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18 Feb 2019

BY DR CHRIS MOY, CHAIR, AMA ETHICS AND MEDICO-LEGAL COMMITTEE

Following a 12-month review, the AMA recently released the updated Guidelines on Doctors’ Relationships with Industry 2018.

The guidelines have undergone a major revision with significant changes highlighted below.

While industry and doctors often work together for the benefit of health care, both may be in a position to profit financially (or otherwise) from collaboration, potentially undermining public trust and confidence in the medical profession if doctors do not manage actual and perceived conflicts of interest appropriately.

The updated guidelines greatly expand on doctors’ ethical obligations to be guided by the primacy of patient care and ensure relationships with industry:

  • reflect core professional values such as transparency, accountability, trust and fairness;
  • do not compromise, or be perceived to compromise, doctors’ professional judgment and professional integrity;
  • are open and transparent, able to withstand public and professional scrutiny, meet public and professional standards and expectations and adhere to relevant legislative and regulatory requirements;
  • promote effective stewardship and responsible use of health care resources; and
  • uphold professional autonomy and clinical independence.

The guidelines also include a new section on industry marketing and promotion, urging doctors to recognise the influence of industry marketing on their own behaviour and to take appropriate steps to minimise it. In addition, doctors should be aware of the influence of industry marketing and promotion on patients’ expectations and be prepared to discuss patient requests for inappropriate medications and treatments. A particularly problematic example is the increasing ‘medicalisation’ of normal human processes (for example, wrinkles or male pattern baldness), where a non-medical condition is portrayed by industry as a medical issue that can be ‘treated’ with certain medications or treatments resulting in increased demand for, and sales of, products or services which do not actually benefit health care. 

The guidelines continue to highlight the importance of integrating formal training in medical curricula to recognise the influence of industry marketing and promotion on prescribing behaviour and in managing ethical relationships with industry. The guidelines advocate that medical schools and other educational bodies should be open and transparent about industry-sponsored sessions and support the AMSA position that it should not be compulsory for medical students to attend any educational sessions or extra-curricular activities organised by industry and those who choose not to attend should not be penalised.

The guidelines have also made some amendments to the section on dispensing and related issues. The current industry guidelines advise that should a doctor choose to dispense therapeutic products, they should be mindful of actual or perceived conflicts of interest and only dispense products that are evidence-based. The previous (now superseded) policy statement advised that doctors should not dispense therapeutic products unless there is no reasonable alternative. This particular policy position will now be considered within the review of the AMA guidelines on doctors owning pharmacies which is due to start shortly.

In addition to the sections outlined above, topic areas such as professional education and training, industry sponsored research, industry sponsored meetings and activities, training organised by industry, key opinion leaders, remuneration for services, product samples, industry representatives and relationships with other medical service and health service providers are also addressed in the guidelines.

If you have any questions in relation to the Guidelines on Doctors’ Relationships with Industry 2018, please send them through to ethics@ama.com.au. The guidelines are accessible on the AMA website at https://ama.com.au/position-statement/doctors-relationships-industry-2018.

 


Published: 18 Feb 2019