The medical profession and the pharmaceutical industry: when will we open our eyes?

Comment: I commend Masters on his personal code of conduct in dealing with the pharmaceutical industry. I also share his concerns about the ethical minefield that lurks in the interface between complementary and conventional medicine. Some of the issues involved have recently been explored in the Journal’s series on Complementary and Alternative Medicine.1

However, his scenario of a doctor selling vitamin E to patients raises specific concerns, and the Australian Medical Association’s Code of Ethics2 provides some ethical principles in this regard. Specifically, it states that a doctor should:

• “make sure that you do not exploit your patient for any reason”

• “exercise caution in publicly endorsing any particular commercial product or service not covered by the Therapeutic Goods Advertising Code”3 and

• “when referring your patient to institutions or services in which you have a direct financial interest, provide full disclosure of such interests”.

Translating these principles into daily professional conduct means the practitioner must at all times declare pecuniary interest in the sale of products and be aware of the evidence base of the commercial recommendation so as to not mislead the patient. This involves clear communication of potential benefit, adverse effects, and possible drug–drug interactions of whatever product is promoted.

But, above all, the whole thrust of the AMA Code of Ethics is to ensure that perverse incentives remain foreign to the patient–doctor relationship. Ultimately, it is an individual doctor’s choice.