Disclosure of previously discretionary information is fundamental to the public’s trust in medicine. As a consequence of growing concerns about financial conflicts of interest in research, increasingly stringent disclosure rules have been introduced in many countries, including in Australia and New Zealand, especially since the early 1990s.
The first edition of the RACP Guidelines, published in 1992, took the form of a set of comparatively abstract principles to help guide physicians to make their own decisions regarding the drug industry. However, increasing awareness about the potential implications of the influence of the pharmaceutical industry on prescribers, medical societies and expert bodies, as well as on research outcomes, led to calls for further regulation in the late 1990s and early 2000s.
The third edition of the RACP Guidelines, published in 2006, laid out detailed, practical advice to physicians for managing dualities and multiplicities of interest, and avoiding any appearance of impropriety in such areas as authorship of pharmaceutical-sponsored research, society meetings and gifts.
The developing empirical understanding of pharmaceutical industry influence since 2006, as well as further intensification of public concerns, has set the stage for a new revision of the Guidelines. Goals of the present revision include expansion of their scope to other (non-pharmaceutical) industries, recognise the close involvement of nurses and allied health professionals in the operation of healthcare teams, integration of the approach to industry across the areas of clinical practice, social policy development, research and education, and explicit acknowledgment of the concomitant unequivocal constructive roles of industry.
International events have affected public awareness of the importance of these issues and have led to changed cultural expectations. The gradual but important strengthening of the Medicines Australia Code of Conduct has been another important step forward. Recognition of the need for a unified approach to the issues across different sectors, including generic and non-generic pharmaceuticals and complementary medicines, has increased. Overseas legislation mandating greater disclosure of relationships with industry and increasing public pressure are reflected in the present text.
The Guidelines include expanded discussion of electronic advertising, non-pecuniary interests, global issues, the role of ‘educational’ activities and various other topics. There has also been recognition of the fact that not all consumer groups express views independent of industry or government.
It is important to note that physicians working in occupational and environmental health have a unique relationship with industry, as indeed do other physicians who undertake medico-legal work. These physicians may need to manage conflicting responsibilities relating to individual patients under their care, workers in a particular workplace, employers, the general public and specific responsibilities under legislation. The Australasian Faculty of Occupational and Environmental Medicine has published its Ethical Guidelines for Occupational and Environmental Physicians (PDF), which should be referred to for more detailed guidance on the specific issues relating to these professions.