The debate over physician–pharmaceutical industry interactions (PPIIs) is clearly a global one. The World Health Organization has published “criteria for medicinal drug promotion and the code of pharmaceutical marketing practice” for countries without national codes. The World Medical Association also published guidelines in 2004. The ethical and legal conflicts of PPII have been highlighted in the medical literature from Norway, Poland, Germany, Australia, Spain, India, Sri Lanka and Turkey.

The pharmaceutical industry interacts not only with physicians but also with other health care professionals such as nurses, nurse practitioners and physician assistants; with health care organizations such as HMOs; and with consumer organizations and pharmacists.

Pharmaceutical companies and patient organizations frequently come together to explore areas of shared interest. Some have argued that these offer the PI a chance to mobilize grassroots lobbying muscle to influence policymakers. Serious issues have recently been highlighted concerning undeclared interests in commercial funding of charitable and lay organizations without apparent conflict.

In addition, the PI relationship with HMOs, including rebate policies, formulary decision making, intervention activities, disease management programs and Medicaid rebate calculations, has recently come under federal scrutiny.

In Canada, potential patient identifiers and physician-linked prescription data stream from pharmacy computers via commercial compliers to pharmaceutical companies without the informed consent of patients and physicians.