Ethical questions

Putting aside questions about the veracity of Mannatech's products and its sales techniques (see The Mannatech pitch), what are the ethics of doctors selling products directly to patients?

The New Zealand Medical Association's (NZMA) code of ethics doesn't prohibit the practice. But there are provisos. Dr John Adams, chair of the Association's ethics committee, says doctors must be open and honest about any financial interest they have in a product and provide patients with scientific evidence on its efficacy. The NZMA represents specialists, GPs, doctors-in-training, and medical students. Membership is voluntary but the Association's code of ethics sets out principles of behaviour applicable to all doctors.

Ethics code

The New Zealand Medical Association's code of ethics states: "Doctors should not allow their standing as medical practitioners to be used inappropriately in the endorsement of commercial products. When doctors are acting as agents for, or have a financial or other interest in, commercial organisations or products, their interest should be declared. If endorsing a product, doctors should use only the proper chemical name for drugs, vaccines and specific ingredients, rather than the trade or commercial name. Any endorsement should be based on specific independent scientific evidence, and that evidence should be clearly outlined."

The Medical Council of New Zealand, the regulatory body responsible for doctors' conduct and competence, also provides guidance on the professional standards expected of doctors. Its publication, 'Good medical practice', states doctors must be upfront in any financial dealings with patients. This includes declaring a financial interest before taking part in any discussions with the patient about buying the product.

Complaints

Are the existing provisions sufficient? We're aware of two complaints involving GPs selling products to patients that have come before the Health and Disability Commissioner. In both cases, the Commissioner found the doctors exceeded the boundaries of proper practice and their conduct breached the Code of Health and Disability Services Consumers' Rights.

One case involved a GP who sold Nutriway products (nutritional supplements marketed by Amway). In her decision in 2006, the Acting Health and Disability Commissioner Tania Thomas said she had serious concerns about the potential conflict of interest raised by the doctor's involvement in Nutriway. Commenting on the case later, Commissioner Ron Paterson concluded: "situations where doctors seek to peddle products to patients are undesirable, and can expect to be carefully scrutinised by regulatory bodies and courts."

The second case, determined by the Commissioner in 1998, involved a GP selling nutritional supplements to a patient to the tune of around $200 a month. The patient bought the supplements unaware the product was part of a multi-level marketing scheme and only discovered this by chance some time later. The Commissioner found the GP exploited the patient by failing to disclose the fact he received a commission on each sale of the product. The Commissioner also found the GP breached the patient's right to be fully informed.

Conflict of interest

We strongly support the Commissioner's view that there's the potential for a serious conflict of interest when doctors sell products in which they have a financial stake.

While we're not asserting Dr Wilson breached the Code of Health and Disability Services Consumers' Rights or any other ethical or professional code, in our opinion it's an unsatisfactory state of affairs that the ethical rules of the medical profession don't prohibit this practice absolutely.

As the professional body for doctors, we think the Medical Association needs to look at strengthening its code of ethics. We think doctors should be prohibited from selling products to patients if the doctor has a direct financial interest in those products.