A Different Prescription

CONSIDERATIONS FOR WOMEN'S HEALTH GROUPS CONTEMPLATING FUNDING FROM THE PHARMACEUTICAL INDUSTRY

By Anne Rochon Ford

For the Institute for Feminist Legal Studies at Osgoode Hall, York University
Financial assistance from the National Network on Environments and Women's Health

The opinions expressed in this booklet are those of the author alone and do not necessarily reflect the opinions of, nor are they necessarily endorsed by any of the organizations and individuals listed above or by Health Canada.

About This Booklet

In May of 1997, a number of Toronto-based women's organizations (the National Network on Environments and Women's Health, the Institute for Feminist Legal Studies at York, DES Action and the Toronto Women's Health Network) sponsored a panel discussion entitled: "Ethical Issues in Women's Health: The Delicate Business of Funding from Drug Companies". To this event, we invited four panellists to discuss their perspective on the issue of accepting money from the pharmaceutical industry. New insights were gained from that panel discussion. This booklet is meant to reflect some of the ideas that were presented that evening in the hope that it may help other organizations making decisions about this issue.

Most of the text reflects discussions which ensued from the panellists' presentations. We have taken a scenario which represents a composite of most of the issues presented at that panel discussion and have broken down the different opinions expressed.

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Introduction

In Canada over the past ten years, community-based women's health organizations have been experiencing continued government cutbacks. Although no organizations were given lavish amounts of government funds, they have, nonetheless, counted on renewal of public money to carry out the work they do in providing services and information to women about their health.

At the same time, non-profit organizations in many sectors, not just health, are being strongly encouraged to form "partnerships" with industry. Although it is not always clear exactly what is meant by "partnerships", one thing that is usually implied is the assumption that money should be sought from industry and if money is offered, it should not be refused.

It is easy to understand why government funders are so anxious to see non-profit organizations turn to the private sector for money. Governments would like to find ways to reduce their deficit and have an interest in supporting economic development and a strong pharmaceutical industry in order to stimulate investment and jobs. The pharmaceutical industry has a vested interest in the promotion of their products which may be used by these organizations. The private sector is also being urged by government to form such partnerships and there is a constant pressure on the industry to be good corporate citizens. It is in their best corporate interest to spread some of their wealth and to give generously to community-based organizations and enter into sponsorship arrangements with them.

Sounds pretty straightforward. But is it? Opinions vary greatly on this topic. If you are reading this, you may be just such an organization struggling with this issue and trying to determine whether you should put your energy into developing such partnerships and, more specifically, whether you should accept money from the pharmaceutical industry.

This booklet may help to shed a little more light on your decision. It has been developed out of strong concerns about the implications of pharmaceutical industry sponsorship of women's health organizations, and what they might mean both to individual groups and to the women's health movement as a whole. It does not proport to be a definitive, objective look at the question. The aim is to raise questions and to foster discussion at the same time as respecting the decisions of individual groups, whether they choose to accept industry sponsorship or not. This booklet will look at groups who have made the decision to accept money and sponsorship agreements and others which have not.

Why just women's health groups? We decided to narrow the focus because women have a particular relationship to pharmaceuticals which makes some of their issues unique. Women are often the specific target for advertising by pharmaceutical companies, either because of their reproductive needs or because women are most often the ones in their families who make decisions about their family's health care needs. They visit doctors more often than men, either for themselves or for other family members and, therefore, are more likely to be prescribed drugs. They are prescribed mood-altering drugs at a higher rate than men. As the sole users of most birth control products - a particularly lucrative market for the pharmaceutical industry - they are often faced with difficult decisions about the safety and efficacy of their choices. As the primary caregivers of sick family members, they are more likely to see the effects - both positive and negative - of prescription and over-the-counter drugs. Women often know "stories" of other women who have had bad experiences with a particular medication, and are more likely to have read magazine and newspaper articles about medication which has been helpful for particular conditions.

Pharmaceutical companies specifically target women's groups because women's health is becoming increasingly medicalized. It was only a few decades ago that there were no drugs for menopause, menstrual discomforts, irregular menstrual cycles, breast cancer prevention and fertility problems.

