Pharmacists and Industry: Guidelines for Ethical Interactions

The American College of Clinical Pharmacy recently updated their Guidelines for Ethical Considerations: Pharmacists and the Pharmaceutical Industry. The guidelines were published in Pharmacotherapy 2008 28(3) and are available here for online perusal.

The ten guidelines cover numerous subjects such as gifts, managing conflict of interest, modest meals and appropriate honoraria, and continued education. The guidelines “recognize that certain relationships between industry and pharmacists are ethically appropriate, often beneficial, and unavoidable.

The guidelines go beyond defining an ethical relationship between the pharmaceutical industry and clinical pharmacists in hospital and community practice. It also includes pharmacists involved in formulary committees, institutional review boards, and academia (research and education). However, it lacks clarity with respect to pharmacists employed in health insurance companies and pharmaceutical companies.

The guidelines define a conflict of interest as a set of conditions in which professional judgment concerning a primary interest (e.g., research or patient welfare) tends to be unduly influenced by a secondary interest (e.g., financial gain). Arguably, based on this definition of conflict of interest, a pharmacist employed (i.e. for financial gain) in a health insurance company or pharmaceutical company and party to activities that unduly influence her/his professional judgement, has a conflict of interest. Let me expand on this point. A pharmacist employed by a health insurance company who is partly to the development and implementation of a highly restrictive formulary that adversely impacts the quality of life of patients has a conflict of interest. Or, a pharmacist employed by a pharmaceutical company who is involved with setting the pricing policy for a new medicine that is beyond the reach of most patients has a conflict of interest. Does employment in such institutions constitute a conflict of interest when the interests of patients are not fully served? The definition in the guidelines suggests it is.

What are your views?

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