Conflicts of Interest in Healthcare: How Pharmaceutical Physicians Can Support the Discussion
Posted on: Thursday 5 November 2026
On 22 October we spoke on the industry panel at an event on conflicting interests in healthcare. The audience included clinicians, academics, journalists and policy voices, many of whom have limited sight of what pharmaceutical physicians do day to day. We took part as we felt it was important to share our insights and contribute to the debate as audiences outside the specialty often lack a clear picture of what the roles involve.
FPM’s purpose is to advance the science and practice of pharmaceutical medicine for the benefit of patients. That includes understanding and responding to societal expectations as they evolve. Our members are physicians working in pharma, medtech, research organisations, academia, regulatory bodies and health services, so we offer a broad pharmaceutical medicine perspective that includes industry practice whilst staying independent of any specific company.
Both of us have worked in the pharmaceutical industry for over 20 years. Sheuli has worked in and with pharmaceutical companies in medical affairs, clinical development, quality and policy, and continues to do so as a consultant at PM Life Sciences. Her voluntary roles include FPM President, Trustee of the Academy of Medical Royal Colleges and member of the Royal Society of Medicine’s Digital Health Council.
Susan has worked in pharmaceutical companies and contract research organisations/consultancies of varying sizes predominantly in clinical research and development in several therapeutic areas. She has an interest in medical ethics and is currently a member of the Nuffield Council on Bioethics.
We see three ways we can contribute to the discussion:
- Explain how pharmaceutical physicians train and are regulated, through Pharmaceutical Medicine Specialty Training (PMST) and revalidation.
- Explain what pharmaceutical physicians do and the importance of ethical judgement.
- Explain the safeguards in place, how they work and what our roles are within them.
Explaining the specialty
Sheuli knew before medical school that doctors worked in industry as she had worked at ICI beforehand and spent two of her medical school summers at Zeneca, where she met medics in the sector. She worked in general medicine, gained MRCP, and moved into pharmaceutical medicine because of its ability to make impact at a population level.
Susan trained in paediatrics and neonatology up to 4th year specialist trainee level and became interested in clinical research while an academic research fellow working on an international clinical trial in pregnancy. She subsequently joined industry to work in clinical development of new medicines and has worked on vaccines and medicines in several therapeutic areas since.
Neither of us had formal industry training before moving to pharmaceutical medicine. Soon after joining industry we both joined the FPM, sat the Diploma in Pharmaceutical Medicine (DPM) and completed Higher Medical Training before being admitted to the GMC specialist register.
For Sheuli, examining for the Faculty, chairing a group and then serving as an Officer, have been ways of paying forward the training she received. Similarly, Susan teaches and lectures to medical students and trainee pharmaceutical physicians on courses organised and run by FPM.
Audiences outside our specialty often hold assumptions about industry roles and it can be helpful to reflect on the following points.
- Pharmaceutical medicine is a recognised medical specialty. Developing medicines requires new training, even for experienced specialists and investigators. We would not expect a cardiologist to replace a hip, and the same logic supports evidence of specialist skills for those who oversee medicines and devices. We would like a pharmaceutical medicine qualification to become the norm for medical roles in pharmaceutical and health technology organisations.
- The environment is highly regulated. Physicians practicing in different areas within pharmaceutical medicine need to understand and adhere to the relevant regulations and guidance such as the UK Medicines Act, clinical trial regulations, ICH E6 (R3) Guideline for good clinical practice and other ICH guidance, medical devices regulations and the ABPI Code of Practice as well as others. In addition, the WMA Declaration of Helsinki 2024 (which sets internationally recognised standards for medical research with human participants) addresses distributive and global justice and equity asking researchers to consider carefully how the benefits, risks and burdens are distributed.
- Careers rarely follow a straightforward path. Pharmaceutical physicians are unlikely to have a single employer through their career as mergers, acquisitions and restructuring happen to most of us. Job titles vary in meaning. Global geopolitical and economic uncertainty has increased, which raises the value of specialty training, continuing medical education, mentoring and networking for our members.
The importance of ethical judgement
Ethical judgement is the skill we consider most important. Despite having many regulations and guidance documents, this skill is broadly needed in two types of situations. In the first, there may be rules but no details on how to interpret them in the specific scenario you are dealing with, such as dealing with new approaches within social media. In the second, there may be no specific rule but judgement is needed – for example when asking whether the medicine we are working on supports health equity.
Pharmaceutical physicians exercise ethical judgement where there can be different interests. For example, when reviewing promotional material, they balance a company’s wish to communicate with the requirement that claims are accurate, balanced and consistent with the licence. When reviewing safety data, they weigh commercial timelines against the duty to act on emerging risks. When considering requests for access to unlicensed medicines, they weigh the needs of an individual patient against the evidence available and the regulatory framework.
Colleagues outside the specialty sometimes ask whether physicians employed by companies can exercise independent ethical judgement. Financial incentives vary across pharmaceutical companies, technology firms, charities and start-ups, and in how pay is structured, for example, salary, benefits and bonuses. Declarations of financial interests are more understandable when the context is explained, including how remuneration is structured and which professional and regulatory safeguards apply, such as registration with the GMC, revalidation and adherence to the respective regulatory standards. Providing this context therefore helps patients, colleagues and the public assess whether safeguards are working.
Examples of safeguards in practice
Specialty training, continuing professional development, annual appraisal and revalidation are important professional standards for individual doctors. These support us to be up-to-date in a fast-moving specialty and also support reflection on whether we are doing our best for those we serve and acting ethically.
Research integrity is further safeguard, and its standards are evolving as practice changes. For example, real-world evidence is used more, and single-arm studies can support a licence in some circumstances. Inidvidual regulators and ICH also recognise the importance of greater diversity among trial participants to ensure representation of populations who could use the new medicine or technology in the future. This includes consideration of gender, ethnicity and socioeconomic status, and reflecting the reality for people living with multiple long-term conditions.
Clinical trial transparency is a third safeguard. This area has evolved significantly in response to concerns that unwelcome data may be withheld from the public domain. ICH E6 (R3) principle 9 states that clinical trials should generate reliable results, and 9.6 describes transparency as timely registration on publicly accessible databases and public posting of results, with communication to participants that is objective and non-promotional. IFPMA has published position papers on principles for responsible data sharing, publication of trial results and registry disclosure. Industry commitments include registering trials soon after enrolment begins, disclosing results for approved medicines regardless of outcome, and considering all sponsored trials for publication, including those from discontinued programmes.
Looking ahead
Discussion with people outside our usual networks, as at this event, helps us all to navigate these questions and move practice forward. Medicines and health technology should serve society, and expectations change over time about how this should happen in practice, such as the need to address underserved populations or the importance of patient involvement. Innovation takes 5-10 years to reach patients, so we need to anticipate those expectations and help define what good looks like.
The debate on conflicts of interest will continue to evolve. Our specialty combines medical accountability, regulatory knowledge and commercial understanding, and each is relevant to how conflicts of interest are identified and managed. Pharmaceutical physicians can add insights into how the regulations and codes work day to day and how ethical judgement is exercised in practice. We would encourage FPM members to get involved and contribute to the discussion.
References
- The Medicines Act, 1968. UK Parliament
- The Medicines for Human Use (Clinical Trials) (Amendment) Regulations, 2025
- ICH E6 (R3) Guideline for good clinical practice, 2025
- The UK Medical Devices Regulations, 2002
- The ABPI Code of Practice for the Pharmaceutical Industry, 2024
- WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Participants, 2024
- IFPMA. Joint Position on the Publication of Clinical Trial Results in the Scientific Literature, 2017