In short, we have a relationship to this issue which is specific to us because we are women. Added to this equation is the fact that drugs and devices which have proven to be harmful to women have appeared on the market in recent decades. Because of the legacy of harmful drugs and devices such as DES, Thalidomide and the Dalkon Shield, many North American women in particular have become increasingly wary about the decisions they make in relation to prescription drugs. At the same time, the pharmaceutical industry has increased its efforts to sell its products directly to a public which has become highly dependent on drugs.

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A Common Scenario

A women's health organization in a large Canadian city has been offering useful information and support to women who have been diagnosed with a particular disease or disorder. Users of this service indicate that they are grateful for the help the service offers them in making difficult decisions about treatment options. They appreciate being able to talk to other women with the disease and feel like they can get on with the rest of their lives.

The organization has been operating on small government grants for the past five years. This has enabled them to keep one staff person - a coordinator - running the organization and training volunteers. Small amounts of money are also raised through an annual direct appeal fundraising campaign and a small fee charged for the production of their quarterly newsletter, but this income alone could not keep the organization afloat. The co-ordinator spends a good deal of her time writing grant applications to keep the service running.

The organization has just learned that their source of government funding is about to dry up due to extensive cutbacks in the health and social services in their province. A member of the board of directors of the organization brings a plan to the board and staff member. She has a good friend who works for Drug Company X, manufacturers of a drug frequently used by women with this disease. This friend has been telling her that she knows her company would give money to help out the service - they just have to say how much they need. The board member presenting this thinks it is a good idea. The board is divided. Opinions vary widely.

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Responses to the issue

"It's a win-win situation — they get to feel better because they're doing something that makes them look good, and we have money to keep our service running. What can be wrong with that?"

"I think we should just take the money wherever we can get it. It's the only way we'll keep this service alive. We can't afford to be purists."

"What do you mean? — It's dirty money. — Isn't all money dirty money?"

"This same company also manufactures pesticides which have been shown to contribute to this disease. Why would we want to endorse that?"

"If we take their money, we're turning our backs on all the women who object to this type of sponsorship, women who feel they've been harmed more than helped by the pharmaceutical industry.

"Most women just want the help. They don't really care where the money comes from."

"If we say no to an offer like this, we're turning our backs on all those women who need help."

"Isn't this just free publicity for the company?"

"They've told us there's no strings attached to this money and they seem to be willing to stick to that. Their attitude seems to be "hands off". Why should we doubt that?"

Let's take a closer look at some of the comments made by the board members and staff:

"It's a win-win situation — they get to feel better because they're doing something that makes them look good, and we have money to keep our service running. What can be wrong with that?"

On the surface, this scenario does indeed look like a win-win situation. And some groups will come to the decision to take the money and not only be quite comfortable with that decision but be able to put the money to good use. Their members will benefit and the drug company will be able to say it has done a good deed with their donation.

A representative from a group for women with AIDS who spoke at the panel discussion described their decision to accept pharmaceutical money: "We are happy to take money from drug companies and turn it into Vitamin C for women with HIV and AIDS." The money they have received from the industry has allowed them to offer programmes which they feel they could not otherwise offer. She also pointed out that the survival of her group members is partially linked to the drugs they take, so they have always had a close relationship with the drug industry. She pays about $2,000 for her drugs and says she is glad to see herself and other HIV positive women "get some of that money back" through a donation from the company which manufactures their drugs. The money is often used for direct donations to the women in need as opposed to being directly tied to a product line.

On the other hand, others feel that it may look like a win-win situation but the winning is mostly by the pharmaceutical company. One panellist, who had canvassed representatives from some of the manufacturers of the most commonly prescribed drugs for women's reproductive conditions, learned that most donations to women's health groups (and other non-profit health organizations) come from the marketing budget of a company. In most cases, donations are linked to a product or product line of that particular company. Therefore, you would not likely see a company which does not manufacture for example, a fertility medication, giving money to an infertility support group, and similarly, companies which manufacture fertility medication would specifically target infertility groups for their donations.

