Pharmacists and Industry: Guidelines for Ethical Interactions

American College of Clinical Pharmacy

Disclosures

Pharmacotherapy. 2008;28(3):410-420. 

In This Article

Guideline 4

Pharmacists who make decisions regarding the purchase, prescribing, or use of drugs or devices by others through formulary committee deliberations, clinical practice guideline development, or administrative responsibilities should avoid financial, consulting, or other relationships with industry that are or appear to constitute conflicts of interest. Pharmacists may serve as expert consultants at the request of formulary committees and clinical practice guideline panels; however, those with industry relationships should not participate in the final deliberations or vote. Furthermore, expert consultants must disclose all relationships with industry that might influence or appear to influence their objectivity.

Pharmacists may serve on committees, boards, and councils or have administrative responsibilities that determine specific drugs or devices to be purchased, prescribed, preferred, and/or recommended for use by individuals and organizations. In these activities, pharmacists must be guided by principles of honesty, fairness, and objectivity.

The pharmacist's role on a formulary committee, including full voting privileges, is particularly critical, as decisions made by the committee determine which products are available within the health care system. These decisions ultimately affect the quality of patient care by influencing the practices of prescribers, especially physicians in residency training programs. As noted previously, the OIG guidelines have identified membership on a formulary committee as a position with significant potential for abuse.[3] A pharmacist is usually responsible for developing the agenda, presenting clinical and economic information, and composing the minutes for the formulary committees—all of which are activities at risk for influence from vendors and the health care industry.[44,45] Pharmacists must fulfill these responsibilities without bias to ensure integrity in the committee decision-making process. Pharmacists involved with formulary committees also should assist with the development of a policy (if none exists) on disclosing potential conflicts of interest for committee members to avoid any appearance of impropriety with deliberations and requiring members to abstain from voting when a true conflict of interest exists with the product under discussion, the class of products, or a competitive product.[46,47,48]

Pharmacists are also involved in the development of clinical practice guidelines that address prevention, prophylaxis, and treatment. These guidelines may be institution specific, regional, national, or international in scope. As such, they guide drug therapy decisions for large numbers of patients and influence the prescribing practices of many providers. Pharmacists must maintain a strong commitment to use evidence based evaluations in developing drug use guidelines and strive to achieve optimal outcomes. Once again, disclosure of all relationships with industry should be mandatory for all participants involved in developing the practice guideline, and the potential conflicts of interest should be published as a component of the practice guideline.[49,50]

This guidance does not prevent clinical pharmacists with industry relationships from providing input into formulary or guideline development decisions. As experts in therapeutics and investigators in clinical studies, including industry-sponsored studies, clinical pharmacists are often requested by formulary committees and practice guideline development panels to serve as expert consultants. After providing expert testimony, these individuals should not participate in the final decision-making process or vote. Final decisions should be made by committee members without any relationships that could be perceived as a conflict of interest. As discussed above, industry relationships for all participants that might influence or appear to influence their objectivity, including those providing expert testimony, should be disclosed during the deliberations and included in any publication summarizing the final decisions.

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