Summary

The Guidelines for ethical relationships between health professionals and industry aim to support health professionals in identifying, assessing and managing conflicts of interest. Their overall goal is to preserve public trust by protecting the integrity of professional judgment in patient care and activities affecting the health of populations. Practitioners consulting these Guidelines are encouraged to consider the arguments and advice included within it, but are ultimately free to make their own decisions.

A number of key points inform the content. The most fundamental is that the primary concern of health professionals is for the safety and welfare of their patients and the community(s) in which they live. This central tenet of health care can, however, be compromised by pecuniary and non-pecuniary interests that lead to conflicts of interest, bias professional judgment, and adversely affect clinical decision-making, patient care and population health activities.

Importantly, conflicts of interest arise not as a consequence of malign motivations but from the facts and settings in which they occur. Furthermore, neither dualities nor conflicts of interest in themselves inevitably cause harm, rather it is ambiguity about goals and values and the possibility for harm that arouses concern.

There are many ways in which conflicting interests may arise, including but not limited to, relationships with industry. Management of such conflicts of interest can be enormously challenging. While physicians generally accept that there are negative effects from certain interactions with industry, many physicians still believe they are personally immune to the influence of industry. Accordingly, the first step is to build awareness that health professionals often face dualities of interest, that some of these interests may bias or unduly influence professional decisions and that this influence can occur subconsciously, without the practitioner being aware of what has taken place.

Disclosure of interests is necessary in order to assess any relevant conflicts. Health care organisations and institutions have a role in recording disclosures of interests and advising on responses which may include removing conflicted individuals from particular decisions, maintaining public registers of relevant interests, and assessing the impact of perceived conflicts of interest. The Guidelines advocate leadership on the part of health institutions by actions which create a ‘firewall’ between industry and physicians such as providing sponsorship-free grand rounds and providing adequate resources for independent professional education.

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. In particular, the Guidelines advise against accepting gifts and hospitality and advise caution in considering industry support for conferences and other meetings. They also promote the provision of independent education for practitioners, trainees and students, and high standards of integrity in research.

FAQs

• Meeting with drug representatives (PDF)
• Speaking at a pharmaceutical company-sponsored event (PDF)
• Funding from a pharmaceutical company to attend a conference (PDF)
• Pharmaceutical company sponsorship for clinical meeting or grand round (PDF)
• Funding from a pharmaceutical company to conduct or participate in research (PDF)
• Invitation to be a member of a pharmaceutical company advisory board (PDF)

Download all FAQs (PDF)

Disclosures of contributors

Members of the working party, Ethics Expert Advisory Group and Ethics Committee^*

Professor Paul Komesaroff is an adult endocrinologist and Professor of Medicine at Monash University and the Alfred Hospital in Melbourne, Executive Director of Global Reconciliation, Director of the Centre for the Study of Ethics in Medicine and Society, a Director of Praxis Australia (a not-for-profit company established to support research and ethics in Australia and internationally). He is the RACP Adult Medicine Division President, a board member of the RACP and a former chair of the RACP Ethics Committee. He has conducted collaborative research involving a number of pharmaceutical companies.

In addition to clinical work, Paul is involved in undergraduate and postgraduate teaching and laboratory, clinical and social science research. He is Ethics Editor of the Internal Medicine Journal, Chair of the Editorial Board of the Journal of Bioethical Inquiry and author of more than 400 articles and 14 books.

Professor Ian Kerridge is a staff haematologist/BMT physician at Royal North Shore Hospital, Sydney and Professor of Bioethics and Medicine at the University of Sydney. He is Chair of the South-Eastern Sydney LHD Clinical Ethics Committee and a member of the NSW Health Department’s Clinical Ethics Advisory Panel and was previously a member of the Australian Health Ethics Committee from 2012 to 2015.