The industry has much to gain from making such donations and forming such links. First, association with a reputable organization can provide a more credible endorsement of their product than if the promotion were coming directly from the industry (i.e the goodwill associated with a company's name when they are seen to be making contributions to groups can have a direct impact in the public's mind about the value of their products).

Secondly, if a company is in the pre-launch phase of the introduction of a new drug, they can use the captive audience of the group they have funded to spread awareness among the public about their drug and about the disease which the drug is treating. This awareness will generally not extend to prevention and other forms of treatment, specifically not to other drugs made by competitors. Funding an organization to provide educational outreach about a disease such as osteoporosis serves to raise the general public's awareness of this issue and, importantly for the drug company, of drug treatments which are being developed to treat it.

Finally, if a drug company is seeking approval from regulatory bodies for a drug which they have manufactured, they can use their funded groups to help them argue for the need for approval of this drug. Particularly in countries where direct-to-consumer advertising is not allowed, companies may not be at liberty to make claims about their products, but patients' groups can do so at press conferences and in newsletters and other publications on the company's behalf.

(The above points were additionally raised by David Gilbert and Andrew Chetley - see Further Reading below. Additional points are well made in Blurring the Boundaries.)

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Some groups may conclude that the concerns pointed out here simply are not a problem for them. As with the women and AIDS group above, their need of that contribution outweighed any moral concerns they had about the issue of accepting industry money, although their decision was not reached without considerable discussion and debate.

There is, however, one way in which industry wins and the recipient of their money can lose: support from the industry dulls criticism. The National Women's Health Network in the United States, for example, has developed a policy not to take money from the pharmaceutical industry. The main reason they offer is that one of the foundations of their educational work is to encourage women to seek alternatives to pills and surgery in dealing with their health problems, and to look at the social and economic reasons behind much ill health.

Promoting education and prevention as cornerstones to improved health, they have worked hard to wean women off of the "pill for every ill" mentality so prevalent in western society. While they also recognize the need for medication in many situations, they have also helped raise awareness about the ways that some medications have done more harm than good to women. This focus runs completely contradictory to a motive of increased profits for the pharmaceutical industry.

"I think we should just take the money wherever we can get it. It's the only way we'll keep this service alive. We can't afford to be purists."

This is a commonly held opinion. Many groups are dealing with the sheer logistics of survival and staying alive and feel they can't afford to look a gift horse in the mouth.

Although hard to look at, it might be worth asking, 'Is this really the only way you'll keep this service alive?' Frequently the option of pharmaceutical money comes to groups without a lot of effort. The industry is looking to form partnerships such as this and in the larger scheme of things, offering money to a community based women's health organization to keep its doors open represents a drop in the bucket of their profits.

Groups are often surprised when after years of hounding philanthropic organizations and individual donors for money, the offer for money from a pharmaceutical company comes to them almost effortlessly. Understandably, this is enormously appealing to anyone who is sick and tired of trying to raise money. But it might be worth asking, if this came so effortlessly, is it the only money to be had without much struggle?

For example, DES Action groups throughout the world have managed to maintain offices with staff, and provide valuable services to the DES-exposed for more than 20 years without ever having engaged in partnerships with the pharmaceutical industry.

You may want to consider the local bank where your group does banking, companies which employ your board members or families of consumers who use your service. Is there a member of your group who knows a wealthy individual dealing with the health problem your group is involved in? One patron can often donate as much as an individual company.

"What do you mean? - 'It's dirty money' - Isn't all money dirty money?"

The term "dirty money" has been used to describe money which may have been used for less than honourable purposes. Some people have argued that there is no difference between taking money from the pharmaceutical companies and accepting money from banks, insurance companies or other large corporations. The argument goes that those companies or financial institutions which may appear to have no strings attached to their money may also be funding practices or carrying out activities, particularly in Third World countries, which your group would find ethically questionable.

