title: Do ethical Guidelines make a difference to decision-making?
abstract: BACKGROUND
  The different levels of knowledge and understanding of attitudes to and use by physicians of the Royal Australasian College of Physicians (RACP) Guidelines for ethical relationships between physicians and the pharmaceutical industry are unknown. The aim of this study was to explore how physician Fellows of the RACP relate to and use the ethical Guidelines of the RACP regarding relationships with the pharmaceutical industry.
  
  
  METHODS
  Focus group discussions and in-depth face-to-face interviews were used to gather information from physicians who responded to invitations placed in electronic newsletters or through word of mouth.
  
  
  RESULTS
  Five focus groups and eight in-depth interviews were conducted with 56 practising physicians in Australia and New Zealand. Most physicians were aware of the RACP ethical Guidelines (3rd edition, 2006), but only a few used them to resolve ethical dilemmas or to influence their decision-making in relation to interacting with the pharmaceutical industry. Ethical standards used or approaches to decision-making practices related to interactions with the pharmaceutical industry were most likely to have been developed through past experiences, peer pressure or decisions that were considered to be 'in the best interests of their patients'. There were strong opinions expressed about relationships with the pharmaceutical industry and how these relationships often lead to feelings of humiliation. Some felt they were prostituting themselves for the sake of acquiring funding for staff positions, medical devices, research or attendance at conferences. Very few physicians recollected having any assistance on how to deal with the pharmaceutical industry during their training, and those few who did recollect such input through their curricula and education felt they did not benefit.
  
  
  CONCLUSIONS
  RACP Guidelines on ethical guidance for relating to the pharmaceutical industry have not been used by most physicians, and very few had read or referred to the Guidelines. Reliance on 'previous' experience, opinions of peers and 'value to patients' had most influence on attitudes and behaviours in interactions with industry. Many physicians felt uncomfortable and embarrassed about interactions with industry, especially varying levels of dependence on industry for resources.
authors.affiliation: The Royal Australasian College of Physicians, Sydney, New South Wales, Australia. mary.osborn@racp.edu.au
authors.forename: M
authors.initials: M
authors.lastname: Osborn
authors.forename: R
authors.initials: R
authors.lastname: Day
authors.forename: P
authors.initials: P
authors.lastname: Komesaroff
authors.forename: A
authors.initials: A
authors.lastname: Mant