Dr Gerard Panting looks at how the Association of the British Pharmaceutical Industry regulates what hospitality and gifts companies may offer to healthcare professionals
- The ABPI Code of Conduct is regularly updated and sets out rules on gifts, inducements, promotional aids, and provision of medical and educational goods and services
- Inexpensive promotional aids that are relevant to the practice of the receiver’s profession or employment are allowed
- Medical and educational goods and services that enhance patient care or that benefit the NHS and maintain patient care can be provided, but these must not bear the name of any medicine
- Companies may only provide hospitality, which must not be out of proportion to the occasion, to healthcare professionals and appropriate administrative staff in association with scientific meetings and congresses, promotional meetings, and other such meetings, at venues conducive to the main event
- Direct payments to healthcare professionals are not allowed
- Sponsorship of meetings must be declared in all documents relating to the meeting and must be sufficiently prominent that all are aware of it from the outset
- Companies breaching the ABPI Code can be suspended or expelled from the ABPI, or in other less serious cases other sanctions may apply such as receiving a public reprimand, or having to issue a public apology
Just how much hospitality pharmaceutical companies can provide to doctors in the hope of winning hearts, minds, and access to the NHS wallet has been a sensitive issue for years. The Association of the British Pharmaceutical Industry (ABPI) represents more than 75 companies in the UK, promoting the industry to the Government, politicians, the media, healthcare professionals, and the general public, and regulating its members.
The ABPI published its first Code of Practice in 1958, with the most recent version coming into force on 1 January 2006.1 The ABPI Code applies to the promotion of prescription-only medicines to healthcare professionals and appropriate administrative staff, and encompasses advertising in professional journals and what pharmaceutical companies can offer to doctors. The ABPI Code also applies to non-promotional publicity including information on prescription-only medicines made available to the general public.
What does the ABPI Code say?
Gifts and inducements
The ABPI Code sets out the rules on gifts, inducements, promotional aids, and the provision of medical and educational goods and services. Clause 18.1 states that: ‘No gift, benefit in kind or pecuniary advantage shall be offered or given to members of the health professions or to administrative staff as an inducement to prescribe, supply, administer, recommend, buy or sell any medicine …’. It continues in clause 18.2: ‘Promotional aids, whether related to a particular product or of general utility, may be distributed to members of the health professions and to appropriate administrative staff, provided that the promotional aids are inexpensive and relevant to the practice of their profession or employment.’1
‘Medical and educational goods and services which enhance patient care, or benefit the NHS and maintain patient care, can be provided subject to the provisions of clause 18.1 (set out above). Medical and educational goods and services must not bear the name of any medicine.’1
Meetings and hospitality
The ABPI Code is also specific with regard to meetings and hospitality. It says: ‘Companies must not provide hospitality to members of the health professions and appropriate administrative staff except in association with scientific meetings, promotional meetings, scientific congresses, and other such meetings. Meetings must be held in appropriate venues conducive to the main purpose of the event. Hospitality must be strictly limited to the main purpose of the event and must be secondary to the purpose of the meeting, i.e. subsistence only. The level of subsistence offered must be appropriate and not out of proportion to the occasion. The costs involved must not exceed that level which the recipients would normally adopt when paying for themselves. It must not extend beyond members of the health professions or appropriate administrative staff.’1
It is not surprising that direct payments to health professionals are ruled out by the ABPI Code: ‘Payments may not be made to doctors or groups of doctors or to other prescribers, either directly or indirectly for rental for rooms to be used for meetings. …. When meetings are sponsored by pharmaceutical companies, that fact must be disclosed in all of the papers relating to the meetings and in any published proceedings. The declaration of sponsorship must be sufficiently prominent to ensure that readers are aware of it at the outset.’1
Interpreting the ABPI Code
Incorporating descriptions like ‘inexpensive’, ‘relevant to the practice’ and ‘appropriate venues’ into the ABPI Code does leave some leeway for interpretation, and even the use of a term like ‘educational’ does not mean that the content of the meeting must be solely non-promotional, simply that the educational content must be the primary focus of the meeting.
Striking the right balance
In order to strike the right balance, a number of factors must be taken into consideration. How much time will be spent on the educational activity and how much on being entertained? Are participants being lured to a highly attractive venue to sit through a lacklustre programme?
While major international meetings, with overseas expert speakers, may warrant grander surroundings, a local GP event would not be deemed to merit the same level of expenditure. When promoting the meeting, the focus should always be on the educational content rather than on ancillary arrangements, such as a luxury five course dinner with Europe’s finest wines.
Activities associated with the meeting must also relate to its main educational purpose. While hepatologists might consider wine tasting relevant to their practice, the ABPI Code would regard it as unprofessional and unacceptable. Equally, sporting activities cannot be offered as part of a meeting.
Consequences of breaching the ABPI Code
Companies found in breach of the Code of Practice can be suspended or expelled from the ABPI. In less serious cases other sanctions may be imposed. These include:1
- issuing a public reprimand
- requiring the offending company to publish a corrective statement
- recovering material from individuals to whom it has been sent
- auditing the company’s procedures to comply with the ABPI Code.
Prior vetting of future material may also be imposed.
With all the negative publicity surrounding censure for failing to abide by the Code of Practice, it is not surprising that pharmaceutical companies go to considerable lengths to ensure that they adhere to it and, at times, can appear very conservative in their approach. However, transgressions do occur.
In October 2006, a pharmaceutical company was suspended from the ABPI for transgressing the ABPI Code.2 This resulted from a complaint by a former sales representative from the company, who said that a nurse audit was not offered in accordance with the ABPI Code.
The Panel of the Prescription Medicines Code of Practice Authority, an arms-length body that administers the ABPI Code of Practice, found that the company’s own documentation clearly linked the service to the promotion of an individual medicine and that the arrangements in place were totally unacceptable.2
In addition to being suspended from the ABPI, the company was required to submit itself to an audit of its procedures, a corrective statement was published, and it was publicly reprimanded.2
What the GMC says
The General Medical Council (GMC) also has expectations of doctors. When it comes to sponsored conferences and meetings, it says that where a contributor has been sponsored by a pharmaceutical company, this should be announced at the meeting and disclosed in all the papers relating to the meeting and in the published proceedings.3 More generally, doctors must not ask for, nor accept any inducement, including gifts or hospitality, which may affect (or appear to affect) how they prescribe for, treat, or refer patients. Nor may they offer similar inducements to colleagues.
- Association of the British Pharmaceutical Industry. Code of Practice for the Pharmaceutical Industry. London: ABPI, 2006.
- General Medical Council. Good Medical Practice. London: GMC, 2006.G