July 29, 2009

Device Makers New Code of Ethics Forbids Gifts or Entertainment--for Medical Care Providers

Jim Purdy commented on the last post that just like medical care providers, we medical bloggers need to consider adopting a code of ethics. This sent me off on some research about existing codes of ethics involving corporate gifts, and what a surprise that turned up!

It turns out that the medical device manufacturing community's trade group, AdvaMed, proposed a Code of Ethics for its members in December 2008 which specifically banned all gifts or providing of entertainment to medical care providers.

AdvaMe is short for the Advanced Medical Technology Association, a trade group that claims its members "produce nearly 90 percent of the health care technology purchased annually in the United States and more than 50 percent purchased annually around the world."

Here's what's included in its new Code of Ethics:
An explicit prohibition on providing entertainment or recreation to Health Care Professionals (HCPs). The changes prohibit gifts of any type -- including all non-educational branded promotional items -- regardless of value.
This Code of Ethics went into effect July 1, 2009.

Note that the code only applies to "health care providers." Not bloggers or those who maintain online support communities. Which might just have something to do with why a medical device maker is suddenly so interested in us humble bloggers.

Doctors are educated highly-paid professionals who, if anything, we would expect to be less influenced by small gifts and junkets, since they can well afford to spend their own money for such things. But it turns out small gifts have a subtle but very effective impact even on wealthy physicians.

You can read a good summary of research documenting how drug company gifts and junkets affect prescribing information in the following journal article. Follow the footnotes to find the studies summarized:

Do Drug Company Do drug company promotions influence physician behavior? Bob Goodman. West J Med.(BMJ) 2001 April; 174(4): 232–233.

How much more likely are we bloggers to be manipulated by drug and device companies?
Many of us earn very modest incomes or are retired. We make huge sacrifices to find the time and resources to do our health support work for which we are rarely compensated. A couple of boxes of free strips is not a trivial issue for many of us. A plane ticket may be out of reach. I have no doubt that we bloggers are highly ethical people, but the impact of the research suggests that drug and device company techniques work very well to influence ethical people who believe they are not being influenced.

Let's Come Up with Our Own Code of Ethics

In this post, I would like to open discussion to all bloggers, community leaders, and blog readers on the topic of what would be a responsible code of ethics for us NON health care providers who provide health information and health-related support to the online community.

For the purposes of this discussion I will define a new group of Online Health Support Providers (OHSP).

Here are my thoughts:

1. OHSP shall not accept any free or discounted items from any health-care related company that are not simultaneously offered free or discounted to the rest of the online community.

2. OHSP who agree to review a product or service shall review it honestly and shall provide reviews for ALL products or services they accept for review, not just those they can endorse.

3. OHSP who allow advertising on their web pages shall make it clear whether they select and endorse the products advertised on their pages. Because Google Ads are the only advertising vehicle available to most bloggers, bloggers who run Google Ads will indicate on their blog that they do NOT have the ability to control the ads that appear on their pages and that they do not endorse the products appearing in Google Ads. If informed by a blog viewer that an ad (with URL) running on their pages is abusive, OHSP agrees to investigate and if the ad is abusive to block the abusive ad via their Google Ads account.

4. OHSP have the right to report their personal experiences with any health related product or service and to highlight stories in the media or medical press relating to any product or service, however any relationship with the companies who produce these goods and services must be disclosed to readers following the same guidelines as are now required by medical journals. This includes disclosing any personal relationship in the past or present with the companies, including past employment, employment of relatives, or past sponsorships, consultancies, etc. OHSP will disclose any significant holdings in the stock of a company whose products they discuss.

5. OHSP who receive compensation for their blog posts from web sites owned by companies will disclose to their readers that they are paid bloggers and indicate who pays them.

This is just a start. I want to hear your suggestions and Ideas.


jimpurdy1943@yahoo.com said...

Excellent suggestions, Jenny.

BTW, are you aware of these sites:



Jenny said...


