Meeting purpose

This BC-PAN meeting was a 2-day Zoom conference on June 9 and 10, 2021. The purpose of the meeting was to hear public advisors’ expectations of health care practitioners who are selling or endorsing products or treatments.

Key messages from public advisors

• Because of the power imbalance between a patient and a practitioner, health regulators should provide a clear line and enforce strong boundaries regarding the topic.
• Guidelines should ensure that the patient’s interests are prioritized above the practitioner’s benefits.

Background on health care practitioners selling products and services

Joanie Bouchard, CDBC Registrar, provided advisors with context for the discussion on practitioners selling services or products. For dieticians, there is a large industry of dietary supplements and products available to the public. Many other fields also offer additional services and products.

• Section 16(2) of the Health Professions Act outlines that regulators must monitor and enforce standards of practice to reduce incompetent, impaired, or unethical practice amongst registrants.
• If a health care practitioner is selling something, there may be a bias that comes with the incentive of making more money.
• Some risks to the public include:
  • The product/service may not be needed to maintain or restore health.
  • Other products/services may be better, as good, cheaper, or more culturally appropriate.
  • Uniformed, incomplete, or false information/claims.  
• Key issues:
  • Conflict on interest, disclosure, and mitigation.
  • Objective and evidence-based recommendations.
  • Transparency.
  • Undue pressure and diminished trust in the patient-practitioner relationship.

Advisors answered a poll: have you ever had an experience of buying a product, treatment or service from a regulated health care professional?

• Yes, many times – 20%
• Yes, one or two times – 60%
• No – 13%
• Unsure – 7%

A public advisor shared their experience with occupational therapists selling alternative health products. As the parent of a child with a severe brain injury and development issues, they experienced an occupational therapist using contact with patients to facilitate the sale of alternative health products. The advisor pointed out that some parents are very susceptible to practitioner recommendations, given their drive to help their children.

Advisors were asked to review CDBC’s draft Conflict of Interest and Sales Guidelines prior to the meeting. The guideline is in its final stages of development and will be implemented in the fall.

• Guideline 1: Speaks to conflict of interest concerns when practitioners undertake the dual role. Dieticians are required to identify a potential, real, or perceived conflict of interest. Guidance is provided on how conflicts of interest should be disclosed and managed.  
• Guideline 2: Addresses objective practice and evidence-based information. Offers guidance on how practitioners should address the lack of evidence so patients can give informed consent. Suggestions on how to make communication to the patient culturally appropriate are welcome.
• Guideline 3: Provides guidance on ensuring transparency and fairness throughout the whole process.
• Guideline 4: Differentiates practitioners’ professional practice from their personal lifestyles. Combining personal and professional social media is becoming popular, and regulators are seeking guidance on how to help the public to be aware of what is professional information and what is personal.

Advisor questions and comments

• Are there Canadian guidelines?
  • Health Canada is responsible for approving products that can be sold in Canada. Regarding claims and efficacy, there is a minimum that companies must meet.

Expectations of health care practitioners selling products and services

Advisors went into break out groups and discussed:

1. Thinking about the issue of registrants selling services and products, what do you hope a guideline like this will enable or prevent?

• Ensure that the interests of the patient are above the benefits for the practitioner.
• Practitioners will need to provide evidence on why the specific product is needed.
• The requirement to provide an alternative product of what is being recommended.
• It is important that practitioners disclose if they are receiving a benefit or incentive from selling products to patients.
• Enable patients to seek a second opinion.
• Prevent a practitioner being unduly influenced by corporate incentives, which undermines the integrity of the practice.
• Ensures clear communication of pros and cons of products or treatments.

2. Review the CDBC Conflict of Interest Sales Guidelines. What’s missing?

• A way to help the public understand if something has been approved by Health Canada as a pharmaceutical or if it is a natural health product.
•  Respect that Indigenous people use traditional medicines that are outside of Western “evidence based” systems.
• Highlight the power imbalance between the patient and practitioner – a patient may feel obligated to purchase a product from their practitioner or may not feel safe to ask questions.
• Practitioners should fully disclose possible risks or side effects of the products or treatments.
• In the context of a shared clinic space where there may be regulated practitioners and unregulated professionals, what may this mean for the patient?
  • The regulated practitioner may be unintentionally endorsing other treatments, and there should be a clear statement whether they do or do no endorse products offered by others.
• Incentives go beyond money and may include gifts, which should be addressed.

Other comments

• Consider implementing a decision tool for patients to help make informed decisions about recommended products.
• Health regulators need to set a clear line and enforce strong boundaries surrounding this topic.