Ian is the current RACP Ethics Committee Chair. Ian is also Director of Praxis Australia – a not-for-profit initiative aimed at promoting and providing education and ethics in research. He has a long interest in research ethics and in research in medicine, haematology, BMT and philosophy/ethics and is the author of over 300 papers in peer reviewed journals and 5 textbooks of ethics, most recently Ethics and Law for the Health Professions (Federation Press, 2013). He is or has been an investigator on numerous investigator-initiated and industry-sponsored clinical trials in haematology and BMT and actively recruits patients to clinical trials but otherwise receives no support from industry, does not work as an advisor or consultant to industry, receives no travel or conference support from industry and owns no shares in the pharmaceutical, biotechnology or pathology industries.

Dr Greg Stewart is Director Primary Integrated and Community Health at South Eastern Sydney Local Health District and a former member and chair of the RACP Ethics Committee. He is a former president of the Australasian Faculty of Public Health Medicine, and a former member of the RACP Board, Finance Committee and Congress Organising Committee. He is a member of the Public Health Association of Australia, NSW Medico-Legal Society and a Fellow of The Royal Australian College of Medical Administrators. He receives no payments or reimbursements from industry for any services, travel, attendance or presentations at meetings and does not have any other financial relationship that could be perceived as a conflict of interest.

Dr Wendy Lipworth is an Associate Professor of bioethics at Sydney Health Ethics, University of Sydney. She leads a program of research on the ethics of emerging technologies with a particular focus on how medicines and other therapeutic technologies (e.g. medical devices, companion guidelines for ethical relationships between health professionals and industry (Fourth edition, August 2018) 83 diagnostics, biological therapies) are developed, commercialised, regulated, funded, marketed and taken up into practice. She has no industry associations or other relevant interests to declare.

Dr Jon Jureidini is a child psychiatrist who heads Adelaide University’s Critical and Ethical Mental Health research group, which promotes safer, more effective and more ethical research and practice in mental health, and the Paediatric Mental Health Training Unit, which provides training in non-pathologising approaches to primary care mental health.

Dr Rob Loblay is a clinical immunologist who is a Senior Lecturer in Immunology at the University of Sydney and Director of the Allergy Unit at the Royal Prince Alfred Hospital where he is also Chair of the Ethics Review Committee. He has no industry associations or other relevant interests to declare.

Professor Russell Gruen is a general and trauma surgeon at a major public hospital in Singapore and is the former director of the National Trauma Research Institute, which is funded through competitive and other government grants, and occasionally receives industry funding which is independent of research methods and reporting. He receives no payments or reimbursements from industry for any services, travel, attendance or presentations at meetings nor does he have any other financial relationships that could create conflicts of interest.

Dr Ken Harvey is an Associate Professor of Public Health at Monash University and a consumer advocate. He was a member of the expert group that drafted the World Health Organization’s ‘Ethical Criteria for Medicinal Drug Promotion’. More recently he represented CHOICE (the Australian Consumers’ Association) on the Therapeutic Goods Administration (TGA) Transparency Review Panel, the Government’s Natural Therapy Review Advisory Committee, the TGA Working Group on Regulatory Reform of Complementary Medicines and the Therapeutic Goods Advertising Code Council.

Dr Phillipa Malpas is Associate Professor of Clinical Medical Ethics working at the University of Auckland (in the Faculty of Medical and Health Sciences). She is interested in the medical education of students, especially the ethical dimension of their training.

Professor Cameron Stewart is a member of Sydney Health Law at Sydney Law School, the University of Sydney. He is the Legal member of the NSW Medical Council and a member of the NSW Ministry of Health’s Clinical Ethics Advisory Panel.

Associate Professor Henry Kilham is a paediatrician involved in clinical ethics at the Sydney Children's Hospitals Network, and is an associate of Sydney Health Ethics, University of Sydney (previously the Centre for Values, Ethics and the Law in Medicine). He has no association with the pharmaceutical industry, nor any relevant dualities or conflicts of interest to declare.

Dr Christopher Clarke is a retired consultant thoracic physician. He has no associations with the pharmaceutical industry or other relevant dualities or conflicts of interest to declare.

