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

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 …