I had seen it but wanted to open discussion for something new.

That code doesn't address gifts, selective reviewing, advertising, or paid blogging.

Anonymous said...

Interesting post. I think points 3 and 4 are very easy to follow. The first two suggestions seem like a pigger minefield. I was just sent a book to promote on my blog. I told the author that I would (of course) have to read it before I could write about it. I haven't started it yet, but let's say I don't like the book. I am not interested in 'flaming' this author and writing a negative review of her book. I would prefer to just not write anything at all about it.

Alan said...

Thanks for the link Jim; I wasn't aware of the code. I like the concept in principle; I may even join that one. But there are limitations as Jenny noted.

Jenny, I understand where you are heading and why. Payola, in one form or another, has been around since before money was invented.

Apart from that, everyone who writes on the web must always be mindful of the national and international laws relating to copyright, libel and false statements. Those of us blogging as lay patients in the medical field also have to be mindful of the implications of offering our unqualified suggestions on the web. We probably do need some sort of code of conduct – but there could also be a high price to pay for it.

The problem with all such codes of conduct is qualification for membership, monitoring and enforcement. If it is left to an honour system then it can be, and will be, abused fairly easily. If membership is qualified and the code enforced and monitored - who becomes the membership selectors and the code monitors and enforcers? Do we hold elections? Or do we accept the self-appointed person or group who start the system? And what punishment, beyond ejecting the blogger from the "trade group", can they enforce? Do they spread the word across the blogosphere about those reprehensible bloggers?

I would be loath to accept restrictions on my freedom to say what I like within the law about any person, organisation or subject using my own conscience and judgement as my guide. So, although I fully intend to meet the lofty ideals you espouse I would not be prepared to have others sit in judgement on whether or not I succeeded in my intention.

Cheers, Alan

Kathy W. said...

Perhaps relevant are the upcoming new FTC rules on reviewing products in blogs or doing pay-per-posts. Here's a NYT article on the subject:


Jenny said...


That's a VERY relevant article, thanks for the link. I would urge everyone interested in the ethics of bloggers receiving freebies to check it out.

Kathy W. said...

I have no idea why Google decided I was an asterisk in the comment above, but that was me...

jimpurdy1943@yahoo.com said...

Kathy, an asterisk means you're special.

An asterisk is "used to draw a reader's attention to a piece of information"

water said...

Egullet has a code for writers that may be of interest, given that the food/restaurant world is some-what incestuous in terms of who knows/is related to/works for whom. And there's plenty of freebies!

It is very brief and clearly written.


Bernard said...

Jenny, this is a good set of basic rules.

If I get a free piece of equipment that I review I point this out in the post itself. I do not see any other reason for taking free equipment except for review purposes. This makes me wonder if rules 1 and 2 need a slight modification.

Jenny said...


You're right that products should be accepted for review purposes. But probably with the same rules that were current in the trade magazines back when I freelanced, where all hardware went back to the manufacturer after review.

Reviewing is a legitimate pursuit, but the article about the blogging mommies and the way some of those bloggers profited by cutting secret deals with manufacturers to promote their stuff energetically in return for money and product points out how careful we have to be.

And I do feel that if we accept something for review, we should review it plus or minus. The bloogging mommy article pointed out that the bloggers who ONLY do positive reviews were getting a lot more "Blogola" for that reason. I have seen that happen in our community too.

Anonymous said...

I recall a truck review magazine that made a facetious comment in a review that a certain truck had such a large steering wheel that "you don't have to be built like a gorilla to drive one but it helps!"

This was actually a safety feature as they pointed out as it made it easier to control if the hydraulic steering died.

Nonetheless the manufacturers went ape and threatened to pull all advertising if they ever again posted a negative review of their products.

So from then on all the reviews were glowing and positive (and all the negative features were confined to later editorials).

So far the internet has not been compromised in this way. Yet. The nearest is all those pseudo-review sites that pop up near the top of any Google search.