Ethics of Pharmaceutical Company Relationships with the Nursing Profession: No Free Lunch.And No More Pens?
Crock, Elizabeth, Contemporary Nurse : a Journal for the Australian Nursing Profession
In July 2008, the drug company giants Pfi zer, GlaxoSmithKline and Roche and several others were fi ned a record $1.8 million by the industry self-regulator Medicines Australia for breaches of the industry codes of conduct (Shanahan, 2008). Many of the complaints upheld related to lavish 'educational events' for doctors. Major pharmaceutical companies in Australia spent $31 million on such events in the last six months of 2007 alone (Shanahan, 2008). Drug promotion and marketing comprise a very large proportion of drug company activities, consuming a quarter to a third of their budgets (Komesaroff & Kerridge, 2002). The activities include advertising, gifts, and travel to scientifi c meetings, as well as harbour cruises and tickets to the opera (Fyfe, 2006). So what, if anything, is actually wrong with health professionals' accepting such benefi ts?
In recent years, nurses have increasingly become benefi ciaries, or some might say targets, of pharmaceutical companies' 'generosity'. Some cite the reason behind this as being related to the increase in nurses who have the authority to prescribe. Whatever the reasons, little research has been published on the relationship between the pharmaceutical industry and nurses and the effects on nurses of receiving such gifts (see Rogers, Mansfi eld, Braunack-Mayer, & Jureidini, 2004). Jutel and Menkes (2008), in a review of the nursing literature, found that few articles expressed or reported any concerns whatsoever about the role of the pharmaceutical industry in infl uencing nurses' practice or behaviour, and those that did express concern rather simplistically argued that nurses need merely be 'aware' of the problem. This article examines the issue of nurses' accepting gifts, scholarships and other benefi ts from pharmaceutical (and other commercial businesses) from an ethical perspective. It aims to encourage nurses to examine critically the implications of deciding whether to accept or reject such gifts or sponsorship, or to enter any form of relationship with commercial companies within the health sector.
ARE NURSES BENEFITING FROM DRUG COMPANY LARGESSE?
It is clear that the infl uence of drug companies now extends far beyond doctors, to nurses, pharmacists, students and even to patients (Kmietowicz, 2004). In the United Kingdom, drug companies are now running educational 'diploma' courses for nurses; one general practitioner, learning about such sponsored training, is quoted as saying, 'it is interesting how local nurses recommend changing to a different pen system or [...] product. [...] we were all uncomfortable about the different gadgets being recommended, and it all makes sense now' (Heath, cited in Kmietowicz, 2004, p. 1206). Nurses have been referred to as 'soft targets' of drug company promotion, as the industry recognises nurses' infl uence on medical prescribing, and is 'heavily invested' in targeting them; but, as Jutel and Menkes (2008) point out, nursing education fails to prepare them to deal with or understand the industry's promotional tactics.
In one pertinent Australian article, the authors discussed the ethics of pharmaceutical relationships with medical students (Rogers et al., 2004). They note that students who receive gifts may believe they are receiving 'something for nothing, contributing to a sense of entitlement that is not in the best interests of their moral development as doctors' (Rogers et al., 2004, p. 411). They also point out that alternatively, students may be subject to reciprocal obligations that might infl uence their decision-making. These authors see most of the potential moral harms to students who accept such gifts are harms to their 'social and moral characters' (Rogers et al., 2004, p. 411). They base their analysis on the assumptions that students' characters are shaped in lasting ways by their education in medicine, and that some character traits in doctors are considered 'more ethically desirable than others' (p. …