The relationship between the physician and the pharmaceutical industry is once again put in the spotlight due to an alleged “pyramid scheme” from doctors who engage in getting credits in exchange for prescriptions AND enticing colleagues to prescribe the products of the pharmaceutical company in order to earn additional credits and benefits.

The Philippine Food and Drug Authority issued FDA circular 2013-0124 on September 5, 2013 which adopts The Mexico City Principles (https://www.fda.gov.ph/wp-content/uploads/2021/08/The-Mexico-City-Principles.pdf) for Voluntary Codes of Business Ethics in the Biopharmaceutical Sector.

The MCP was adopted in 2011 during the US APEC host year and was recognized by APEC leaders and ministers.

Six principles form the pillars of the MCP:

1. Healthcare and patient focus means everything we do is intended to benefit patients.

2. Integrity means dealing ethically, honestly and respectfully in everything we do.

3. Independence means to respect the autonomous decision-making of all parties, free from improper influence.

4. Legitimate intent means that everything we do is for the right reasons, is lawful, and aligns with the spirit and values of these principles.

5. Transparency means a general willingness to be open about our actions while respecting the legitimate commercial sensitivities and intellectual property rights.

6. Accountability means a willingness to be responsible for our actions and interactions.

During my term as director for the CDRR at the FDA, we constantly monitored and reminded the industry to manage their entanglements with physicians. While it is not wrong to promote any biopharmaceutical product, promotions should be within the scientific merits of the product, sans pomp and enticement.

Some physicians may not be able to discern entanglements with the industry as some believe that “gifts” are entitlements to them. There is no such thing as a free lunch.

The greater the value the gift, the greater the responsibility. Gifts do not need to be ostentatious to be a bribe. A bribe is a bribe, regardless of value. It is the intent that is crucial.

A lawyer commented that this practice is not illegal, but it is unethical.

Undue influence is legally defined as “influence by which a person is induced to act otherwise than by their own free will or without adequate attention to the consequences”. Undue influence clouds clinical judgement in the healthcare system.

The practice of medicine is not a business. Our relationship with patients rely on trust, compassion and respect. There should be no lines that blur the relationship between doctors and patients at all touch points.

And the guiding principles of ethics – TO FIRST DO NO HARM – is the overarching dictum that should be followed.