Italian paediatric association has launched code on competing interests

Editor—The BMJ's policy of promoting the declaration of competing interests by authors is praiseworthy and should concern more people than the journal's contributors.¹ Transparency should be requested of lecturers as well as organisers of and delegates to workshops and congresses. Bero's editorial shows how things are changing with publication of the Royal College of Paediatrics and Child Health's report.² This idea is also taking hold in Italy.

In 1998 our association, whose main aims are providing continuing medical education, promoting primary care research, and protecting children, launched an initiative to develop a code on competing interests. This was based on the principles of the code of the International Pharmaceutical Manufacturers' Association and the international code for the marketing of breast milk substitutes. The code was intended as a list of recommendations for members without any intention to punish violations. Its main principles are:

• Sponsorship is acceptable if it originates from any industry complying with the international codes

• Sponsorship for individual people and groups must be declared to the local health authority and customers

• Support for participation in congresses and training courses should not include any direct or indirect payments, gifts, or travel expenses for accompanying people

• Research proposals supported by industry must be submitted to an independent ethics committee, with researchers being fully responsible for publishing the results

• Paediatricians should watch over advertising by the industry and reject any claimed benefit of drugs and baby food that contrasts with the codes or current scientific evidence.

A draft of the document was submitted to all 2700 members of the association, who are mainly family paediatricians, and fierce debate ensued. Despite its non-compulsory nature, a few members suggested modifying some sentences to make them more lenient; others opposed the initiative because doctors should respond to their own conscience rather than codes. Most members started to regard sponsorship differently. Some initial outcomes have already been measured.

Although the association has tried to limit costs and consistently reduced registration fees, fewer members have attended some of its more recent events; the same seems to be happening for the next national congress. The Italian Society of Paediatrics was invited to join the code initiative, but more time seems to be needed for a similar code to be adopted formally. The relationship with manufacturers must obviously continue, but it must be based on the ethical principles of transparency and independence, keeping in mind that the most important beneficiary is the patient.