For example, one group was considering approaching Shoppers Drug Mart, a large chain of pharmacies across Canada, for a donation to its awareness campaign on women's cancers. After doing some research into the company's background and holdings, they discovered that Shoppers Drug Mart is owned by the Imperial Tobacco Company. This group chose not to pursue funding from Shoppers since it felt compromised in being involved - even indirectly - with manufacturers of a cancer-causing substance. Another organization agreed to accept a donation from Shoppers Drug Mart providing the money was not perceived to come directly from Imperial Tobacco, requiring that the cheque be made out by Shoppers.

"Isn't this just free publicity for the company?"

In Canada, discussions are underway between the federal government and representatives of the pharmaceutical industry to consider allowing the industry the right to advertise prescription drugs directly to the public. At present they can only advertise directly to health professionals, usually done through direct mail, in advertisements in medical journals and through sales representatives of the industry. Direct-to-consumer advertising is already allowed in the United States. This means that one commonly finds advertisements for birth control, anti-depressants, cholesterol-lowering drugs and other medicines available only through prescription from a doctor in such everyday places as magazines, radio and television.

Because Canada currently has a prohibition against direct-to-consumer advertising — a prohibition which health care advocates are arguing strongly to maintain — the pharmaceutical industry seeks out other ways to reach the consumer directly about their products without having to go through the intermediary of the doctor.

If your organization does choose to accept money from a pharmaceutical company which manufactures a product used by members of your group, it is worth keeping in mind that you are indirectly providing endorsement of that company and their product through your action. It is in the company's best interest to have this endorsement of their product from a non-commercial source.

Similarly, if the company funding you is developing a new product for your user group (e.g. a fertility drug in the case of an infertility group) your group may unwittingly become the focus for promotion of this drug by the company. The group may become a conduit of information for the company to the potential users of the drug. In the case of a drug which is badly needed and has been properly tested, this may not be such a bad thing. In the case of a drug which is simply a copy-cat of another product on the market, the relationship becomes a little more questionable.

The phenomenon of "copy-cat drugs" is more prevalent than is widely known. For example, the 1995 report of Canada's Patented Medicines Prices Review Board notes that of the 404 new patented drugs licensed between 1991-1995, only 33 of these — or just over 8% — were judged to be real breakthroughs or to offer substantial improvement over the treatments already on the market.

Some groups may be quite comfortable with this while others may not. Each group must come to its own conclusions about what role they may want to play - either directly or indirectly - in promoting a company and its product. Some groups go as far as outright promotion of a product in exchange for funding. For example, the Crohn's and Colitis Foundation of Canada agreed to have their organization's name printed on the product labelling for Imodium, an anti-diarrheal drug. The packaging includes the message: "Proud Sponsor of the Crohn's and Colitis Foundation of Canada".

If you are accepting money, you may want to be very clear from the start what the parameters of that relationship are and get it in writing. As a minimum, the company should be made to understand clearly that it cannot directly attempt to influence the advice a group gives its members, nor can it use the members as targets for promotion of their products. This may be easier said than done. You may want to seek legal advice around the wording of your contract or letter of agreement.

"This same company also manufactures pesticides which have been shown to contribute to this disease. Why would we want to endorse that?"

In part from pressure from environmental and health activists, more research is slowly being done into the links between cancer and toxins in the environment, such as pesticides. As women's health groups probe further into this, we have been disturbed to find that sometimes the very companies which are manufacturing cancer therapy are also producing toxic pesticides which may be contributing to cancer in the first place.

For example, Zeneca, the manufacturers of tamoxifen citrate earn $470 million each year marketing this cancer therapy drug, at the same time as it earns $300 million each year from sales of the carcinogenic herbicide acetochlor (Elisabeth Rosenthal, Maker of cancer drugs to oversee prescriptions at 11 cancer clinics, New York Times, April 15, 1997, section A, pg. 1.)

As one member of the audience at our panel discussion put it: "They're killing us on one side and curing us on the other and making money both ways!"

The women's health movement and more recently the breast cancer movement has long purported prevention as one of the main tenets of its outreach and advocacy efforts. When links are found between potential funders and the causes of the diseases the groups are fighting, this is often a connection many are not prepared to live with.

