Have we reached the limit of effectiveness of self-regulation and codes of ethics?

Abstract

Over the past decade, both the health-care professions and the pharmaceutical industry have revised the codes governing their interaction. These adjustments were responses to changing public standards and to data demonstrating the adverse impact of such interactions on prescribing behaviour and on health spending. Now the relationships between health professions and industry are more tightly regulated than ever before. They’re characterised by a commitment to transparency and to processes that avoid conflicts of interest – more than at any time in the past. Perhaps the two most significant sets of guidelines governing interaction between doctors and the pharmaceutical industry - the Royal Australasian College of Physician’s “Guidelines for relationships between physicians and industry” and the “Code of Conduct” of Medicines Australia (the peak industry group for the pharmaceutical industry) – are currently under review. It’s clear that each body will likely introduce incremental changes to the way relationships are managed in the health sector. Sadly, incremental variations achieve little and what we need is fundamental change to the ways in which medicine and medical professionals interact with industry. And despite the progress to date, promotional activities continue, often under the guise of education. Marketing data remain generally aggregated, obscuring the identities of the beneficiaries of industry support.