Dr Shane Carney is Associate Professor of Medicine at the University of Newcastle and Honorary Medical Officer, Department of Nephrology John Hunter Hospital.

Professor Wendy Rogers is a member of Clinical Ethics at Macquarie University, Co-Chair of NSW Health Clinical Ethics Advisory Panel and a former member of the Australian Health Ethics Committee. She has a longstanding interest in conflicts of interest and research ethics, and has published widely on these and other topics.

Dr Alina Iser is a paediatrician at Alice Springs Hospital with outreach to remote communities. She is a member of the RACP Ethics Committee. She has no industry associations or conflict of interests.

Dr Danielle Ko is a palliative care consultant and Clinical Ethics Lead at Austin Health, and is a member of the RACP Clinical Ethics Committee. Prior to practicing medicine, she worked as a lawyer. She has no associations with the pharmaceutical industry or other relevant dualities or conflicts of interest to declare.

Dr Alastair Macdonald is a retired renal physician and now a clinical ethics advisor with the Capital & Coast District Health Board (CCDHB). He is a member of the CCDHB Clinical Ethics Advisory Group and Choosing Wisely Committee. He is also involved in the formation of a clinical ethics network in New Zealand. His appointment to the RACP Ethics Committee is an important part of his work in ethics.

Associate Professor Jill Sewell is the Clinical Director of the Children’s Bioethics Centre, and a senior paediatrician in the Centre for Community Child Health at the Royal Children’s Hospital. She is Chair of the Victorian Clinical Council, and President of the Australian Medical Council. She has no industry associations or other relevant interests to declare.

Dr Linda Sheahan is a palliative care physician and the Clinical Ethics Consultant for South East Sydney Local Health District. She is an Honorary Associate with Sydney Health Ethics at the University of Sydney, and a Clinical Conjoint with University of NSW School of Medicine. Linda has a Fellowship in Clinical and Organisational Ethics from the Joint Centre for Bioethics in Toronto, Canada, and remains an affiliated Ethicist with the Joint Centre. She is a member of the RACP Clinical Ethics Committee, the SESLHD Clinical Ethics Committee, Australian Association of Bioethics and Health Law, Australian and New Zealand Society of Palliative Medicine, and Palliative Care Australia.

Professor Ron Paterson is a legal professional and former board director based in Auckland. Ron has no industry associations or other relevant interests to declare.

Professor Ngiare Brown is a Yuin Nation woman from the south coast of New South Wales, is a senior Aboriginal medical practitioner and holds an academic appointment at the University of Wollongong as Professor of Indigenous Health and Education. Professor Brown was the first identified Aboriginal medical graduate from NSW and is one of the first Aboriginal doctors in Australia. She has qualifications in medicine, public health and primary care, and has studied bioethics, medical law and human rights.

Ngiare has also undertaken doctoral research in law, addressing Aboriginal child protection systems and practice. Ngiare is part of a new international network, International Indigenous Genomics Alliance, addressing cultural governance protocols, and the ethical and legal impacts of genomic research and Aboriginal and Torres Strait Islander people. Ngiare has been a chief investigator, associate investigator and named investigator on a range of National Health and Medical Research Council (NHMRC) funded grants, valued at more than $10 million. She has also been a member and chair of numerous committees, including contributions to the NHMRC, some of which include:

• founding member and previous foundation chief executive officer of the Australian Indigenous Doctors’ Association
• founding member of the Pacific Region Indigenous Doctors’ Congress (PRIDoC) and chair of the Health, Rights and Sovereignty Committee
• board member for the Bangarra Aboriginal Dance Theatre
• board member for the Australian Research Alliance for Children and Youth
• inaugural and current member of the Prime Minister’s Indigenous Advisory Council
• commissioner, National Mental Health Commission
• advisory board member of the National Centre for Indigenous Genomics ANU

Dr Hirini Kaa is of Ngati Porou, Ngati Kahungunu and Rongowhakaata descent. Hirini has worked in a range of areas including in the social services sector, for the Anglican Church and for his iwi. He currently lectures in History and Theology at the University of Auckland and is a trustee of the Te Taurahere o Ngati Porou ki Tamaki Trust.

