Ethics of accepting suppliers’ gifts in the business v medical world

The business and medical worlds are replete with examples of unethical conduct when it comes to accepting and giving gifts. Li'l Wolf

TRANSPARENCY AND MEDICINE – A series examining issues from ethics to the evidence in evidence-based medicine, the influence of medical journals to the role of Big Pharma in our present and future health.

Today Linda Brennan and Ken Harvey consider ethical governance in the corporate and medical worlds.

The business world is replete with examples of unethical conduct when it comes to accepting and giving gifts and hospitality. In some countries “facilitation fees” (money paid to fixers without whom the business of business would not get done) are common. These are accepted, if not always acceptable practices. Similar problems exist in the medical world.

In 1999, the Howard government enacted legislation specifically outlawing bribery of foreign officials but allowing defined “facilitation payments”. The 2011 UK Bribery Act went further, expressly forbidding employees, subsidiaries and agents from offering facilitation payments.

Given such legislation, it’s surprising that there are not more headlines such as, “UK charges businessman over Bahrain aluminium deals” or “Serious Fraud Office alleges UK businessman made corrupt payments”.

The Australian Competition and Consumer Commission (ACCC) enforces the Competition and Consumer Act 2010 (formerly the Trade Practices Act), which prohibits a variety of business behaviour including misleading, deceptive and unconscionable conduct. The ACCC has taken action on promoters offering “free” goods or services but attaching fine-print conditions that contradict the “free” in the offer.

In addition to these legal foundations, many businesses have embedded codes of conduct that describe specific activities considered inappropriate in relation to procurement and/or sales. These are usually found on corporate websites. Such codes are rarely prescribed or overseen by professional bodies, possibly because there are so many professional bodies that might be involved when it comes to developing a code for business.

Hospitality, such as wining and dining end-users in corporate boxes and pavilions is also common in the business world, despite (or because of) the debt of reciprocity it creates.

While the medical world is more circumscribed, unethical behaviour is more likely to impact on people’s health and life, as the recent scandal over metal-on-metal hip replacements has shown.

In 2009, the Australian government released a position paper on the promotion of therapeutic goods in response to concerns about inappropriate marketing to health professionals. The government proposed industry strengthen and standardise self-regulation by developing a framework for universal adherence to consistent industry-wide codes based on a common set of high-level principles.

A number of submissions were received, a “Working Group on the Promotion of Therapeutic Goods” was set up and a report was produced. The government’s response is contained in, “TGA reforms: a blueprint for TGA’s future”.

A key concern of the Working Group was that compliance with an industry code should be a condition of marketing approval. This was not accepted as the government believed it departed from their preferred self-regulatory model.

But Working Group members noted that the worst perpetrators of unethical promotion are usually not members of industry associations and are unlikely to sign up to code compliance voluntarily.

The Working Group also recommended that industry codes should have a level of sanction to effectively deter non-compliance and this should be monitored by an advisory group. The latter recommendation was also not accepted by the government.

Health professionals now have government-mandated national registration and must comply with Australian Health Practitioner Regulation Agency (AHPRA) code, guidelines and policies. These are currently much less detailed than other ethical guidelines, such as those of the Royal Australasian College of Physicians.

And the pharmaceutical industry body Medicines Australia is currently revising its code of conduct, which governs promotion of prescription drugs to health professionals. Many submissions have been received, especially about the effectiveness of current sanctions and the need for public disclosure of hospitality, gifts and payments made to health professionals. Public consultations are in progress.

Ethical conduct is a societal construct and the line between what is and is not acceptable is increasingly contested by the various stakeholders. It will be interesting to see what latest Medicines Australia Code revision contains.

This is the thirteenth part of Transparency and Medicine. You can read previous instalments by clicking the links below:

Part One: Power and duty: is the social contract in medicine still relevant?

Part Two: Big debts in small packages – the dangers of pens and post-it notes

Part Three: Show and tell: conflicts of interest undeclared for clinical guidelines

Part Four: Eminence or evidence? The ethics of using untested treatments

Part Five: Don’t show me the money: the dangers of non-financial conflicts

Part Six: Ghosts in the machine: better definition of author may stem bias

Part Seven: Clearing the air: why more retractions are good for science

Part Eight: Pharma’s influence over published clinical evidence

Part Nine: Insight into how pharma manipulates research evidence: a case study

Part Ten: Why data from published trials should be made public

Part Eleven: Open disclosure: why doctors should be honest about errors

Part Twelve: Reaching full and open disclosure for universities, medical schools and doctors

Part Fourteen: Conflicts of interest in guideline development: the NHMRC responds

Part Fifteen: Consumer input in Medicines Australia’s code of conduct review