Professor Warwick Anderson, the ceo of the NHMRC, recently set the cat amongst the pigeons with a call for doctors and other health professionals to avoid appearing in advertising for pharmaceuticals or other health and medical products. He also suggested that they steer clear of commercially driven disease-awareness campaigns.

At the time, I thought it a big call which wouldn’t necessarily garner widespread support. However, you can see below that much of the feedback, from various groups and individuals, is broadly supportive. I wouldn’t be surprised though if it’s also generated some behind-the-scenes muttering, given the proliferation of promotional professionals.

Professor Garry Jennings, Director, Baker IDI Heart and Diabetes Institute, agrees with Anderson:

“I agree with Professor Anderson, especially in relation to participation in commercial advertising. In our field, if something is worth saying, it is worth doing so in the thousands of peer review journals that are published each week. The public and our peers have a right to know who is behind the scenes and whether a particular view is freely expressed or bought.

That said, a blanket ban might not be so important if there was frank and open disclosure – it’s the relationship being there and NOT being disclosed that causes the greatest problems.

In this respect, participation in commercial advertising may be less problematic than the more surreptitious alliances that are sometimes present in relation to advertorials and disease awareness programs. With advertising it is for the most part clear that the health professional and the pharmaceutical company are in league, almost certainly under a commercial arrangement which is arguably no different to a respected sports star participating in fast food advertising (and probably less harmful).

Disease awareness campaigns are more complex though, and health professionals should be very careful how they are quoted in them whether or not they are being paid. There is often not a good match between disease burden and hype and although a new treatment for a disease for which there has previously been no treatment is often worth telling people about, there are enough examples where health professionals have been manipulated by companies paying for their commentary in the cause of public awareness for us all to heed Professor Anderson’s advice to take extreme care.

I have personally experienced situations when my freely expressed and well meant views were dressed up in advertorials and surrounded by material that the casual reader might reasonably assume was mine.”

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Medicines Australia. A spokesman, speaking on behalf of chief executive, Ian Chalmers, disagrees:

“This is a matter for judgment by the individual medical practitioner involved. There is no reason why an appropriately qualified medical specialist should not be free to impart knowledge and information about the efficacy of a medicine with which he or she is familiar.”

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Dr Chris Mitchell, president of the Royal Australian College of General Practitioners, agrees:

“The RACGP has endorsed the AMA Code of Ethics 2006 and we believe that general practice is an ethical and honest profession. As a part of this, we have agreed that RACGP members should not participate in commercial advertising or advertorials.

The RACGP has a sponsorship policy which clearly states that any sponsorship activity should be in line with the principles of the AMA Code of Ethics.

The RACGP has agreed that college members should not be involved in/ appear in advertising of commercial products where it appears the GP is endorsing that product. The RACGP believes in the primacy of the GP/ patient relationship and believes that GPs should not enter into any arrangement that would impact on this.”

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Dr Rosanna Capolingua, president of the AMA, agrees:

“As found in the AMA’s Code of Ethics (and supported in our Position Statement on Advertising and Public Endorsement) the AMA advises doctors:

2.2.3        Do not endorse therapeutic goods in public advertising

2.2.4        Exercise caution in endorsing non-therapeutic goods in public advertising.

Further, health care professionals are currently not allowed to undertake such endorsements, as covered in the Therapeutic Goods Advertising Code 2007, as follows:
(b) Advertisements must not contain or imply endorsement by:
(i) any government agency;
(ii) hospitals and other facilities providing healthcare services;
(iii) individual or groups of healthcare professionals, other than where
the emphasis is on the availability, which may include the price of
therapeutic goods through his/her retail business; or
(iv) by individuals, who are healthcare professionals by way of their
representation in advertisements or academic qualifications, and /
or who are likely to be known as healthcare professionals by the
reasonable person.

There may be a serious perception of a conflict of interest for doctors who publicly advertise or endorse therapeutic goods – that doctors will prescribe or recommend a medication with which they are publicly associated rather than a more effective (or cost-effective) treatment. We need to ensure that patients continue to trust their doctors to prescribe or recommend treatments in the patient’s interest (and not the doctor’s perceived self-interest).”

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Associate Professor Merrilyn Walton, University of Sydney, agrees:

“The role of pharmaceutical companies is to make a profit – their marketing is designed to sell their drugs. Health professionals are required to put the best interests of patients first. By promoting a particular drug (in the context of little knowledge about a drug and its role in improving a particular patients health care) health professional are putting the interest of the drug companies ahead of the interests of patients. The public needs to be able to trust health professionals and their judgements about the best drug for them- if they are compromised in advertising, the perception of trust is lost. If there is a payment or advantage to the health professional there is a real conflict rather than a perceived one.”

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Michael Roff, CEO of the Australian Private Hospitals Association, has a bob each way:

“This is an important issue and we are pleased to see the NHMRC will be fostering the debate by hosting a forum next year. As I read Professor Anderson’s comments, he is saying while his personal advice is for health professionals not to participate in such campaigns, he goes on to say if they do, there should be full and open disclosure and I think that this is the real issue. Otherwise are we saying that Professor Ian Frazer should not have been involved in promoting the benefits of Gardasil, even though he openly disclosed he received a financial benefit from the commercialisation of the vaccine?

There are complex issues involved but full disclosure of interests would appear to be a reasonable course of action. I understand that in Australia, both the pharmaceutical and medical technology industries have codes of conduct that deal with the issues of disclosure. Whether or not these mechanisms are resulting in appropriate levels of disclosure or whether their scope is adequate may require further examination.

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The Australian Healthcare & Hospitals Association also has a bob each way:

“The AHHA recognises the high level of trust consumers place in doctors and health services and therefore supports a system of full disclosure of financial arrangements between any health professionals and health service providers and the sellers of pharmaceuticals and other health care products.

It is essential that consumers can trust that advice they receive from their health care provider is unbiased by any commercial interest and based solely on the professional opinion of the provider.

A perception of bias among health care providers can be as damaging to consumers’ trust in the health system as an actual bias. Therefore, while the AHHA does not support a ban on health professionals’ involvement in advertising and promotional activities, we do support the mandatory disclosure of thus involvement to patients.”

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Professor Peter Brooks, Executive Dean, Health Sciences, University of Queensland, agrees – because the proposal would lead to “more transparency”.

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