MIDIRS Essence > March 2010 > Informed Choice

Just a harmless perk of the job…?

Originally posted on Mar 2010

The role of the health care professional is well recognised: it engenders widespread public respect and trust and can offer significant influence on the values and attitudes of society in terms of health promotion and protection from harm.

Such accolade is entrenched in tradition, through a number of eminent men and women who laid the framework for what constitutes the acceptable standard and conduct of a professional. It is probably for this reason that, where a health professional recommends or endorses a given product, this will be seen as being associated with their professional, and not personal, status. This ‘halo’ effect of practitioners’ association with a brand or product is therefore highly valued by the companies who are manufacturing them (UNICEF UK Baby Friendly Initiative 2009a). This can apply to a diverse range of products, from smaller items such as branded pens, post-it pads, mugs and diaries through to more overt forms of commercial sponsorship. These include: practitioners’ attendance at industry-funded study days and events; funding for staff positions/clinical roles and facilities/equipment; and collaborative partnerships and sponsorship within longer-term service developments, education and research programmes. In the UK, drug companies are running educational ‘diploma’ courses for nurses, which could be seen as filling a gap in NHS resources in a climate where practitioners receive very little financial support for undertaking continuing professional development (Crock 2009). However, a ‘conflict of interest’ can be encountered as personal interests may prevail over a professional role, which can in turn affect professional decisions and judgements (Beauchamp & Childress 2009).

However, what exactly constitutes commercial sponsorship? The Department of Health (DH 2000) has issued guidance about these issues in their publication, Commercial sponsorship: ethical standards for the NHS (DH 2000) and defines commercial sponsorship as encompassing the following:

‘NHS funding from an external source, including funding of all or part of the costs of a member of staff, NHS research, staff training, pharmaceuticals, equipment, meeting rooms, costs associated with meetings, meals, gifts, hospitality, hotel and transport costs (including trips abroad), provision of free services (speakers), buildings or premises.’ (DH 2000)

The guidance also points out that such collaborative partnerships with industry can afford a number of benefits where they improve the health of the local population and the health services provided for them. It is understandable that these opportunities are tempting where individual NHS Trusts are facing increased financial and resource constraints despite an ever-growing demand for their health services. This is particularly noticeable within certain sectors of the NHS, particularly within UK maternity services where the birth rate continues to rise, and also in the care of the elderly where increased longevity has resulted in a growing elderly population. However, the guidance also states, ‘whatever type of agreement is entered into, clinicians’ judgement should always be based upon clinical evidence that the product is best for their patients.’ (DH 2000)

Such guidance also needs to be relevant to the individual who may find themselves faced with a decision about whether to attend a commercially sponsored study day, or whether to accept a gift from a woman that they have cared for. For the latter, where personal gifts are less than £25 per gift, the guidance does not apply. However, where several small gifts worth a total of more than £100 are received from the same or closely related source in a 12 month period, then this needs to be declared. The Nursing and Midwifery Council (NMC) provides specific guidance relating to advertising and sponsorship that is clear and concise. The NMC Code (NMC 2008) states:

• ‘You must be open and honest, act with integrity and uphold the reputation of your profession


• You must ensure that any advice you give is evidence based if you are suggesting health care products or services


• You must not abuse your privileged position for your own ends


• You must ensure that your professional judgement is not influenced by any commercial considerations.’ (NMC 2008)

This has been written to ensure that any commercial or financial gain that is acquired in the course of health care provision to the vulnerable is openly declared and transparent. It does not intend to stifle the efforts of practitioners working in the private and independent sectors, who are wishing to succeed in private enterprise, but is instead a means of safeguarding against compromise to those in their care. However, more explicit is the unacceptability of nurses and midwives carrying commercial advertising or promotional material when they are giving direct care. One such example would be a midwife using a pen or diary clearly bearing the branding/logo of a specific company when involved in clinical care. While there has been much discussion within the profession about this, especially in relation to formula milk company advertising (Richens 2001, Wilson 2001), other less obvious examples are the, perhaps covert, endorsements of baby skin care products (Trotter 2002) and other technology related to pregnancy and childcare where there is no evidence of its overall benefit (Chakladar & Adams 2009). In the case of infant formula promotion, this could also be seen as contravention of good practice in undermining support for breastfeeding (UNICEF UK Baby Friendly Initiative 2009b). Many examples have been cited over the years of women assuming that their midwife was endorsing a particular product, to the extent that women have switched brands, or in some cases, have even changed their method of infant feeding.

Similarly, while some Trusts may actively look to attract sponsors from companies and manufacturers of clinical/specialist equipment in order to fund clinical posts, provide educational resources or involve NHS staff in research studies, midwives and nurses do have support from their professional body where they are concerned about their involvement in this. The NMC points out that where a nurse/midwife is involved in sponsorship, they still have a professional obligation to ensure that product choice is evidence-based and NOT influenced by personal or commercial gain (NMC 2008). There will however, be circumstances where practitioners may be required to attend training events that are sponsored by the company that manufactures the equipment they need to be trained to operate or use in their clinical practice. Where this is the case, practitioners need to ensure that, ‘the product choice is based on professional and clinical decisions, patient choice and adequate research into similar products available for the same treatments.’ (NMC 2008)

Anyone who has attended an RCM conference will have seen how commercial enterprise views the power of professional involvement. At the same time, midwives are not naïve and most will offer information to women that is unbiased and based on their professional credibility. At the same time, women have access to increasing information about products manufactured by companies that are becoming increasingly sophisticated in their construction and their marketing expertise. In such circumstances, the professional knowledge of the midwife can help women understand what choices are available and appropriate to her needs and those of her baby.

References

Beauchamp T, Childress JF (2009). Principles of biomedical ethics. 6th ed. New York: Oxford University Press.

Chakladar A, Adams H (2009). The dangers of listening to the fetal heart at home BMJ 339(7730):1112-3.

Crock E (2009). Ethics of pharmaceutical company relationships with the nursing profession: no free lunch…and no more pens? Contemporary Nurse 33(2):202-9.

Department of Health (2000). Commercial sponsorship: ethical standards for the NHS. London: DH.

Nursing and Midwifery Council (2008). The code: standards of conduct, performance and ethics for nurses and midwives. London: NMC.

Richens Y (2001). We should make peace with baby milk representatives British Journal of Midwifery 9(2):110.

Trotter S (2002). Skincare for the newborn: exploring the potential harm of manufactured products Royal College of Midwives Journal 5(11):376-8.

UNICEF UK Baby Friendly Initiative (2009a) Baby Friendly Initiative statement on formula company-funded study days. 16 December 2009.
http://www.babyfriendly.org.uk/items/item_detail.asp?item=619

UNICEF UK Baby Friendly Initiative (2009b). Developing a breastfeeding strategy. London: UNICEF UK Baby Friendly Initiative.

Wilson L (2001). Marketing formula-feeding: it doesn't work, does it? MIDIRS Midwifery Digest 11(1):99-102.

Vicky Carne | Head of Midwifery | MIDIRS | Photo Credit: Ian Hooton / Science Photo Library

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