Approved by Council October 1998

INDEX

I. Statement of Ethical Position

II. Commercial Support of Academy Related Educational Activities

III. Name Lending for Profit

IV. Advertising in AACAP Publications

V. Use of Corporate and Non-Profit Logos

VI. Exhibits as AACAP Activities

VII. Media Events in Conjunction with AACAP Activities

Guidelines for Commercial Contribution to The American Academy of Child and Adolescent Psychiatry

Approved by Council October 1998

I. Statement of Ethical Position

The American Academy of Child and Adolescent Psychiatry (Academy) Ethical Code deals primarily with the child and adolescent psychiatrist's relationship with patients and their families. When the Code was written in 1982, not much thought was given to the business of psychiatry. Only the last line of the last principle (XVII), "The source of compensation should not influence professional judgement,"would appear to have relevance to the Academy=s corporate relationships.

In attempting to weigh the pros and cons of accepting money from corporations, we (the Academy) need to consider two types of ethical theory which affect decision making. Utilitarian theory, in essence, states that the ends justify the means and that we should be concerned with promoting the greatest good for the most number of people. Notes Beauchamp and Childress, "The utilitarian need not demand that all future consequences or even all avoidable consequences be anticipated." According to this theory, forming corporate liaisons would be acceptable if the transaction were beneficial to the Academy and the corporation in question.

In contrast, deontological theory, which is based on duty rather than outcome, holds that "some acts are right or wrong for reasons other than their consequences (Beauchamp & Childress, p. 36)." Approving a line of children's toys might profit the Academy financially and encourage parents to buy developmentally appropriate toys. However, some might argue that there are hidden costs in this endeavor, namely, the risks of tainting our name and commercializing a professional organization. Critics might also invoke a slippery slope which leads to compromising our standards and entering into relationships which we might later come to regret. At the same time, one must weigh the value of the act contemplated. Thus, accepting money from a pharmaceutical company to underwrite an educational program might be more acceptable, to some, than accepting the company's money to endorse a particular medication.

The very nature of an ethical dilemma involves the weighing of competing ethical principles. As noted by Hundert, this may lead to lingering anxiety given the outweighed value "can never find expression in any action we take." The following discussion encapsulates the issues deliberated by the Corporate Contributions Policy Committee, on behalf of the Council, concerning our ethical relations with corporations.

Beauchamp, T. And Childress (1989). Principles of Biomedical Ethics. New York: Oxford.

Hundert, E. (1990): ACompeting Medical and Legal Ethical Values: Balancing Problems of the Forensic Psychiatrist.@ In Rossner and Weinstock: Ethical Practice in Psychiatry and the Law. New York: Plenum.

II. Commercial Support of Academy Related Educational Activities

Normal Continuing Medical Education activities of the Academy are well defined by the current Continuing Medical Education agreement forms. The following guideline refers to accepting corporate support for activities not covered by the CME agreement, i.e., corporate sponsored symposia or other educational activities.

(Corporate support of non-educational activities, such as receptions, dinners, or luncheons was not addressed here, but remains a concern to the Committee. Question: will support of programs such as the Book Drop or the President's Reception have an undue influence on the decisions made by the Academy or its members.)

There is a "perceived influence" that accompanies all Commercial support of educational activities. While noted researchers and clinicians are ethically bound to report accurate information, this does not remove the perception that a Commercial supporter has influenced the content of a presentation. All precautions must be taken to insure that such influence is not perceived at Academy related activities. As a professional organization, the Academy must maintain a higher standard than may even apply to individual members.

Statement of Purpose:
Programs are for scientific and educational purposes only and will not promote products, directly or indirectly.

Control of Content and Selection of Presenters and Moderators:
The Academy is responsible for the control of content, format, and selection of presenters and moderators. The Commercial supporter agrees not to direct the content of the program. The Commercial supporter will respond only to Academy requests for suggestions of presenters or sources of possible presenters.

Publicity:
The Academy will publicize the educational activities in its usual materials to describe educational activities of the Annual Meeting. The Commercial supporter will not send additional mailings.

Disclosure of Financial Relationships:
The Academy will ensure meaningful disclosure to the audience prior to the program of:

  1. Commercial support or funding,
  2. Any significant relationship between the Academy and the Commercial supporter and between individual presenters or moderators and the Commercial supporter; and
  3. Other significant financial relationships between presenter and other commercial entities.

