Intended for healthcare professionals

Education And Debate

How to dance with porcupines: rules and guidelines on doctors' relations with drug companies

BMJ 2003; 326 doi: (Published 29 May 2003) Cite this as: BMJ 2003;326:1196
  1. Elizabeth Wager, publications consultant (
  1. 1 Sideview, Princes Risborough HP27 9DE

    Interactions between doctors and drug companies can lead to ethical dilemmas. This article gives an overview of the guidance and codes of practice that aim to regulate the relationship

    Like the porcupine's quills, drug companies' interactions with doctors are numerous and can be harmful if approached the wrong way. (Lewis and colleagues used the analogy of dancing with porcupines to describe university-industry relations,1 and I liked it so much I have appropriated it.) I have aimed to highlight the major rules and guidelines relating to interactions between doctors and drug companies, but this is not an exhaustive survey.

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    Drug company codes of practice

    Codes of conduct for pharmaceutical companies developed by industry organisations tend to be voluntary but are often backed up by complaints procedures. Many countries with major pharmaceutical sectors have national codes, such as those of the Association of the British Pharmaceutical Industry (ABPI),2 Medicines Australia,3 and the Pharmaceutical Research and Manufacturers of America.4 These usually concentrate on drug companies' marketing activities—most prohibit companies from giving doctors inducements to prescribe their products in the form of payments, lavish gifts, or extravagant hospitality.

    The ABPI code stipulates that gifts from companies must cost less than £6 (about $9 or ‡8) and be relevant to the doctor's work.2 The accompanying guidance helpfully explains that pens, diaries, and surgical gloves “have been held to be acceptable,” whereas table mats, plant seeds, and music CDs are not. The level of hospitality for meetings must be “appropriate and not out of proportion to the occasion,” and costs “must not exceed that level which the recipients would normally adopt when paying for themselves.” The Australian guidelines state that hospitality should be “simple, modest [and] secondary to the educational content” of a meeting.3 The venue for such meetings “must not be chosen …

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