3. Ethical Medical Practice

3. Ethical Medical Practice

3.1  The DRS believes that improving well-being, minimising harm, respecting individual freedom and dignity and working for social justice are principles underlying ethical medical practice.

3.2  The DRS recognises that conflicting interests can make claims on medical practitioners, and believes that the interests of individual patients and the community generally take precedence over a practitioner’s self-interest and obligations to professional peers.

3.3  The DRS believes that the conduct of medical practitioners should respect the rights of patients.  (see 2. Health Rights)

3.4  Financial and Industry Influences:

3.4.1  The DRS believes medical practitioners should not allow commercial or financial interests to bias advice given to patients (e.g. about private vs. public access to surgery), or management (e.g. refusing to provide necessary services for public patients).

3.4.2  The DRS recognises that medical practitioners may be influenced by promotional activities and that misleading promotion may be harmful. The DRS recognises that conflicts of interest commonly exist between rational use of treatments and the commercial imperatives of manufacturers. Consequently, the DRS believes that the best sources of information for medical practitioners about treatments are those which are evidence-based and independent of manufacturing companies. The DRS supports government funding of such independent education.

3.4.3  The DRS believes company representatives and advertising should not be a primary source of information for medical practitioners.  Company sponsorship of educational events is only appropriate if it does not interfere with the educational value of the event.

3.4.4  The DRS believes that regulation of promotional activities of industry must include sanctions serious enough to make unethical or harmful promotional practices unprofitable. The DRS supports a decreased reliance on self-regulation by industry of promotional materials, and an increase in government regulation.

3.4.5  The DRS recognises that medical practitioners are offered inducements from private companies and the cost, even if small (e.g. pens), is part of an advertising budget ultimately paid for by consumers.The DRS believes no inducement should be accepted.

3.4.6  The DRS recognises the potential conflicts of interest that exist when health product manufacturers sponsor health consumer organisations. The DRS believes that consumer organisations should have sufficient independent funding that reliance on industry funding is unnecessary.

3.4.7  The DRS believes that authors of publications or presentations including information about health care should declare any relevant conflicts of interest, regardless of the medium in which they are published.

3.4.8 The DRS believes that the use of the use of relative rather than absolute measures can be misleading and adversely affect doctors’ prescribing.

3.5  Research:

3.5.1  The DRS believes experimentation should be carried out in line with National Health and Medical Research Council guidelines and the Declaration of Helsinki, and supports the role of ethics committees in assessing and monitoring the use of humans and animals in research and teaching.

3.5.2  The DRS believes the use of subjects (human or non-human) in research and teaching is only justifiable if the likely benefits of their use will clearly outweigh any inconvenience or suffering caused to the subject.

3.5.3  The DRS believes students should be allowed to refuse on ethical grounds to participate in research and teaching involving animals.  The DRS believes that adequate provision should be made for these students to be taught and assessed by alternative means, and supports the use and development whenever possible of alternatives (e.g. computer simulation, in-vitro experimentation).

3.5.4  The DRS believes that scientific developments and research in contentious areas (e.g. genetic manipulation, cloning, IVF, organ transplantation) need to be closely monitored and should not occur without clarifying potential benefits and risks, and broadly assessing community views regarding its desirability.

3.5.5  The DRS believes that issues addressed by research and teaching should demonstrate appropriate gender balance.

3.5.6  The DRS believes that decision-making in health care is ideally guided by the best available research evidence, in combination with clinical experience and the patient’s own opinions and values.

3.5.7  The DRS supports measures to improve the accessibility of research publications and publications which systematically review the evidence base. Such measures include the publication of research in open access journals and other publicly accessible media.

3.5.8  The DRS recognises that the incomplete publication of research findings is a threat to the integrity of the scientific record and potentially harmful to patients. The DRS believes that researchers and sponsors of research have an obligation to publish or make available all results from research, and to share full clinical trial reports and appropriately de-identified data with other researchers for the purposes of systematic review or other independent analysis.

3.5.9  The DRS believes that clinical trial protocols should be published in publicly accessible registries prior to trial commencement, and that mechanisms should exist for identification of unpublished trials. Such protocols should include prespecification of main outcome measures to guard against incomplete reporting of outcomes and post hoc modification of outcomes, which can bias the scientific record.

3.5.10  The DRS believes that health research should be funded according to public health needs rather than opportunities for profit. To this end, the DRS supports a greater role for public funding of health research and the setting of research priorities by bodies independent of drug and device manufacturers.

3.5.11  While recognising the important role of sponsorship of research, the DRS believes that the conduct of research and the manner of publication of results should be independent from the sponsor.