SECOND OPINION:Links with the alcohol industry are troubling, writes DES O'NEILL
SOME ASPECTS of ethical probity in medicine, rather like Charles-Maurice de Talleyrand’s famous dictum on loyalty and treason, are a matter of dates. A striking example is the 1940s US advertising campaign proclaiming that more doctors smoked Camels than any other type of cigarette. At around the same time, medical journals around the world hosted advertisements for cigarettes and tobacco.
While this stance seems almost laughable today, the important historical lesson is that those engaged with healthcare need to exercise due caution in their relationships with industries that pose a danger to the well-being of the public, and to ensure vigilance in reviewing any such relationship in the face of new and emerging evidence.
This can be challenging in the face of restricted healthcare and research budgets, which have in turn engendered a large number of medical charities in Ireland. The source of donations to all charities, medical and non-medical, involves a conundrum wittily explored by George Bernard Shaw in his play Major Barbara. The eponymous heroine, a major in the Salvation Army, does not wish to accept money from an armaments manufacturer and a whisky distillery, but her church believes carrying out good works requires a less sensitive approach to the origin of donations.
This tension is an ever-present reality: the sponsorship of the Olympics by a fast-food company and a soft-drinks manufacturer has provoked considerable public comment and disquiet. Similarly, in a country so affected by problems with alcohol dependency, the sponsorship of sporting associations and competitions by the alcohol industry remains a blot on the landscape.
But it is widely recognised that medical organisations and charities have a particular duty to develop policies on industries that run counter to the goals of their organisation. One of the great heroes of Irish life, the GP and sporting legend Mick Loftus, was surely responding to the best traditions of medicine in his (sadly unsuccessful) attempts to wean the GAA off its dependency on alcohol sponsorship. So it is with some sadness that I note that there is a persisting association with the alcohol industry and some Irish medical charities. As well as the linkage between the Irish Hospice Foundation and a book of short stories arising from a competition sponsored by an alcohol company, I was quite astonished in recent weeks to come across advertisements on bus shelters for a charitable event that linked one of our major teaching hospitals and an alcohol company.
Given that more than €1 billion is spent within our health system each year on alcohol-related illness, it is important that clear water is maintained between the alcohol industry and healthcare providers when it comes to funding. In terms of this particular charitable event, given that high levels of alcohol consumption are associated with an increased risk of virtually every illness, the money raised could be directed to virtually any department of the hospital, from oncology through to stroke to child psychiatry. But it would always represent a drop in the ocean of needs created by excessive alcohol consumption.
Such links undermine the message from the medical profession that we need a radical rethink of the prominent position of alcohol advertising and sponsorship in our society.
It would be helpful for the medical profession and medical charities to come together to formulate a clearly articulated policy on what sources of sponsorship are acceptable. This could be supported by similar moves emerging on the clarification of conflicts of interest in relation to links with the pharmaceutical industry. In a small country where life sciences are a key part of our industrial strategy, it is not surprising that medical researchers should engage with the pharmaceutical industry – but all are protected by the international trend for routine transparent disclosure of conflicts of interest, for example when giving lectures or undertaking advocacy for new and costly medications.
The Council on Stroke of the Irish Heart Foundation was the first body in Ireland to routinely use this approach, and this could serve as a useful template to reassure the public that the profession is doing the best it can in an imperfect world.
Prof Des O’Neill is a consultant in geriatric and stroke medicine