When considering funding from a pharmaceutical company, it is always helpful to do some background research on the products the company manufacturers and other aspects of their dealings. You may also want to consider a company's employment practices - how it treats its workers, if women have been allowed to advance equitably in the company and about its practices in Third World countries.

In 1993, the United States Office of Technology Assessment released a report which substantiated some observers' concerns that several companies are involved in questionable marketing practices in Third World countries. In an examination of how US-based multinationals marketed their drugs in developing countries, they found that roughly half the time, companies failed to provide enough information for safe and effective use of drugs. The report indicated that relying on the information which was provided could lead to "non-trivial harm to a substantial proportion of users and severe harm or death to some users". (U.S. Congress, Office of Technology Assessment. Drug Labelling in Developing Countries, OTA-H-464, Washington, DC, US Government Printing Office, 1993)

This information is easily found in public libraries, in the company's annual reports and on the Internet. Doing this kind of research is generally good advice for accepting any corporate donations, not just those from pharmaceutical companies, since corporations can often have disparate holdings you are unaware of. Organizations such as EthicScan (see Resources section below) examine the full social, labour and environmental performance of Canadian companies.

"If we take their money, we're turning our backs on all the women who object to this type of sponsorship, women who feel they've been harmed more than helped by the pharmaceutical industry."

There is no question that many products of the pharmaceutical industry help countless people worldwide to both stay alive and to live a better quality of life. Nevertheless, in its aim to increase its profits, the industry has also manufactured products which have seriously harmed many women, usually due to improper initial testing.

One such example is DES (diethylstilbestrol) a synthetic form of the hormone estrogen which was given to millions of pregnant women in both the developed and developing world between the 1940s and the 1970s in the belief that it could prevent miscarriage. Instead it was found to not only be ineffective in preventing miscarriage but was also found to cause serious harm to many of the children (both daughters and sons) of those women who took it. Many daughters of the women developed a range of problems in their reproductive organs, including a rare form of vaginal cancer generally not found in young women.

Regrettably, in spite of volumes of scientific evidence, the companies which manufactured DES until it was banned for use in pregnancy in the 1970s, have denied any negligence and instead have paid out millions of dollars in the settlement of lawsuits against them. (Note that DES was only banned in 1970 in some parts of the world, mainly the US and western Europe. It is still being sold over the counter in a number of developing countries and some parts of Eastern Europe.)

Further, the companies which manufactured the drug have done nothing to notify the millions of mothers, daughters and sons around the world who were harmed by the drug to ensure that they are receiving proper follow-up care. Instead this responsibility has fallen in the hands of the women who were harmed by the drug in the first place. Organizations such as DES Action, with chapters in most of the developed countries where the drug was prescribed, exist to inform the public about the history of this drug and the need for close medical surveillance of those exposed to it.

Groups such as DES Action have taken strong positions against accepting money from the pharmaceutical industry because of the negligence it has displayed with drugs like DES. DES Action Canada, for example, has publicly stated that they will not engage in any dealings with the particular companies which manufactured the drug unless the following conditions are met:

that the company publicly acknowledge that DES has caused health problems in the mothers and their children, including cancer and reproductive/fertility problems;
that the company publicize the ill effects of DES in order to locate all the DES exposed mothers and children in Canada;
that the company compensate all the DES-exposed who have been harmed by the drug.

To strengthen their point regarding negligence, DES Action, in fact, has a position of taking no money from any pharmaceutical companies, not just those which manufactured DES.

The experience of DES strongly influenced the women's health movement worldwide to take a close look at the pharmaceutical industry. As a result, women working for women's health have led campaigns to press for a more careful review of our drug approval process, and in particular, have argued against the approval of particular drugs whose long-term safety has been questioned, such as some injectable contraceptives.

It is wise to keep in mind that a decision of whether or not to be involved with the pharmaceutical industry is a decision which is taken within an historical context. The context is one which has a particularly problematic legacy.

"Most women just want the help. They don't really care where the money comes from."