Ms Eliza McEwin holds a Master of Bioethics and is a member of the RACP Ethics Committee and Ethics eLearning Resource Working Party. Eliza currently works at The Australian Commission on Safety and Quality in Health Care.

Mr Peter Martin's first career was in education where he was a secondary teacher of Economics and Geography, eventually becoming a long-serving principal of secondary schools in the government system. He was also heavily involved in professional leadership at regional, state and national levels as well as becoming involved in representative roles in professional development, working parties and negotiating teams at high levels.

Other interests and involvement included ambulance services (both management and front line), service clubs (Lions) for over 35 years, health (membership of a public hospital board for 18 years), health regulation (state and national dental boards), ethics (Dental Health Services Victoria), firearms regulation, transport facilities in rural areas, services for older persons, 10 years as a bail justice, currently a Justice of the Peace and numerous and varied consumer representative positions in health and related areas such as infection control; also rural health services' finances, safety, quality and governance. Currently a Community Sessional Member of the Post Sentence Authority in Victoria.

Peter is very concerned that consumers and the general community are genuinely involved in all decisions which are relevant to them. He is particularly passionate that rural people are involved to the maximum extent possible in these decisions despite the practical difficulties involved. His experience tells him that far too often they are ignored or at least just tolerated in debates about the provision of services which urban people regard as 'normal' and to which they feel entitled.

Peter is a Member of the Order of Australia in recognition of his contributions to education and the community.

Mr Tim Benson has been a Western Australian based health consumer representative, advocate, and consultant for over 20 years.

He is a member of the Consumers Health Forum of Australia and the Health Consumers Council of WA, and has served on both their Boards of Management, additionally he is a Patient for Patient Safety Champion for the World Health Organization, a member of the WA Consumer & Community Health Research Network, a contributor to the International Consortium for Health Outcomes Measurement Diabetes Standard Project Group, and a member of the Ethics Committee of Audiology Australia.

Among his many previous roles has been a ministerial appointment as the inaugural community member of the National Lead Clinicians Group (a role he then held for the life of the group), a member of the Western Australian Clinical Senate Executive, and the chairman of the North Metropolitan Health Service Community Advisory Council (WA).

His passion for the involvement of the patient and carers in the safety and quality of the patient journey makes him a valuable contributor to the RACP's Ethics Committee. Tim has been a member of the RACP Ethics Committee since 2016.

Professional guidelines and codes

Australia

Australian Medical Association – Doctors’ Relationships with Industry 2018

Medical Board AHPRA – Good medical practice: a code of conduct for doctors in Australia

Medicines Australia – Code of Conduct

International

American Medical Association – Code of Medical Ethics

British Medical Association – Transparency for doctors with competing interests

Canadian Medical Association – Guidelines for Physicians in Interactions with Industry

Bibliography and further reading

Background, context, process and principles

Books

Angell M, Editor, (2004), The truth about drug companies: how they deceive us and what to do about it, New York: Random House.

Beauchamp T, Childress J, Editors (2001), Principles of biomedical ethics, New York: Oxford University Press.

Consumers International, (2007), Drugs, doctors and dinners. How drug companies influence health in the developing world. London: Consumers International (Internet), [cited 10 April 2012].

Goldacre, B, (2012), Bad Pharma: How drug companies mislead doctors and harm patients, London, Fourth Estate.

Kerridge I, Lowe M, Stewart C, Editors (2009), Ethics and law for the health professions, Sydney: The Federation Press.

Moss M, (2013), Salt, Sugar, Fat. How the food giants hooked us. New York: Random House.

Journal articles

Francke A, Smit M, De Veer A, Mistiaen P, (2008), Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Medical Informatics and Decision Making, Vol 8(38).

