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This in part reflects public concern about the probity of the relationships between doctors and the pharmaceutical industry,2 and many doctors share this concern.3 The perception is one of cosy deals and greed to the advantage of doctors and companies at the expense of patients.4,5 This state of affairs risks the reputations of both doctors and companies.6 The professional behaviour of physicians and surgeons has never been under greater public scrutiny and subject to greater independent regulation.7 This extends to all areas of professional practice, including consultancy to commercial organisations. While clinical and research practice have robust governance requirements, including specified training, appraisal and peer review, they appear to be almost absent in respect of consultancy to the pharmaceutical industry.8 Few medical professional guidelines on best practice exist and those that do remain at the level of principle rather than practice.9 The pharmaceutical industries in the UK, through their trade association the Association of the British Pharmaceutical Industry (ABPI), have recognised this problem and are taking action. They invited revised guidance on promotional practice from the Prescription Medicines Code of Practice Authority (PMCPA), an independent regulatory group set up to self-regulate ABPI members’ promotional behaviour. This places good promotional practice requirements on ABPI members beyond that required by the regulator, the Medicines and Healthcare products Regulatory Agency (MHRA).10 The problem is that guidance developed by the ABPI has not been widely known or accessed by physicians. Their Code Awareness Day 2006 focused mainly on raising awareness of the code among doctors and between 2006 and 2007 this rose from 52% to 73%.11 Nurses, pharmacists and NHS management will continue to be targeted. The revised ABPI guidance issued in April 2006 responded to the challenge and further restricts the range of benefits that can be offered in the context of promotion to healthcare professionals. Industry additionally recognised the extension of prescribing roles in nursing and pharmacy. The guidance originally designed for pharmaceutical physicians has been summarised in a version for health professionals. The focus and the responsibilities, however, still lie with the pharmaceutical side of the partnership.12 The ABPI code of practice for the pharmaceutical industry 2006 and its guidance notes for health professionals entitled Understanding the ABPI code of practice for the pharmaceutical industry, controls on the promotion of prescription pedicines in the UK,13 are freely available to download on the ABPI website (www.abpi.org.uk). The code is based on principles. Promotion should: • be overt, not covert • follow licence • inform prescribing decisions • be rational ethical and professional • have ‘no strings attached’ • offer ‘no free lunch’ • not be to the public. These principles underpin guidance in respect to all aspects of promotional work. The main provisions in the code are as follows. • It guides in respect of the promotion of prescription medicines to health professionals and NHS managers, not over-the-counter medicines. • Promotion to the public is not allowed except in the instance of vaccination campaigns with ministerial approval. • Promotion must not be disguised and any sponsorship by a pharmaceutical company must be declared. • Promotion before regulatory approval of a medicine for use in the UK is not allowed. Relevant factual information can be shared with policymakers and senior health planners where there are significant financial implications of a new medicine or indication. International conferences held in the UK may see EDITORIALS

The ABPI code of practice: controls on the promotion of prescription medicines