1. Introduction

Non-governmental healthcare organizations serve a purpose in aiding the nation’s healthcare services through education, dissemination of information, public awareness, promotion of research, patient support programmes and other activities. The education of healthcare workers may include the discussion of effective treatment modalities, new drugs and treatment approaches, through education and training programmes, which may be organised by different organisations and institutions. Often, these educational programs have been organised with the support of various agencies including pharmaceutical companies. 

In recent years, primarily with regards to companies involved in the sales and distribution of opioid medicines, the issue of transparency and ethics has arisen with regards to the relationship between healthcare organisations and pharmaceutical companies.

2. Principles of relationship with Pharmaceutical and other commercial companies

In order to provide greater transparency in the relationship between MASP and pharmaceutical as well as other commercial companies, the following are the principles that MASP shall adhere to:

• MASP, whilst promoting best practice and evidence in pain management, will not endorse any particular company product. Discussions and educational talks or written papers will use generic names for all medications.
• MASP maintains a conflict of interest (COI) policy regarding endorsements that all EXCO are required to follow. It declares that it is acceptable for EXCO to participate in activities with industry - such as speaking roles, advisory board memberships, authors of monographs or papers, consultation - but it must be clear at the time of accepting an invitation that the leader is not representing MASP. Exco members are required to declare their COI upon being elected into the Exco. 
• MASP events should not be compelled to be seen as supportive of certain companies, and common items such as name cards, lanyards and bags etc. should be free of company endorsements. Sections of a venue should be clearly demarcated for trade exhibitions. 

3. Guidelines for key areas of engagements and consideration of requests from pharmaceuticals

1. Educational grants. Grants from commercial companies could still be accepted for the purpose of enhancing national pain awareness and education. Educational grants will be accepted under the following conditions:
   • MASP will solely decide on how the grant will be utilised 
   • Any publication of the grant must include a transparency clause that that the acceptance of the grant does not indicate an endorsement of the company. This should also be reflected in the internal accounts and audit.
   • Accepting the grant does not contravene the other principles of ethics and transparency. 
      
2. Endorsements
   Direct endorsement of companies and products will not be allowed. MASP will not endorse drug launches/promotions. Where possible, MASP will only use generic names in any literature. 
    
3. Participation as experts
   A request from a company for the participation of an expert on the field of pain needs to be clearly indicated. Whilst any clinician has the right to accept a position with a pharmaceutical company, this needs to be carefully considered by the EXCO of MASP. If the requirement of an MASP EXCO member could be seen as an independent expert and in the interest of the public, this could be allowed but due consideration should be taken if this could be seen as endorsement of a product / company. To avoid the appearance that the leader is endorsing a product or company on behalf of MASP, all marketing of the activity must omit the leader’s role within MASP.
    
4. Conferences
   All speakers at conferences need to sign a disclosure agreement. Any information provided by pharmaceutical and medical device companies need to be clearly demarcated in an area for exhibition. Sponsored symposiums could be allowed but needs to be clearly stated that this is not part of the scientific meeting and not publicised directly by the conference. Conference materials such as name badges, pens, lanyards and bags should not carry company / product endorsement.
    
5. Workshops
   Collaboration, but not endorsement, in workshops with pharmaceutical entities could still be accepted for the purpose of enhancing national pain awareness and education.  Collaboration will be accepted under the following conditions:
   • No talks directly on specific products or devices, even during lunch/dinner
   • MASP to receive the proposal at least 3 months prior to the workshop. MASP reserves the right to review workshop content, speakers and target audience and make suggestions for changes if deemed appropriate.
      
6. Reimbursement to speakers and participants in Expert Groups when the engagement of speakers is through MASP
   • If the honorarium is paid directly to speaker, one third of the honorarium received by the speaker will be contributed back to MASP (taking into consideration of the income tax incurred on the speaker) 
   • If the honorarium is paid to MASP (e.g. through a third party like MIMS), one third of the honorarium received by MASP will be paid to speaker by MASP (taking into consideration of the income tax incurred on the MASP)