Gagliardi AR, (2012), More bang for the buck: exploring optimal approaches for guideline implementation through interviews with international developers. BMC Health Services Research, Vol 12(404).

Komesaroff PA, Kerridge IH (2009), The Australian Medical Council draft Code of Professional Conduct: good practice or creeping authoritarianism?, (Letter), Medical Journal of Australia, Vol 190(4): 204-205.

Komesaroff PA, Kerridge IJ, (2002), Ethical issues concerning the relationships between medical practitioners and the pharmaceutical industry, Medical Journal of Australia, Vol 176(3): 118-121.

Komesaroff PA, Patterson CG, (2000), Managed care, managed ethics. Medical Journal of Australia, Vol 172(12): 609-611.

Osborn M, Day R, Komesaroff P, Mant A, (2009), Do ethical guidelines make a difference to decision making? Internal Medical Journal, Vol 39(12): 800-805.

Policy documents and reports

Australasian Faculty of Occupational And Environmental Medicine, (2016), Ethical Guidelines for Occupational and Environmental Physicians (PDF). Royal Australasian College of Physicians, [cited 6 December 2017].

Australian Department of Health and Aged Care, (1999), National Medicines Policy. Canberra, Commonwealth of Australia, [cited 6 December 2017].

Australian Department of Health and Ageing, (2004), The National Strategy for Quality Use of Medicines: executive summary, Canberra, Commonwealth of Australia, [cited 6 December 2017].

Medical Board of Australia, (July 2009), Good medical practice: a code of conduct for doctors in Australia, Canberra, [cited 6 December 2017].

Australian Department of Health & Ageing, (18 March 2011), Working Group on Promotion of Therapeutic Products Report to Parliamentary Secretary Catherine King, Canberra.

World Health Organization, (September 2002), Promoting rational use of medicines: core components 2002, WHO Policy Perspectives on Medicines No. 005, Geneva, [cited 6 December 2017].

Interests, dualities of interest and conflicts of interest

Books

Field J, Lo B, Editors, (2009), Conflict of interest in medical research, education, and practice. Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and Practice, Washington DC, National Academies Press (US).

Lexchin J, Kawachi I, Voluntary codes of pharmaceutical marketing: controlling promotion or licensing deception, In: Davis P, Editor, (1996), Contested ground: public purpose and private interest in the regulation of prescription drugs, New York: Oxford University Press.

Journal articles

Bindslev J, Schroll J,Gøtzsche P, Lundh A, (2013), Underreporting of conflicts of interest in clinical practice guidelines: cross sectional study, BMC Medical Ethics, Vol 14(19).

Bowman MA, Pearle DL, (1988), Changes in drug prescribing patterns related to commercial company funding of continuing medical education, Journal of Continuing Education in the Health Professions, Vol 8: 13-20.

Greenland S, (2012), Transparency and disclosure, neutrality and balance: shared values or just shared words?, Journal of Epidemiology and Community Health, Vol 66(11): 967-970.

Licurse A, Barber E, Joffe S, Gross C, (2010), The impact of disclosing financial ties in research and clinical care: a systematic review, Archives of Internal Medicine, Vol 170: 675-682.

Loewenstein G, Sah S, Cain D. (2012), The unintended consequences of conflict of interest disclosure, The Journal of the American Medical Association, Vol 307: 669-670.

Mason P, Tattersall H, (2011), Conflicts of interest: a review of institutional policy in Australian medical schools, Medical Journal of Australia, Vol 194: 121-125.

Roseman M, Milette K, Bero LA, (2010), Reporting of conflicts of interest in meta-analyses of trials of pharmacological treatments, The Journal of the American Medical Association, Vol 305: 1008-1017.

Silverman GK, Loewenstein GF, Anderson BL, Ubel PA, Zinberg S, Schulkin J, (2010), Failure to discount for conflict of interest when evaluating medical literature: a randomised trial of physicians, Journal of Medical Ethics, Vol 36: 265-270.

