Time to move from rhetoric to reality
The perception of appropriate interactions between doctors and pharma has changed dramatically; scepticism surrounds the intent of industry and there are concerns for the vulnerability of doctors in the relationship. Stringent guidelines have been introduced with doctors expected to make multiple conflict of interest statements and public databases of spend fast becoming the norm for industry. This elicits regular debate about the nature and consequences of relationships. As one of the most contentious issues in healthcare, views range from pledges for no interactions at all, through to consideration that collaborations are essential to underpin scientific advances. Opponents of relationships purport that financial gains from the interactions influence prescribing habits whereas supporters feel that conflating an ethical issue with a financial one will only hinder the production of new/improved treatments.

There is agreement that pharma and healthcare professionals must focus on the goal of improving health. However, we have lost sight of shared aspirations between medical and pharmaceutical professionals. It is in everyone's interest that medicines are safe and effective; it is not credible to imply that healthcare professionals are easy victims to an industry that readily fools them. Many medical leaders find it condescending to be considered so malleable to 'marketing exercises' and it is offensive to suggest they cannot conduct an ethical exchange with industry.

Despite strong differences of opinion, this is the critical time to determine how to establish and nourish authentic alliances between professionals. 

There are three core challenges:

1. Equipping medical communities with greater 'promotional literacy' so they can discern between clinical information and commercial embellishment.
   
   
2. Encouraging adoption of 'good relationship practice' (GRP) protocol to consolidate all guidelines and limit the potential for poor experiences to eclipse interactions of merit.
   
   
3. Ensuring both parties are transparent about combining research, clinical and educational endeavors within a framework of professional networking.

The media prefer to publish stories about unsafe drugs, doctors who succumb to financial incentives and sensationalism that data have been withheld or played down. This fuels fears that interactions with industry erode medical professionalism. Yet, there are numerous examples where industry readily awards grants for scientific meetings that are important to the research community without expectation that promotional information will be included.

Industry's best interest is to develop drugs that help healthcare professionals excel and each must achieve this within a highly-regulated environment where governments, trade associations, professional societies and individual company codes of practice apply to protect scientific integrity. Medical innovation may be hindered if we further limit interactions. Medical professionals and industry researchers may find it equally frustrating if this limits their professional aspirations.

Pharma is held responsible for the rising costs of healthcare because companies are rewarded for the risks taken to develop drugs. Yet it is easy to ignore that products developed within pharma have consistently improved human health for three decades. Industry capitalizes on our desire to live longer, healthier lives; it is a victim of its own success in meeting our desires. When industry, physicians and academia collaborate, the most likely result is expediency in producing new treatments. The first step to recover the value of relationships is to accept that both parties must assume accountability for the transparency and outcomes of their collaborations.

One way to smooth interactions and allay fears, is to include more teaching of drug development. The pharmaceutical industry claims that 35 per cent of the estimated $9—14bn it spends each year on pharmaceutical marketing goes towards educational support. If pharma-sponsored CME is no longer allowed we may witness tomorrow's doctors practicing yesterday's medicine.

Three changes can be made easily without introducing yet more stringent regulations:

1. Improving promotional literacy with key objectives to ensure that medical professionals can:

1. Disentangle commercial reasoning from clinical applicability.
2. Judge the methodological qualities of clinical trials.
3. Comprehend comparative outcome measures used in clinical trials.
4. Eliminate emotive distortion to facilitate subjective assessment.

2. Adhering to GRP. A guide to good relationship practice has been drafted that centres on these questions:

1. Do interactions encourage scientific information exchange or broaden skill sets with ultimate benefits to patient care?
2. Do interactions require a minimal level of promotional literacy to guarantee merit?
3. Could interactions be perceived to be damaging to the participants' integrity?

3. Engaging authentically and transparently in an environment where all voices broadcast equally. This will be helped by:

1. Adopting of more 'neutral' web and multimedia technologies that have public access for review and approval.
2. Reducing the frequency of sales-rep visits that are considered to be of 'product bias'.
3. Using professional networking facilities like myPHID, which invites all stakeholders in the challenges of healthcare to communicate commendably.

Responsible leadership is no longer about influencing opinion but is instead about aligning aspirations and realising ambitions. Doctors champion patient needs and pharma requires a positive presence in healthcare, committed to addressing these needs. Both groups want to make necessary moves to improve interactions. Embracing a new era of engagement and acknowledging the positive aspects of aligning will move this debate from rhetoric to reality.