Table 2. Incentive categories and relevant policy statements from the three organizations.

Incentive category	Description	Total # of interviews	Policy statements
			Drug Regulatory Authority Pakistan1	Pakistan Medical and Dental Council2	World Health Organization
Financial	Direct and indirect transfer of funds to physicians to increase their wealth.	36 [25 physicians; 11 MSRs]	Prohibits companies from providing ‘gifts’ to doctors, which includes cash.	Prohibits doctors’ professional autonomy or integrity from being compromised once any ‘gift, benefit in kind or economic advantage’ is offered to them as an inducement. Also discourages doctors from entering into business or other arrangements that include financial incentives.	Prohibits financial or material benefits being offered to or sought by doctors to influence their clinical decision-making.
Material	A range of high and low value items that benefit physicians personally and/or professionally.	35 [23 physicians; 12 MSRs]	Prohibits companies from providing ‘gifts’, which includes gift cards, food, flowers, or branded promotional items, even if the item is of minimal value. Permits companies to occasionally provide items to doctors that benefit patients or serve a genuine educational function for HCPs. Educational items should be modest in cost, as determined by local standards, and should not be provided in excess.	Permits doctors to occasionally accept promotional aid items from companies, provided that these items are primarily for the benefit of patients, as well as text or reference-books, medical journals, and other educational materials, if they are satisfied that these serve a genuine, demonstrable and direct educational function.	Prohibits financial or material benefits being offered to or sought by doctors to influence their clinical decision-making.
Professional or Educational	Opportunities to acquire new knowledge, develop skills related to the medical profession and expand professional networks.	26 [16 physicians; 10 MSRs]	Prohibits companies from directly paying for, or reimbursing, individual doctors to attend conferences; any support must not inappropriately benefit individual doctors or provide for side-benefits e.g., trips, recreation, entertainment or lavish meals or accommodations. Permits companies to provide training and education for doctors on company products, at which companies may provide reasonably-priced meals or, when it is impractical or inefficient to provide training at or close to a doctor’s place of business, reasonable travel and accommodation costs.	Permits doctors to accept industry support to attend CME or scientific and educational conferences or professional meetings, provided that any financial support is strictly through cheque or bank draft deposited in a duly designated account rather than in their personal bank accounts and that the support is disclosed to the institution and to the Council on demand.	Prohibits any support provided to individual doctors to participate in any domestic or international symposia being conditional upon any obligation to promote any medicinal product.
Social or Recreational	Opportunities outside of the professional setting to socialise or to participate in activities that primarily constitute leisure or entertainment.	20 [13 physicians; 7 MSRs]	Prohibits companies from providing, organizing or paying for recreational or entertainment activities for doctors, including [without limitation] tours, cultural or artistic activities, or leisure activities. Permits MSRs to meet doctors from time to time to discuss products, conduct contract negotiations, or discuss sales terms. Such discussions may take place at another mutually convenient location, provided it is conducive to the business discussion. Meals must be modest and incidental to the business discussion.	Permits a maximum of twenty percent of the total time allocated to attending an industry-sponsored event to recreational activities, which are in accordance with the dignity of the medical profession.	Permits entertainment or other hospitality, and any gifts offered to doctors, so long as they are secondary to the main purpose of the meeting and kept to a modest level.
Familial	Financial and non-financial benefits aimed primarily at physicians’ families.	15 [9 physicians; 6 MSRs]	Prohibits spousal expenses as part of consulting arrangements with doctors.	None	Prohibits invitations and financial support to attend industry-sponsored events that include doctors’ spouses or children.

¹ DRAP statements extracted from the 2017 Regulations.

² Formerly Pakistan Medical and Dental Council