Issues affecting health practitioners

Journal articles

Agrawal S, (2002), Pharmaceutical industry and sponsorship of delegates for national conferences. Indian Pediatrics, Vol 39: 445-448.

Arkinson J, Holbrook A, Wiercioch W, (2012), Public perceptions of physician – pharmaceutical industry interactions: a systematic review, Healthcare Policy, Vol 5: 69-89.

Brody H, Light DW, (2011), The inverse benefit law: how drug marketing undermines patient safety and public health, American Journal of Public Health, Vol 101: 399-404.

Choudhry N, Stelfox H, Detsky AS, (2002), Relationships between authors of clinical practice guidelines and the pharmaceutical industry, The Journal of the American Medical Association, Vol 287: 612-617.

Chren MM, Landefeld CS, (1994), Physicians' behavior and their interactions with drug companies. A controlled study of physicians who requested additions to a hospital drug formulary, Journal of the American Medical Association, Vol 271(9): 684-689.

Doran E, Kerridge I, McNeill P, Henry D, (2006), Empirical uncertainty and moral contest: a qualitative analysis of the relationship between medical specialist and the pharmaceutical industry in Australia, Social Science & Medicine, Vol 62: 1510-1519.

Gøtzsche PC, Hróbjartsson A, Johansen HK, Haahr MT, Altman DG, Chan AW, (2007), Ghost Authorship in Industry-Initiated Randomised Trials, PLOS Medicine, Vol 4: e19.

Grande D, (2010), Limiting the influence of pharmaceutical industry gifts on physicians: self-regulation or government intervention?, Journal of General Internal Medicine, Vol 25: 79-83.

Grande D, Frosch DL, Perkins AW, Kahn BE (2009), Effect of exposure to small pharmaceutical promotional items on treatment preferences, Archives of Internal Medicine, Vol 169(9): 887-893.

Lacasse JR, Leo J, (2005), Serotonin and depression: a disconnect between the advertisements and the scientific literature, PLoS Medicine, Vol 2: e392.

Landefeld CS, Steinman MA, (2009), The Neurontin legacy – marketing through misinformation and manipulation, New England Journal of Medicine, Vol 360: 103-106.

Law M, Soumerai SB, Adams AS, Majumdar S, (2009), Costs and consequences of direct-to-consumer advertising for clopidogrel in Medicaid, Archives of Internal Medicine, Vol 169: 1969-1974.

MacNeill P, Kerridge I, Newby D, Stokes B, Doran E, Henry D, (2010), Attitudes of physicians and public to pharmaceutical industry ‘gifts’, Internal Medicine Journal, Vol 40: 335-341.

Moynihan R, (2012), Most Australians believe that drug company payments influence doctors’ decisions, BMJ, (Feb), Vol 13(344): e1076.

Ruff TA, Haikal-Mukhtar H, (2005). Doctors, drugs, information and ethics: a never-ending story, Medical Journal of Australia, Vol 183(2): 73-74.

Smith R, (2005), Medical journals are an extension of the marketing arm of pharmaceutical companies, PLoS Medicine, Vol 2: e138.

Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, Vitry AI, (2010), Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review, PLoS Medicine, Vol 7: e1000352.

Wang AT, McCoy CP, Murad MH, Montori VM, (2010), Association between industry affiliation and position on cardiovascular risk with rosiglitazone: cross sectional systematic review, BMJ, (Mar), Vol 18(340): c1344.

Wazana A, (2000), Physicians and the pharmaceutical industry: Is a gift ever just a gift?, Journal of the American Medical Association, Vol 283: 373-380.

Wislar JS, Flanagin A, Fontanarosa PB, DeAngelis CD, (2011), Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey, BMJ, Vol 343: d6128.

Issues affecting trainees and students

Books

Hafferty F, Editor, (2009), Professionalism and the socialization of medical students, Cambridge University Press. 

