AUTH/3207/6/19 - Anonymous v Santen

Conduct of employees

  • Received
    19 June 2019
  • Case number
  • Applicable Code year
  • Completed
    15 November 2019
  • No breach Clause(s)
  • Additional sanctions
  • Appeal
    No appeal
  • Review
    To be published in the February 2020 Review

Case Summary

An anonymous, non-contactable individual who described him/herself as a concerned physician, complained about the conduct of Santen UK Limited employees at the annual meeting of the Royal College of Ophthalmologists (RCOphth) in 2019 and a Santen organised meeting. Santen held marketing authorizations for a number of prescription-only eye drops including those used to treat glaucoma. It had also acquired the rights to Microshunt, a medical device for use in glaucoma.

The complainant drew attention to a poster session where a number of personnel from Santen asked delegates to leave the poster session to attend a meeting Santen was organising at a different venue. They even interrupted the judges during the judging of the posters to encourage them to attend the meeting. At one point, a senior company employee encouraged people to attend the Santen meeting by offering wine and dinner. The whole process felt a little desperate, as earlier personnel at the Santen booth had handed leaflets out and encouraged registration. The complainant was handed a bottle of water branded Santen, which was confusing as he/she thought the company must have a presence in ophthalmology. It was rather inappropriate to pollute the environment further with plastic.

The complainant stated that he/she was disappointed to find the first two sessions at the Santen meeting were irrelevant to his/her practice and only the final glaucoma presentation was interesting. The Santen meeting went on very late and food was not provided until the end although wine was provided much earlier. It was unclear as to what Santen was promoting, there did not appear to be any new therapies that Santen had developed or researched; it had bought other products and was promoting them.

The complainant stated that the final presentation was interesting but he/she was not sure what the speaker was there for. He/she seemed to promote a medical device (Microshunt) which the complainant was not sure belonged to Santen. Afterwards, the speaker indicated that he/she was paid a lot of money by Santen for the talk and given a business class ticket. In the complainant’s view there were very capable UK physicians who could share experience. The complainant alleged that the conduct, activity and promotion of the products seemed ostentatious and inappropriate and pulled him/her and others away from networking to listen to talks (some irrelevant) and to wait to eat at a very late hour.

The complainant was unclear as to whether Santen could promote other companies’ products since most of the glaucoma products appeared to be owned by another company and not developed by Santen. Santen was not well known in ophthalmology, unlike some other companies, which did not behave in such an inappropriate and unethical manner.

The detailed response from Santen is given below.

The Panel considered that it was important for a company to be mindful of the impression created by its activities; perception and cost were important factors when deciding whether subsistence was appropriate. In the Panel’s view, it was not unreasonable to provide water from the company’s exhibition stand. The Panel noted that the complainant stated he/she was confused when handed the bottle of water as he/she thought the company must have a presence in ophthalmology. The Panel noted that Santen clearly had products in the area and based on the allegation the Panel did not consider the single use, recyclable bottle of water as given by Santen which had a presence in ophthalmology was a gift as prohibited by the Code and thus ruled no breach of the Code.

In relation to the Santen meeting, the Panel noted that drinks were provided at the start and again with the buffet. The meeting started at 19.15 and according to the agenda ran for 2 hours. The Panel noted that the cost of dinner and drinks was £46.71. The Panel considered that, on balance, this was not unreasonable and was not out of line with what the recipients would normally adopt when paying for themselves. The Panel ruled no breaches of the Code.

The Panel noted that there was a difference of opinion in relation to what was said by and the conduct of Santen employees. The complainant had not provided any evidence to support his/her allegations in relation to the arrangements and invitations by Santen employees. The Panel, therefore, ruled no breach of the Code.

The Panel did not consider it was necessarily a breach of the Code to contact doctors outside the UK to present at meetings in the UK. The company’s explanation that the Microshunt device was primarily developed in the USA and the relative experience of the speaker appeared to be an acceptable reason. Further, the complainant did not identify any relevant UK expert and Santen submitted it was not aware of any UK physicians with similar experience and knowledge. The Panel noted the payment. It was not a breach of the Code to provide business class flights for health professionals providing services to pharmaceutical companies. The Panel did not consider that the arrangements were such that they were in breach of the Code as alleged and ruled no breaches of the Code.

The Panel noted that Santen had medicines for glaucoma. There was no evidence with regard to the complainant’s allegation that Santen promoted another named company’s medicines or that promotion of Santen’s medicines were ostentatious or inappropriate for the setting. The Code did not prevent companies from referring to other companies’ medicines. The Panel decided that the complainant had not discharged the burden of proof in this regard that Santen had failed to maintain high standards and therefore ruled no breach of the Code.

The Panel considered that the meeting was tailored to the audience and therefore ruled no breach of the Code.

The Panel noted its comments and rulings above and did not consider that on the available information Santen had brought discredit upon, or reduced confidence in, the pharmaceutical industry. No breach of Clause 2 was ruled.