This may be very true for a number of women and for many organizations. Certainly when we are dealing with diseases such as cancer, it is often the case that people will "do anything" to get help or get access to a new treatment, whatever the emotional or financial cost.

Staff members and members of boards have a duty to make fair and ethical decisions on behalf of their members or clients. A group may choose to use this time of decision-making as an opportunity to raise awareness about a number of related issues: 1) the role the pharmaceutical industry plays in our lives and the extent to which we have become a society dependent on pharmaceutical solutions; 2) the level of transparency and accountability in the regulation of drugs by their federal government; or 3) arrange an evening with speakers from women's health organizations who have developed policies on this issue (e.g.a breast cancer organization, DES Action or an AIDS organization).

Admittedly the consciousness-raising route is not for everyone. Some groups simply do not have the time or the inclination. One Ontario-based breast cancer organization canvassed its members through a mailed questionnaire asking for their thoughts on accepting money from pharmaceutical companies before they developed their board policy on this issue.

There is no one correct prescription for everyone on this issue. Each group must decide for itself which is the best route to go.

"They've told us there's no strings attached to this money and they seem to be willing to stick to that. Their attitude seems to be ‘hands off‘. Why should we doubt that?"

One women's health organizer looking at this issue for her organization, commented, "There are strings, but they are strings of gossamer", meaning there are strings but you can't always see them.

The point is made best by Barbara Mintzes, in a publication for Health Action International, Blurring the Boundaries: "Any patient group, charity or institution with financial links to the industry or a specific company which spreads awareness of a disease so that more people may seek drug treatment, endorses specific products, or presents positively biased drug information is helping to promote product sales." (p. 26)

It is important to remember that industry's motivations for giving money to an organization are not philanthropic in nature. They give money to targetted groups in targetted fields which relate to their product lines.

Groups may find themselves in this situation unwittingly. The original overture from a drug company may have come from a perfectly well-intentioned individual who cared about their group. Companies are made up of individuals, and individuals of all companies would like to feel they work for a business which is a good corporate citizen. As much as companies wish to buy good will, staff in drug companies also pressure their employers to make donations to community based organizations they feel committed to. Although the donation may come from marketing and all that that involves, the original impetus may not.

Similarly, most researchers who work for pharmaceutical companies come directly from university or have been recruited from a research project. Most of them begin their career with good intentions of hoping to "cure" diseases. While the company as an entity is concerned with profit, the individuals lower down the hierarchy are not always so motivated. Contacts between individuals from a pharmaceutical company and a community organization can be made with the best of intentions by the initial individuals. Later the group may be taken by surprise when the company indicates they would like a higher level of public recognition or sponsorship or indicates they don't like the way in which their product or the whole industry is portrayed in the group's literature.

One thing your group can do is talk to other community organizations which have accepted money from or engaged in some sort of partnership with that same company. Find out what their experience has been in working with that company. For example, the Infertility Network (Canada), which has received funds from Organon and Serono, agreed to have their name added to a brochure about infertility produced by Serono. The Executive Director noted "This was important to them [the company], but it helped raise our profile and so it suited our purposes to do it." Another group might feel compromised by the same experience. Each organization has their own story to tell.

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If your group decides to work with the industry…

David Gilbert, in his paper, "Much to gain, more to lose", suggests that there are six questions a group can ask itself when considering this issue: 1) Do we need to accept funding from a company? 2) What do we seek to gain from such an arrangement? 3) What are our views on the use of medicines for the patients we purport to represent - what do the patients think (i.e. attitudes to care and treatment choice issues)? 4) What are our views on the nature of the industry? 5) What are the alternatives to company funding? and 6) What are the risks of such arrangements?

We can learn from the experience of other organizations who have worked through this issue. The following are some general guidelines culled from the May '97 panel discussion and from other groups consulted since then about how to proceed when entering into sponsorship agreements with a pharmaceutical company or in accepting money from them.

If you are a newly-formed group or one which has not yet dealt with this issue, it is probably best to assume that you will be confronted with it at some point. Most groups find it helpful to develop a written policy on the subject and to make the policy known to your members. The policy may be as formal as being a part of your by-laws or, more commonly, a general policy of the organization. Some treat it as a separate policy while others include it as part of their overall policy on corporate donations.

