Ethical Guidelines for Physician- Pharma industry
interaction by Karachi Bioethics Group

KARACHI: Karachi Bioethics Group has published its ethical guidelines on Physician Pharmaceutical Industry Interaction which has its most focus on institutions. In view of the fact that medicine is fast turning into a business enterprise and there are no regulation of medical practice in Pakistan, the group believes that “if the medical professionals in Pakistan are to regain public trust and re-establish their credibility, then it is essential that their actions are grounded in ethics and morality and their conduct is guided by a sense of personal integrity and professionalism.” The objective of this ethical framework, it says is to “guide the physician-pharmaceutical industry interactions in Pakistan in order to move from what is to what ought to be.
A copy of these guidelines was received a few days ago through the courtesy of Prof. Farhat Moazzam Professor and Chairperson CEBEC who has sent it to all the members of the National Bioethics Committee and it makes an interesting reading. Although the groups feels that it should be the responsibility of the healthcare organizations and academic institutions to cater to the education, training and research requirements of their students, trainees, staff and faculty, provision of educational and academic grants and funding for research besides arranging CME events including conferences, seminars, workshops but scarcity of funding compels to accept financial support and assistance from the pharmaceutical trade and industry. However, the Karachi Bioethics Group is of the view that all this should go to the institutions rather than individuals. An institution committee should make best use of this funding, keep proper accounts ensuring transparency but there should be no direct interaction between the healthcare professionals and Pharma industry. Further more the donors should have no say on how to use these funds and how to select the individuals for grants etc. The group recommends that a common pool of money meant for CME activities and other academic activities including research should be created by the institutions and funds generated from different sources be kept in this pool.
Guidelines also cover disclosure by institutions on institutional website. As regards gifts, giveaways and drug samples, it discourages one-to-one contact between physicians and the Pharma industry representatives but they should also be donated to institutions and they should not display the name of the drug or product except company logo and name. It also calls upon the physicians to declare Pharma industry support prior to their presentations at seminars and conferences. Research funds should also be utilized through institutional committees while research protocols should be approved by in-house and if that does not exist, by external Ethical Review Committees. Pharma industry has been asked to organize drug information talks at institutions rather than hotels. Any event like Gala Dinner or musical evening should be contributory by the participants rather than using funds donated for academic activities. The practice by the Pharma industry of flying in foreign experts should be discouraged. Instead drug information from relatively independent sources such as Cochrane Collaboration and other similar services available on the internet should be encouraged. Healthcare professionals should refrain from promoting drugs, bands through print and electronic media.
Since most of the guidelines and recommendations are institution specific, it leaves out a very large segment of healthcare professionals who are not associated, affiliated with any institution from any monitoring and regulation. This appears to be its major drawback and deficiency. Moreover, giving too much importance to institutions has its own disadvantages and drawbacks. Even at present some of the medical institutions in the private sector have pioneered some unethical practices which are being adopted by many other healthcare establishments. They do not hesitate to coerce and black mail the pharmaceutical trade and industry to generate funds for various activities, hence this might give them an excuse to further intensify their efforts. Having ideal guidelines is an excellent idea but to have guidelines which are practical, feasible and which could be implemented is the best course. Moreover, keeping in view the environment in most of ou pubic healthcare facilities, expecting the healthcare professionals to become angels may be asking for too much but if they can be pursued to become good human beings, it might solve the problem to a great extent. Any such guidelines, if implemented gradually, in a phased programme could be much more beneficial. However, any effort which aims at achieving the objective of ensuring ethical medical practice by the doctors community and ethical marketing practiced by the pharmaceutical trade and industry must be appreciated and deserve to be commended. SAJ.