Journal articles

Austad KE, Avorn J, Kesselheim AS, (2011), Medical students’ exposure to and attitudes about the pharmaceutical industry: a systematic review, PLoS Medicine, Vol 8: e1001037.

Avorn J, Choudhry NK, (2010), Funding for medical education: maintaining a healthy separation from industry, Circulation, Vol 121: 2228-2234.

Bowman MA, (1986), The impact of drug company funding on the content of continuing medical education, Möbius: A Journal for Continuing Education Professionals in Health Sciences, Vol 6: 66-69.

Carmody D, Mansfield P, (2010), What do medical students think about pharmaceutical promotion?, Australian Medical Student Journal, Vol 1: 54.

Garattini L, Gritti S, De Compadri P, Casadei G, (2010), Continuing medical education in six European countries: a comparative analysis, Health Policy, Vol 94: 246-254.

Mansfield P, Lexchin J, Wen L, Grandori L, McCoy C, Hoffman J, Ramos J, Jureidini J, (2006), Education for health professionals about drug and device promotion: advocates’ recommendations, PLoS Medicine, Vol 3: e451.

NPS MedicineWise, (2009), Finding evidence recognising hype.

NPS MedicineWise Online training programs 2017 [cited 6 December 2017].

Rogers WA, Mansfield PR, Braunack-Mayer AJ, Jureidini JN, (2004), The ethics of pharmaceutical industry relationships with medical students, Medical Journal of Australia, (Apr), Vol 180(8): 411-414.

Sierles F, Brodkey AC, Cleary LM, Mccurdy FA, Mintz M, Frank J, Lynn DJ, Chao J, Morgenstern BZ, Shore W, Woodard Jl, (2005), Medical students’ exposure to and attitudes about drug company interactions: a national survey, Journal of the American Medical Association, Vol 294(9): 1034-1042.

Soyk C, Pfefferkorn B, Mcbride P, Rieselbach R, (2010), Medical student exposure to and attitudes about pharmaceutical companies, World Medical Journal, Vol 109: 142-148.

Tabas JA, Boscardin C, Jacobsen Dm, Steinman MA, Volberding PA, Baron RB, (2011), Clinician attitudes about commercial support of continuing medical education: results of a detailed survey, Archives of Internal Medicine, Vol 171: 840-846.

World Health Organization / Health Action International (2010), Understanding and responding to pharmaceutical promotion: A practical guide. Working draft for pilot field testing. (Sept) [cited 6 December 2017].

Issues affecting institutions and professional societies

Books

McCarthy M, (2012), The patient paradox: why sexed-up medicine is bad for your health, London: Pinter & Martin Ltd.

Moynihan R, Cassels A, (2005), Selling sickness. How drug companies are turning us all into patients, Crows Nest, NSW: Allen & Unwin.

Pellegrino E, Editor, (1991), Trust and distrust in professional ethics Washington DC, Georgetown University Press. 

Journal articles

Fischer MA, Keough ME, Baril JL, Saccoccio L, Mazor KM, Ladd E, Worley AV, Gurwitz JH, (2009), Prescribers and pharmaceutical representatives: why are we still meeting?, Journal of General Internal Medicine, Vol 24: 795-801.

Kerridge I, Maguire J, Newby D, Mcneill PM, Henry D, Hill S, Day R, Macdonald G, Stokes B, Henderson K, (2005), Cooperative partnerships or conflict-of-interest? A national survey of interaction between the pharmaceutical industry and medical organizations, Internal Medicine Journal, Vol 35(4): 206-210.

Kesselheim AS, Robertson CT, Siri K, Batra P, Franklin JM, (2013), Distributions of industry payments to Massachusetts physicians, New England Journal of Medicine, (May) Vol 30; 368(22): 2049-2052.

Mintzes B, (2012), Advertising of prescription-only medicines to the public: does evidence of benefit counterbalance harm?, Annual Review of Public Health, Vol 33: 259-277.