Be very clear with any newly-hired or volunteer fundraiser what your group's policy is on this issue. Be as specific as possible with anyone doing this work on your behalf (e.g. "We will not consider funds from individual pharmaceutical companies but will consider accepting funds from pharmaceutical organizations.", "We will consider all types of funds, regardless of their source.", "We will not take money from any organization which manufactures substances which have been linked to cancer." "We will consider money from companies which have made a strong public statement and put money behind the advancement of women.", etc.)

When dealing with representatives from a pharmaceutical company who may potentially give your group money, you may want to consider, as some groups have, only meeting on your "turf", i.e. not meeting at their offices, and having a policy not to accept free meals or other freebies as part of the discussion. The point is to maintain control of the discussion and not to be beholden to them, whatever your group's decision may be.

Be sure that any arrangements entered into with a pharmaceutical company are documented and copies are kept in your files and sent to the donor. These can take the form of a letter of agreement outlining what your terms are (e.g. "We agree to use this money responsibly but/and agree/do not agree to enter into the promotion of Company X's product." "We agree/do not agree to carry the company's logo on our printed materials.") Be as clear as possible about your intent. Possibilities left open to interpretation may not always work in your group's best interest. The National Osteoporosis Society of Great Britain has developed very clear guidelines relating to any liaison between their organization and pharmaceutical companies and their agents. (see Resources section below)

5) Your group may wish to only agree to take money which has been put in a blind trust controlled by an independent board, to avoid any possible influence.

6) You owe it to your membership and anyone who supports your group to be as transparent as possible. If you have accepted money from a pharmaceutical company, be sure to acknowledge it in publications, annual reports and at public meetings.

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Other Resources

For a copy of their guidelines on this topic:

National Osteoporosis Society
PO Box 10, Radstock, Bath, BA3 3YB, UK
Tel: 01761 471771

For the HAI publications listed above:

Health Action International - Europe
Jacob van Lennepkade 334-T
1053 NJ Amsterdam, The Netherlands
Tel (+31-20) 683-3684
Fax: (+31-20) 685-5002

e-mail: hai@hai.antenna.nl

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Resources for researching specific pharmaceutical companies

EthicScan, P.O. Box 54034, Toronto, Ontario, M6A 3B7, Canada.

Tel: 416-783-6776, Fax: 416-783-7386, e-mail: ethic@concentric.net, Internet: www.ethicscan.on.ca

For a fee - reduced for non-profit organizations - EthicScan offers detailed information on the ethical profiles of many Canadian pharmaceutical companies.

Rachel's Environment and Health Weekly is a weekly publication available electronically or by mail, which covers a wide range of environmental and corporate issues. An electronic search will bring up anything they have published on questions relating to the environmental practices of specific corporations. Available from:

Environmental Research Foundation,
P.O. Box 5036, Annapolis, Maryland 21403

Fax (410) 263-8944; e-mail: erf@rachel.org, or on the Internet: www.monitor.net/rachel

The Multinational Monitor is published monthly except bimonthly in January/February and July/August by Essential Information, Inc. The Multinational Monitor tracks corporate activity, especially in the Third World, focusing on the export of hazardous substances, worker health and safety, labor union issues and the environment.
To contact:

Multinational Monitor, PO Box 19405, Washington, DC 20036

e-mail: monitor@essential.org, Internet: www.essential.org/monitor/monitor.html

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Acknowledgements

The author wishes to thank the following people for their input:

Theresa Dobko (Canada), David Gilbert (UK), Lisa Hayes (Netherlands), Joel Lexchin (Canada), Peter Mansfield (Australia), Barbara Mintzes (Canada), & Ellen 't Hoen (France)

Additional copies of this booklet available from:

National Network on Environments and Women's Health
214 York Lanes
York University
4700 Keele St.
Toronto, ON, M3J 1P3 CANADA

(e-mail: nnewh@yorku.ca)
for the cost of printing and postage ($5.00 CDN)

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