by Amy Spangler
April 15, 2009

The recent decision by the International Lactation Consultant Association (ILCA’s) to ban a breast pump company from exhibiting at its annual conference and advertising in its professional journal was met with both adulation and consternation. The adulation emanated from those who believe that the International Code of Marketing of Breast-Milk Substitutes needs to be vigorously enforced. Consternation was expressed by those wondering how ILCA’s decision will impact their relationship with Medela, the company whose marketing practices are at the center of the controversy. (Read more on baby gooroo here.)

As evidence that ILCA is not alone in its concern over industry relationships, another article on the subject was recently published in the April 1, 2009 issue of the Journal of the American Medical Association (JAMA).

In the JAMA article, David Rotham, PhD and colleagues explore the relationships between professional medical associations and industry (particularly pharmaceutical and device makers). They discuss real and perceived conflicts of interest, formulate guidelines for prevention, and cite the need for sacrifice on the part of health professionals and the organizations that represent them. They acknowledge the role professional associations play in protecting the public by disseminating evidence-based information and recommendations and establishing ethical codes of conduct for its members. They also caution that the stronger the ties between industry and health professional associations, the greater the likelihood that clinical decision making, health care delivery, and the reputation of the profession will be adversely affected. They offer a list of suggestions for how to reduce or eliminate conflicts of interests:

• Ban industry funding with the exception of exhibit hall fees and journal advertising. Both are non-educational, marketing activities that members can choose to ignore.

• Restrict industry support to no more than 25 percent of an association’s operating budget, as an interim step toward a total ban on industry support.

• Establish a continuing education committee comprised of individuals who have no affiliation with industry. Give this committee exclusive control over educational programs including speakers and topics. Ban industry funding of specific topics or speakers.

• Ban the distribution of all promotional items such as tote bags, name tags, and notebooks to conference participants.

• Establish standards for conduct in the exhibit hall and enforce those standards, including a ban on all gifts and food.

• Industry funding intended for research should be channeled through a central committee. No conditions should be attached to the funding and recipients should have no knowledge of the source of the funding.

• Ban endorsements of commercial products by health professional associations. Require the same standard of conduct from affiliated foundations.

• Require that all directors and officers of the association be free of conflict of interest.

What price integrity?
Industry sponsorship is so common (Rothman and team term it “pervasive”) that most health care professionals view it as acceptable, but nothing could be further from the truth. It’s time for everyone to make a clear distinction: health care providers and health professional associations market health; industry representatives and the industries they represent market products—products that, too often, health care professionals and health professional associations promote through the distribution of samples, coupons, and discharge bags—freebies that everyone knows are not free. The changes that Rothman and his colleagues are suggesting, demand not only a change in personal conduct but a much needed change in the culture in which we all live and work.

It won’t be easy, and it won’t be painless.

But if not now, when? And if not you, who?