This is certainly one of the most controversial topics in recent years with regard to the interaction of the medical profession with the health industry – which encompasses the pharmaceutical industry, medical and hospital products and even cosmetics and food.

My use of the verb “to sponsor” is deliberate. In my opinion, this is because it is wrongly used by many companies, including multinationals as sponsors, when granting an airline ticket, transfers, hotel accommodation, meals and registration fees at events. Despite the restrictions contained in some codes of industry associations, which promote self-regulation, some companies go further and even pay for obtaining visas (for abroad events), luggage storage, entertainment, etc.

I refer to the mistaken use of the verb to sponsor in the previous paragraph due to the concept of sponsorship, which presupposes the offer of a value transfer, always aiming for a counterpart. Therefore, it would be correct to use it when stating that a certain company will sponsor a certain event, wherein it will transfer a certain amount that will be used in the funding and profit of the organizing institution. It will also have, for its benefit, some counterparts to be determined by the share of the amount it is paying, either by exposure of its logo, promotional videos, sponsor banners spread throughout the event location, and so on.

However, using “sponsorship” to justify a physician's trip to a congress is an indiscretion. The significant majority of companies that cover physicians' expenses at congresses have as their main reason the fact that such an initiative should never interfere with the physician's prescribing act, guaranteeing their autonomy in the decision to prescribe the best treatment for the patient. No wonder many of these companies take a series of internal decisions to mitigate the potential conflict of interest. That is, they create clear policies regarding how such an initiative should be conducted internally and leave the resources and decision-making of choosing the benefited physician to be exclusively in charge of the medical area instead of the commercial area, establishing the criteria for the physician eligibility, limiting the amount of benefits for the same physician in the same year and establishing value transfer ceilings, here not referring to fees, instead for the coverage of expenses.

In any case, the most correct is the use of the term “grant”, which is similar to the term donation, but with educational or scientific purposes. It is unquestionable that the role played by the health industry in keeping healthcare professionals qualified and up to date contributes a lot to the dissemination of updated knowledge, considering the speed with which transformations and innovations occur in this field. However, two points which can be questioned are the criteria for choosing such physicians and to what extent such an initiative does not compromise the physician's choice in prescribing the product of that particular company or not.

With regard to the choice, no matter how much the company tries to leave it to the exclusive nature of the medical area, shielding the commercial area from choosing the physician who should benefit from it, it is very difficult for the medical area to direct resources to a physician who might be in most need of financial aid to participate in the event. Rather, the Key Opinion Leader is sought, on the grounds that he or she, generally being a faculty member or someone who is admired and respected by their peers, would be able to assimilate such knowledge and would have more opportunity to disseminate this knowledge.

There are some ways to try to curb the power of choice on the part of companies, for instance the resources could be destined to medical societies which would then have the power of choice when determining which physicians will receive the benefit. This eliminates the potential conflict of interest to be established between the company holding the resources and the sponsored physician, as the resources would come from a common fund of medical societies, as was already done in the United States for many years. In the past, the author of this article, on behalf of a class entity and discussing this issue with one of the leading clinical oncologists in Brazil, received a proposal to redirect these resources to hospitals, leaving them with the power to choose the physicians who would receive the benefit. Both situations still face a dilemma: the political criterion for choosing the eligible physicians, possibly favoring only a certain group of professionals, either by the medical society or by the hospital that receives such resources.

However, the second point is even more complex: to what extent such an initiative does not compel the physician to prescribing the product of that particular company. Primarily, a physician is a human being, and however honest and upright he may be, he is still driven by human reasons and emotions. Bearing this in mind and looking at the diversity and quality of current products in the health area that are offered for a given treatment, it is clear that the options are as diverse as possible and, for the most part, differ very little in terms of effectiveness and security profile. Therefore, if a physician receives subvention from a certain company to participate in a congress and considering that their product is similar to that of the competition, that physician might tend to change their prescribing habit in favor of the company, thus giving back for the support received, without this causing any harm or deficiency in the treatment of patients. The reports marketed by pharmaceutical audits evidence this fact.

In 2017, during a postgraduate class in Buenos Aires, the most significant discussion I have ever participated in took place. In the presence of representatives of the largest healthcare companies in the world and some specialists in the sector, after a debate session in which one group defended the practice and another condemned it, a question arose from a participant of one of the 3 largest pharmaceutical companies in the world that silenced everyone present, practically ending the discussion. Her question was: when you hire an architect or a lawyer, do you pay their expenses so that he can train and provide the service for you? Silence reigned for a few seconds in the room.

In any case, the issue needs to be faced head-on by class entities in each sector, in an open, transparent manner. Their respective ethics committees need to look into this to try to mitigate potential conflicts of interest in this practice or, as a last option, ban it. It is not easy to lose privileges, but such privileges need to serve the collective interest of society and not of an individual or a company.

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