Mintzes B, Lexchin J, Sutherland J, Beaulieu MD, Wilkes M, Durrieu G, Reynolds E, (2013), Pharmaceutical sales representatives and patient safety: a comparative prospective study of information quality in Canada, France and the United States, Journal of General Internal Medicine, Vol 28(10): 1368-1375.

Issues affecting research

Books

National Health and Medical Research Council, (2010), National Statement on Ethical Conduct in Research Involving Humans, Canberra, Commonwealth of Australia, revised 2015 and 2018.

National Health and Medical Research Council, (2001), The Human Research Ethics Handbook, Canberra, Commonwealth of Australia.

Pharmaceutical Research and Manufacturers of America (PhRMA), (2009), Code on Interactions with Health Care Professionals, Washington, DC, [cited 6 December 2017].

Journal articles

Azoulay P, (2002), Do Pharmaceutical sales respond to scientific evidence?, Journal of Economics & Management Strategy, Vol 11: 551-594.

Chapman S, Forsyth R, Kerridge I, Stewart C, (2012), Policies and practices on competing interests of academic staff in Australian universities, Medical Journal of Australia, Vol 196: 452-456.

Deangelis CD, Drazen JM, Frizelle FA, Haug C, Hoey J, Horton R, Kotzin S, Laine C, Marusic A, Overbeke AJ, Schroeder TV, Sox HC, Van Der Weyden MB, (2004), International Committee of Medical Journal Editors, Clinical trial registration, A statement from the International Committee of Medical Journal Editors, Medical Journal of Australia, Vol 181: 293-294.

Glaser B, Bero L, (2005), Attitudes of academic and clinical researchers toward financial ties in research, Science and Engineering Ethics, Vol 11: 553-573.

Henry D, Doran E, Kerridge I, Hill S, McNeill P, Day R, (2005), Ties that bind: multiple relationships between clinical researchers and the pharmaceutical industry, Archives of Internal Medicine, Vol 165: 2493-2496.

Kesselheim AS, Robertson CT, Myers JA, Rose SL, Gillet V, Ross Km, Glynn RJ, Joffe S, Avorn J, (2012), A randomized study of how physicians interpret research funding disclosures, New England Journal of Medicine, Vol 367(12): 1119-1127.

Lundh A, Sismondo S, Lexchin J, Busuioc OA, Bero L, (2012), Industry sponsorship and research outcome (review), Cochrane Database of Systematic Reviews, (Dec) 12:MR000033. DOI: 10.1002/14651858.MR000033.pub2.

Sismondo S, (2008), How pharmaceutical industry funding affects trial outcomes: causal structures and responses, Social Science & Medicine, Vol 66: 1909-1914.

Chapman S, Forsyth R, Kerridge I, Stewart C, (2012), Policies and practices on competing interests of academic staff in Australian universities, Medical Journal of Australia, Vol 196: 452-456.

Deangelis CD, Drazen JM, Frizelle FA, Haug C, Hoey J, Horton R, Kotzin S, Laine C, Marusic A, Overbeke AJ, Schroeder TV, Sox HC, Van Der Weyden MB, (2004), International Committee of Medical Journal Editors. Clinical trial registration. A statement from the International Committee of Medical Journal Editors, Medical Journal of Australia, Vol 181: 293-294.

Glaser B, Bero L, (2005), Attitudes of academic and clinical researchers toward financial ties in research, Science and Engineering Ethics, Vol 11: 553-573.

Henry D, Doran E, Kerridge I, Hill S, McNeill P, Day R, (2005), Ties that bind: multiple relationships between clinical researchers and the pharmaceutical industry, Archives of Internal Medicine, Vol 165: 2493-2496.

Kesselheim AS, Robertson CT, Myers JA, Rose SL, Gillet V, Ross KM, Glynn RJ, Joffe S, Avorn J, (2012) A randomized study of how physicians interpret research funding disclosures, New England Journal of Medicine, Vol 367(12): 1119-1127.