By Saroj Jayasinghe.
Globally, a range of medical conferences are sponsored by pharma. At one end of the spectrum we continue to have conferences and their social programmes that are completely funded and organized by pharma, where the only obligation for the participating health professional is to apply for legitimate leave. At the other end there are those which do not receive any such funds directly or indirectly. In the midst are the vast majority of conferences where a mixed bag of pharma sponsorship is visible: Sponsored academic sessions or speakers, waivers for registration fees or access to social programmes. The depth and breadth of pharma involvement varies. In some countries the industry has to follow strict rules of engagement and clearly demarcated areas where sponsorship is allowed, while in some the boundaries are blurred beyond recognition. As the spectrum moves towards the latter, we observe many tangles which carry potential for conflicts of interest for health professionals.
At the heart of it is the necessity to reduce or avoid instances of conflicts of interests, i.e. a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest (e.g. prescription of a drug to a patient) will be unduly influenced by secondary interests (i.e. the interest of the pharma which sponsored your travel to a particular conference). The latter influence could be subconscious or a subliminal idea inserted by clever marketing tactics. The other adverse consequences of such a relationship include disruption of social trust in the profession and distal Interests (DI) which lie beyond the immediately visible COIs. These are ‘distal’ in time or place, i.e. consequences of decisions in the future or impinging on other institutions or bodies, respectively.
In judging the consequences, it is also necessary to consider the reality of the existing relationship between the pharmaceutical industry and organizers of conferences. In more developed countries these relationships are governed by stricter regulations, adherence to codes of conduct by both parties and stronger institutional oversights. In contrast, in developing countries such as Sri Lanka the regulatory environment is lax and there is room for the interests of the pharmaceutical industry to exert undue influence on the medical profession.
In such instances, establishing clear rules of engagement between the pharmaceutical industry and the profession should be considered as an attempt to clear muddy waters rather than a regressive step. The paper proposes a set of rules of engagement or guidelines based on a few principles: a) Avoid the sponsors having any influence on the decision-making of conference; b) Avoid promotion of specific products; c) Transparency of sponsorship; d) Develop guidelines for future interactions; e) Consider contextual factors such as the trust in the profession and social roles of physicians; f) Ensure that the long-term objective of the organizations are independent of influences of the industry. The hope is that the proposal will promote discussions on these matters and help to untangle conflicts of interests that are inevitable when the pharmaceutical industry sponsors academic conferences.
Author: Saroj Jayasinghe
Affiliations: Chair Professor of Medicine Faculty of Medicine of University of Colombo; Founder Head, Department of Medical Humanities
Competing interests: None
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