “[b]ig drug firms have spent millions of pounds on bankrolling events and trips for NHS staff” and cites a number of recent PMCPA alleged breaches to highlight what it identifies to be ‘concerns over the influence of drug companies’.

"...the image of the pharmaceutical industry continues to be an uphill battle..."

My view is that, once again, the pharmaceutical industry is perceived as a bulldozer that has no consideration for the public and is only concerned by self-interest. The Code and the fact that there is a process in place to monitor and reprimand anyone that falls foul was not properly given credit, and doctors and those who are on the receiving end of the hospitality and honoraria are depicted as almost innocent victims. I think there is a continued failure to see the bigger picture – one which needs to be addressed in order for true transparency to be achieved – that of the role of the doctor.

It is well known that there is a link between physician–industry interactions and prescribing. Therefore it is essential to strive for an open and transparent relationship between the pharmaceutical industry and the medical profession to ensure that the patient remains the most important factor and that patient trust is upheld.

The recent update to the ABPI Code goes someway to address this, it states that pharmaceutical companies must make publicly available details of the fees paid to consultants in the UK for certain services, e.g. chairing and speaking at meetings, and participation in advisory boards. In addition, companies must make publicly available details of payments for accommodation (both inside and outside the UK) and travel outside the UK. While these changes to the Code are a step in the right direction, only the total number of consultants must be declared and not names of the consultants.

I believe that if the pharmaceutical industry has to declare payments given, then doctors should also be made to disclose the amount of money they receive from their interactions with the industry. Only then can transparency be fully achieved.

One of the six commonly used values in medical ethics is that of beneficence – whereby a practitioner should act in the best interest of the patient. I do not think that this can fully be achieved if the doctor is not declaring payments received. In addition, it raises questions of truthfulness and honesty.

"Some accountability and openness on the part of the doctor is needed."

I am not in any way saying that doctors should not receive consultancy fees, however I think it is necessary for them to declare any honoraria and / or hospitality that they are given. Some accountability and openness on the part of the doctor is needed.

The US has adopted a scheme which I see as not only necessary but also an ethical imperative, that is, for individual physicians to be named alongside the amount of monies and / or hospitality given. Who is required to declare this information (the pharmaceutical industry or the doctor) is up for debate, but I think those who are recipients have as much obligation to declare what they receive and make this information publicly available as the giver.

Only when this is achieved can we move towards a truly transparent system, one which all parties are held equally responsible, one where the ethics can be justified. People may argue that this may reduce the involvement of doctors working with pharmaceutical companies – if it does then surely alarm bells should be raised and the credibility of any doctors willing to receive but not willing to disclose should be questioned.

Part 2 of this series will be published 26th August.

About the author:

Claire works for the specialist health communications agency Red Health. Any views expressed are her own.

She can be reached at Claire.Nicholson@redconsultancy.com or via Twitter - @clairenics.

How much responsibility should physicians have in achieving a transparent system?