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.