“Working with the drug industry—is your reputation at risk?”

(1) Recognise the nature of the problem

Fundamentally, this is a question of different primary interests. While a public service ethos governs clinical practice and university research, the main “driver” for industry is, unavoidably, the need to protect shareholder interests. Clinicians seek better patient care, academics seek independent research that serves the public good, but industry seeks timely delivery of innovative products that will maximise financial return and shareholder value. While it does not necessarily follow that these interests are conflicting, it is at the very least necessary to recognise how easily such conflicts can arise.

(2) Understand the nature of partnership

There is a need to secure a more equal partnership reliant on pooled expertise rather than on exploitation of ignorance. Interaction between consultants and sales and marketing through drug representatives presents a risk to both sides. Each party must understand the agenda of the other, be clear as to the goals of any partnership, be clear as to the legal implications of the partnership (written or unwritten), and be transparent in their working practice.

Doctors intending to consult to the drug industry need to understand the motives and interests of their industry counterparts. It is equally important that they understand the strict regulatory frameworks that govern the actions of industry employees in order to support companies in preventing any breach of these regulations and to avoid impropriety. These range from the International Conference on Harmonisation of Good Clinical Practice (ICH GCP)⁴ in research to codes of promotional practice governing sales and marketing.⁵

(3) Be clear exactly what you’re being asked to do

Drug companies have many functional areas, including research departments, regulatory affairs, marketing, sales, and corporate affairs. How well do you understand what will be done with the work to which you are contributing? More specifically, how will your contribution be used? Do you understand the role of the person in the company who is inviting your collaboration (box 1)?

How will your work be recognised? Will you have authorship? Will you be paid? Are you acting as an individual or on behalf of your employer or other body? Should you receive payment personally or should it go to your employer? Are you trained to negotiate these conditions, and should your employer be involved in the negotiation?

(4) Formalise appropriate training in your personal development plan

The new NHS consultant contracts are time sensitive, with agreed job plans supported by appropriate personal development plans and training within the frameworks of clinical and research governance. Job plans can include specified arrangements for consultancy work and this work should be included in personal development plans. For clinicians and clinical academics who work, or intend to work, with industry the issues outlined above should be considered within the job plan and resultant personal development plan. There may well be a case for study leave and funding to train in support of this agenda. There is a pressing need to establish and regulate this field. Through training, benchmarking, and shared learning, best practice standards will emerge and can be disseminated, protecting the reputation for those who observe the standards set.

While clinicians undertaking research in collaboration with the drug industry are required to undergo ICH GCP training, there is no such requirement for clinicians to be trained with regard to promotional codes of practice before working with marketing or other corporate functions.

Some organisations provide useful guidance (box 2). This is often general in its scope, however, and does not address the real world dilemmas encountered by clinicians and academics offered money by drug companies for various activities.