Doctors & Pharma Industry – Part 2 of 2 – Asrar Qureshi’s Blog Post 1218

Doctors & Pharma Industry – Part 2 of 2 – Asrar Qureshi’s Blog Post 1218

Dear Colleagues! This is Asrar Qureshi’s Blog Post 1218 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to pharmaveterans2017@gmail.com  for publishing your contributions here.

Credit: cottonbro studio

Preamble

Few relationships in modern healthcare are as debated, or as misunderstood, as that between pharmaceutical companies and doctors. To critics, it is a story of undue influence, conflicts of interest, and distorted prescribing. To defenders, it is a necessary partnership that enables medical innovation, education, and patient access to life-saving therapies.

The truth lies in between.

Code of Conduct – Pharma Companies

Pharmaceutical companies play a critical role in safeguarding public health by discovering, manufacturing, and supplying medicines. In Pakistan, where healthcare resources are constrained and patients bear a high out-of-pocket cost burden, the ethical responsibility of pharmaceutical companies is especially significant.

This Code of Conduct establishes minimum ethical standards for pharmaceutical companies operating in Pakistan to ensure that commercial activities support patient welfare, rational use of medicines, professional independence of healthcare providers, and public trust in the healthcare system. 

This Code complements national laws and regulations enforced by Drug Regulatory Authority of Pakistan and other statutory bodies.

Core Principles

All pharmaceutical business activities shall be guided by the following principles:

• Commercial success must never compromise patient safety, affordability, or access.

• All promotional and educational activities must be accurate, balanced, and evidence based.

• Companies shall respect the clinical autonomy of healthcare professionals.

• All interactions must withstand public and regulatory scrutiny.

• Legal compliance is the minimum standard; ethical conduct is the expectation.

Ethical Promotion of Medicines

All promotional materials must be consistent with approved prescribing information, present benefits and risks fairly, and avoid exaggerated, misleading, or unsubstantiated claims.  Selective presentation of data or omission of safety information is prohibited.

Companies shall not offer incentives linked to prescription volume or brand loyalty, encourage off-label use without regulatory approval, and use fear-based or emotional manipulation in promotion.

Companies must not influence prescribing through gifts, travel, or personal benefits, apply pressure tactics to achieve sales targets, and condition access to information or support on prescribing behavior.

Legitimate interactions include scientific discussions, product information aligned with approved indications, and professional service engagements under written contracts.

Pharmaceutical companies shall not provide cash or cash equivalents, personal gifts of monetary value, sponsored leisure travel or vacations, entertainment unrelated to scientific or educational purpose, and gifts to family members of healthcare professionals. 

Modest hospitality is permissible only when it is secondary to a scientific or educational event, it is reasonable in value, and it does not include entertainment. Hospitality must never be the primary purpose of an engagement.

Companies may support CME only if content is developed independently by medical professionals, speaker selection is free from company control, and multiple therapeutic options are discussed.

All sponsorships must be clearly disclosed, documented, and unlinked to prescribing expectations. “Education” designed primarily to promote a brand is unethical.

Healthcare professionals may be engaged as consultants or advisors only if there is a legitimate scientific or technical need, a written contract exists, compensation reflects fair market value, and services are documented and verifiable.

Companies must not use consultancy roles as disguised incentives, pay for advisory boards without meaningful output, and engage doctors solely to influence peers.

Medical representatives must be adequately trained in product knowledge and ethics, provide balanced and accurate information, and respect time, institutional rules, and professional boundaries. Misrepresentation, coercion, or inducement is prohibited.

Company incentive structures shall not encourage unethical conduct. 

Samples may be provided to support treatment initiation, and for patients with financial hardship. Samples must not be used to create brand dependency and influence long-term prescribing.

Patient Assistance Programs must have transparent eligibility criteria, be independent of future prescribing expectations, and fully inform patients of terms and limitations.

Companies must avoid covert digital promotion, clearly disclose sponsored online content, refrain from using influencers or doctors to promote brands without disclosure. Digital platforms are subject to the same ethical standards as traditional promotion.

This Code affirms that pharmaceutical companies can be commercially successful and ethically responsible at the same time. 

Ethical conduct builds long-term trust, protects patients, strengthens professional relationships, reduces regulatory risk, and enhances industry credibility. 

The legitimacy of the pharmaceutical industry rests not on its products alone, but on how those products are promoted and used.

Codes of Conduct – Doctors

The medical profession is founded on trust, integrity, and service to patients. Physicians hold a privileged position in society because their decisions directly affect human life and well-being. Relationships with pharmaceutical companies are legitimate and often necessary for advancing medical knowledge and patient care, but they must always be ethical, transparent, and patient-centered.

This Code of Conduct sets out minimum ethical standards for doctors when interacting with pharmaceutical companies, ensuring that clinical independence is preserved and public trust is maintained.

Core Ethical Principles

• All professional interactions shall be governed by the following principles:

• Patient interest must always override commercial, personal, or institutional interests.

• Prescribing and treatment decisions must be based solely on scientific evidence, clinical judgment, and patient needs.

• Any relationship with industry must withstand public scrutiny.

• A doctor’s conduct should uphold the dignity and credibility of the medical profession.

Prescribing Ethics

Doctors shall prescribe medicines based on clinical efficacy, safety profile, cost-effectiveness, and patient suitability. Brand preference must never be influenced by incentives.

Doctors shall not accept benefits linked to prescription volume, prescribe specific brands in exchange for gifts, travel, or favors, and allow commercial targets to influence treatment decisions.

Doctors shall not accept cash or cash equivalents, personal gifts of monetary value, sponsored leisure travel or vacations, entertainment unrelated to professional education, and gifts for family members. The following may be accepted only if modest, relevant, and non-promotional:

• Educational materials (textbooks, guidelines)

• Modest meals during scientific meetings

• Low-value items directly related to clinical practice

Doctors shall participate only in CME activities where scientific content is evidence-based, speakers are selected independently, and multiple therapeutic options are discussed. Industry sponsorship is acceptable only if content control rests with medical professionals, sponsorship is openly declared, and attendance is not tied to prescribing behavior. Doctors must decline “educational” events that are clearly promotional in intent.

Doctors may engage with pharma companies as consultants, advisors, and/or investigators in clinical research, only if there is a written contract, compensation reflects fair market value, and work performed is genuine and documented.

Drug samples should be used to initiate therapy, given to patients who cannot afford treatment, and distributed transparently and fairly. Samples must not be used to create brand dependency.

Doctors should ensure that interactions with medical representatives are time-bound, professional, and scientifically focused. Doctors should discourage exaggerated claims, selective data, or pressure tactics and should report unethical behavior where possible.

Context of Pakistan

Given Pakistan’s healthcare realities, limited institutional funding for CME, high out-of-pocket patient spending, and competitive generic markets, this Code recognizes that industry interaction is often unavoidable. However, necessity does not justify compromise of ethics.

This Code does not seek to demonize pharmaceutical companies nor isolate doctors from scientific progress. It seeks to restore balance—where collaboration serves patients, not profits.

“The strength of a profession is measured not by the absence of temptation, but by the clarity of its standards.”

Concluded.

Disclaimers: Pictures in these blogs are taken from free resources at Pexels, Pixabay, Unsplash, and Google. Credit is given where available. If a copyright claim is lodged, we shall remove the picture with appropriate regrets.

For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intent to infringe upon anyone’s copyrights. If, any claim is lodged, it will be acknowledged and duly recognized immediately.