WMA Statement concerning the Relationship between Physicians and Commercial Enterprises
Adopted by the 55th WMA General Assembly, Tokyo, Japan, October 2004,
amended by the 60th WMA General Assembly, New Delhi, India, October 2009
and by the 71st WMA General Assembly (online), Cordoba, Spain, October 2020
In the treatment of their patients, physicians use medicines, instruments, diagnostic tools, equipment and materials developed and produced by commercial enterprises. Industry possesses resources to finance expensive research and development programmes, for which the knowledge and experience of physicians are essential. Moreover, industry support enables the progress of medical research, scientific conferences and continuing medical education that can be of benefit to patients and the entire health care system. The combination of financial resources and product knowledge contributed by industry and the medical knowledge possessed by physicians enables the development of new diagnostic procedures, drugs, therapies, and treatments and can lead to great advances in medicine.
However, conflicts of interest between commercial enterprises and physicians occur and can affect the care of patients as well as the reputation of the medical profession. The duty of the physician is to objectively evaluate what is best for the patient and to promote the patient-physician relationship, while commercial enterprises are expected to bring profit to owners by selling their own products and competing for customers. Commercial considerations can affect the physician’s objectivity, especially if the physician is in any way dependent on the enterprise.
Rather than forbidding any relationships between physicians and industry, it is preferable to establish guidelines for such relationships. These guidelines must incorporate the key principles of disclosure, transparency, avoidance of conflicts of interest and promoting the physician’s ability to act in the best interests of patients.
The guidelines regulating the Physician-Commercial Enterprise relationship should be understood in the light of WMA core ethical values, as stated in particular in the Declaration of Geneva, the International Code of Medical Ethics. the Statement on Conflict of Interest, and the Declaration of Seoul on Professional Autonomy and Clinical Independence.
The autonomy and clinical independence of physicians should be foremost in all physician decisions for patients, regardless of practice setting, whether government-sponsored, private, for profit or not for profit, investor funded, insurance company employers or otherwise.
Curricula of medical schools and residency programs should include educational courses on the relation between enterprises and the medical profession in the light of ethical principles and values of the profession.
- These guidelines related to medical conferences apply, where pertinent, to corporation events, such as educational events, and promotional activities including for items of medical utility, sponsored by a commercial enterprise.
- Physicians may attend medical conferences, sponsored in whole or in part by a commercial entity if these conform to the following principles:
- The main purpose of the conference is the exchange of professional or scientific information for the benefit of patient care.
- Hospitality during the conference is secondary to the professional exchange of information and does not exceed what is locally customary and generally acceptable.
- Physicians do not receive payment directly from a commercial entity to cover travelling expenses, room and board at the conference for themselves or an accompanying person or compensation for their time unless provided for by law and/or the policy of their National Medical Association, or unless it is a reasonable honorarium for speaking at the conference.
- The name of a commercial entity providing financial support is publicly disclosed in order to allow the medical community and the public to fairly evaluate the information presented. In addition, conference organizers and lecturers are transparent and disclose any financial affiliations that could potentially influence educational activities or any other substantial outcome that may result from the conference.
- In accordance with the WMA Guidelines on Promotional Mass Media Appearances by Physicians, presentation of material by a physician should be scientifically accurate, give a balanced review of possible treatment options, and not be influenced by the sponsoring organization.
- In addition, a conference can be recognized for purposes of continuing medical education/ continuing professional development (CME/CPD) only if it conforms to the following principles:
- The commercial entities acting as sponsors, such as pharmaceutical companies or enterprises in the medical devices sector, have no influence on the content, presentation, choice of lecturers, or publication of results.
- Funding for the conference is accepted only as a contribution to the general costs of the meeting.
- The independence of the contents of the conference is guaranteed.
- To preserve the trust between patients and physicians, physicians should decline:
- cash, cash equivalents and other gifts for personal benefit from a commercial entity
- gifts designed to influence clinical practice, including direct prescription incentives.
- Physicians may accept:
- Promotional aids provided that the gift is of minimal value and is not connected to any stipulation that the physician uses certain instruments, medications or materials or refers patients to a certain facility.
- Cultural courtesy gifts on an infrequent basis according to local standards if the gift is of minimal value and not related to the practice of medicine.
- A physician may carry out research funded by a commercial entity, whether individually or in an institutional setting, if it conforms to the following principles:
- The physician is subject only to the law, the ethical principles and guidelines of the Declaration of Helsinki, and clinical judgment when undertaking research and should guard against external pressure regarding the research results or its publications.
- If possible, a physician or institution wishing to undertake research approaches more than one commercial source for research funds.
- Identifiable personal information about research patients or voluntary participants is not passed to the sponsoring company without the consent of the individuals concerned.
- A physician’s compensation for research is based on his or her time and effort and such compensation must not be connected to the results of the research.
- The results of research are made public with the name of the sponsoring entity disclosed, along with a statement disclosing who requested the research. This applies whether the sponsorship is direct or indirect, full or partial.
- Commercial entities allow unrestricted publication of research results.
- Where possible, research financed by commercial enterprises should be managed by interposed, non-profit entities, such as institutes or foundations.
Affiliations with Commercial Entities
- A physician may not enter into an affiliation with a commercial entity, such as consulting or membership on an advisory board unless the affiliation conforms to the following principles:
- The affiliation does not compromise the physician’s integrity.
- The affiliation does not conflict with the physician’s obligations to his or her patients.
- The affiliation or other relationship with a commercial entity is fully disclosed in all relevant situations, such as lectures, personal appearances, articles, reports and influential contributions to the mission of medical associations or other non-profit health entities.