Letters to the Editor

Indian Pediatrics 2002; 39:696-697

Ethical Issues of Conferences and Pharmaceutical Sponsorship

I read with interest the viewpoints (1,2) and have the following comments with regards ethical issues of conferences and pharmaceutical sponsorship. Both authors have identified and highlight a series of problems.

Problem I: The crux of the matter lies in each of our personal objectives of attending a national conference. It may be for academic continued medical education, social fellowship and interactions, or, purely for a family vacation. One tends to believe that many attend predominately for the latter two reasons, the first reason being incidental. The number of delegates attending of late makes it even unreasonable to expect the academic reason to be possible with existing infrastructure.

A Solution: A simple measure of encouraging academic reasons for attending CMEs would be to recommend the need for biyearly local medical council re-registration. This would require a minimum point system based on IAP recognized CME attendance and post test evaluations on CME topics.

Problem II: Too many people, inadequate infrastructure!

A Solution: The logistic nightmare could be lessened with alternate year National Conferences (therefore, alternate year executives!). As suggested, these can be interspersed with strengthened Zonal conferences. Multiple small halls with specific sub-specialty compact crisp, brief schedules should make the day. All conferences should immediately ban non-essentials like bags, mementos and expensive banquets. Instead this should be replaced with text material of all talks and discussions including presentations. Restriction to only a few cities in rotation is not fair especially since it is a National Conference. Instead by the restriction of delegate numbers (depending upon venue) and pre requested areas of interest would improve overall quality. Depending upon IAP state wise registered members and location of venue, available delegate numbers can be allotted. (This will encourage membership!)

Problem III: Erratic quality of presentations, selection of topics/speakers!

A Solution: Either event managers or local organizing teams could suffice in terms of non-scientific logistics and organization. Individual capabilities will have to be considered in the selection. More important is the selection of speakers and topics. No pharmaceutical company should dictate or be allowed to run sessions (even if it is on inhaler therapy!). Criteria of selection of speakers should be laid out and based on original publications, work, teaching/speaking abilities and areas of interest all taken into consideration. Interaction and debate should be the objective. Conflicts of interest should be declared by all speakers’ not restricted only to conflict as being a company employee, but to favours received (trips to Paris/ Barcelona for training!; company sponsored transport/ accommodation/ slides!). There should be no chairpersons who tend to become speakers sometime during their chairing a session. Enthusiastic and efficient no-frill moderators could briefly introduce speakers, keep time and thank them. They could also collect and rapidly complete question time.

Problem IV: Unethical Pharmaceutical sponsorship of delegates, faculty and conferences.

A Solution: Conflicts of interest are ethically perilous because they may harm patients, impair physicians’ judgments, and undermine trust in Physicians. However I would suggest the middle path and not be an extremist. There should be no direct payments to attend meetings or lavish entertainment that has no clear educational or scientific justification. Organizers should retain complete control over scientific content and choice of speakers and companies should not select participants or delegates. Events should be scientific events not promotional events. They should remain independent, objective, balanced and should have scientific rigour. Certain practices could be allowed as acceptable. Assistance with printing and distribution of abstracts, exhibition stalls, and distribution of basic stationary are some practices. Drug companies should be encouraged to support jointly and such pooled support would be more balanced. The primary concern should not be our own personal convenience or well-being but the best interest of our patients (3).

The proposal to hold a self-paid National CME does reduce all sponsorship dictating scientific content, reduces expenses and also allows for a fair control over choice of excellent faculty. However, it will fail in preventing companies sponsoring delegates as an astute colleague mentioned! This I feel will need a more public awareness of the direct and indirect involvement of pharmaceutical industry in our clinical patient decision making process. We have to change and the IAP must clean itself to clean the system around us.

1. Srivastava RN. XXXIX Annual Conference of IAP. Indian Pediatr 2002; 39: 444-445.

2. Agarwal S. Pharmaceutical Industry and Sponsorship of Delegates for National conferences. Indian Pediatr 2002; 39: 445-448.

3. Lo B. Conflicts of Interest. In: Resolving Ethical Dilemmas: a guide for clinicians. Eds. Lo B, Baltimore, Williams &Wilkins, 1995; pp 265-306.