No individual doctors should receive direct payment from commercial companies to cover travelling expenses, room and board at a conference, or compensation for their time, according to proposed guidelines from the World Medical Association.
The association is developing the guidelines to clarify the relationship between doctors and commercial enterprises, including the pharmaceutical industry. Underpinning the proposals is the need for doctors to disclose and avoid competing interests.
The guidelines, discussed at a recent meeting of the association, acknowledge the complex nature of the relationship between doctors and industry. They also acknowledge that a potential conflict of interest clearly exists when a commercial enterprise, such as a pharmaceutical or medical supplies company, has direct or indirect influence over doctors' behaviour because it offers financial support.
However, the association acknowledged that industry support was often important, enabling medical research, scientific conferences, and continuing medical education. So, rather than forbidding any connection between doctors and industry it argued that it was better to establish guidelines for ethical relations.
The draft statement, based on guidelines already established by the World Health Organization, national medical associations, and the pharmaceutical industry, includes recommendations for industry sponsorship of conferences, research, and gifts to doctors.
For example, it would be acceptable for companies that sponsor medical conferences recognised as continuing medical education to ask for a certain topic be included in the programme. But companies should have no influence on the content, presentation, choice of speakers, or publication of results. Ideally, proposes the association, several companies should sponsor a conference. The names of any companies providing financial support should be publicly disclosed. Funding for a conference can be accepted as a contribution to the general costs of the meeting but not as payment for any specific lecturer or participant.
But more controversial is the recommendation that no doctors should receive payment to cover travelling expenses, room and board at a conference, or compensation for their time. Many doctors rely on support from drug companies towards travel and hotel costs for attending international medical conferences, which they would otherwise be unable to attend.
Charles Medawar, director of Social Audit Limited, an independent consumer research group, said: "The draft guidelines are a curious mix of naive ideas. The committee developing the recommendations needs to think what it is trying to do. There need to be measures for monitoring and enforcement of the guidelines for them to make any difference."
He warned that some of the suggestions were impractical and that the recommendation that doctors should not be sponsored to attend meetings would destroy 90% of conferences. In contrast, he said, other suggestions did not go far enough. For example, the recommendation on disclosure should require doctors to disclose the amount of funding or sponsorship they have received from companies.
Less controversial is the suggestion that all conference organisers and lecturers disclose to conference participants any financial affiliations they have with manufacturers of products mentioned at the meeting or with manufacturers of competing products.
Other guidelines are that doctors involved in commercially funded research doctors should be subject to legal, ethical, and professional regulations and must not be subject to external pressure on the results of their research or its publication. Doctors can be compensated for their time and effort in conducting research, but this compensation should in no way be connected to the results of the research. Any doctor working for an institution that funds research centrally should be compensated through the central fund. Sponsorship of research should be disclosed in any publication of results. Doctors with a significant financial interest in a company should not accept research funding from that company if there is a risk of conflict of interest, unless the case is approved by an ethics committee. Finally, companies should offer doctors only gifts that are of nominal value and are related to their work.
The association has set up a working group to take the issue forward for further discussion at the general assembly in Helsinki in September.