Please note: there was extensive discussion on the issue of disclosing the specific monetary compensation given a presenter. While some members felt this information would help the Committee determine whether the presenter could be influenced by the corporation paying them, others considered this an invasion of privacy and a business issue not an ethical issue. Each presenter must make their own decisions about compensation. A majority vote endorsed the statement, AIndividual Academy members receiving honoraria will make their own decision regarding whether to accept honoraria for symposia. (Note: we are not saying it is okay to promote products at the Academy Annual Meeting even if an individual decides it is.)

In addition, only disclosure of the presence of financial support, and not the amount, will be required. An alternative is to disclose that "speakers honoraria are provided by _____ and fall within Academy-approved ranges."

Promotional Activities:
No promotional activities will be permitted in the same room as the educational activities. Product advertisements will not be permitted in the program room.

Objectivity and Balance:
The Academy faculty will make every effort to ensure that the data regarding the Commercial supporter's products is objectively selected and presented.

Discussion of Unapproved Uses:
The Academy will require that presenters disclose when the product is not approved in the United States for the use under discussion.

Food Receptions:
The Academy will ensure that no food/beverage will be served at Commercially supported activities that is not also served at all regular Academy programs.

Please Note: The Committee agreed that they had no jurisdiction over Regional Councils and could therefore not regulate their decisions concerning food/beverage service at Commercially supported activities.

Independence of Academy in the Use of Contributed Funds:
The Academy shall examine the potential dependence on corporate funds, and shall always be able to maintain sufficient financial independence to enable the Academy to decline commercial funding.

  1. The Commercial supporter will pay an administrative fee determined by the Academy for administrative support, equipment, and labor. (A minimum amount of $10,000 per three hour symposium was suggested. The Committee could not agree on setting a minimum or a maximum for this fee to the Academy. It warrants further discussion.)
  2. The Commercial supporter will also provide a restricted educational grant for payment of honoraria and travel to faculty.
  3. Any other support associated with this educational activity must be given with the full knowledge and approval of the Academy and a complete budget must be submitted to ensure full knowledge.

III. Name Lending for Profit

Definition:
For practical purposes, lending the Academy's name to a product, group or activity for profit is very similar to endorsement. Subtle semantic nuances may have different legal implications but in the public mind, the linking of the Academy with a commercial product equals an endorsement.

Issue 1:
Should the Academy ever lend its name to specific products or organizations in return for money?

Pro: 

  1. Some products may help children. 
  2. Academy participation in the development of a product can shape or improve it. 
  3. Revenue from lending our name may further Academy programs. 
  4. Tacit name lending may already be common, i.e., use of logos.

Con: 

  1. Lending our name to a specific company may compromise objectivity of the Academy in fact or appearance. 
  2. May adversely affect the professional image of the Academy. 
  3. Academy may not be able to control use of our name once lent. 
  4. May increase the price of the items to the public. 
  5. May imply other items without our name are inferior. 
  6. May involve liability. 
  7. Lines may be hard to draw regarding what is appropriate and not appropriate to carry our name.
  8. Academy may become dependent on such funding sources for normal operations.

Issue 2:
If the Academy decides that it is appropriate to lend our name to products, what are required characteristics of products that may carry our name?

The Committee recommends that such products be: 

  1. Good for children 
  2. Safe 
  3. High quality 
  4. Good value 
  5. Available/affordable for most children 
  6. Marketed honestly and in good taste 
  7. Manufactured under appropriate conditions 
  8. Produced by a company with a good reputation and image to reflect positively on the Academy.
  9. Free of specific religious affiliations 
  10. Appropriate in portrayal of gender and racial characteristics, if relevant.

Issue 3:

If the Academy decides to lend its name to a specific product, what procedures should be followed? The Committee recommended the following steps to provide maximal protection:

  1. Written proof regarding points 1-10 in Issue 2 above must be provided to Academy before proceeding. Consultation should be obtained in circumstances where Academy lacks sufficient expertise to evaluate a particular point.
  2. Legal issues must be addressed explicitly in every instance concerning:
    • Liability
    • Threats to non-profit status of Academy
    • Limits to use of the Academy name by the company
    • Duration of the agreement
    • Procedure for withdrawing the use of our name
    • Disclosure of profit from the arrangement by any member of the Academy or member's family.
  3. Contract must be approved by Academy lawyer, not just the Company's lawyer.
  4. Contract for the name lending should be disclosed to any member or public group who wants to see it.

Issue 4:
Are there categories of products, or specific companies within categories, to which under no circumstances the Academy should lend its name?

  1. Is there a hierarchy of appropriateness ranging from educational materials (publishing companies) to toys to pharmaceuticals to managed care companies?
  2. Perhaps the points in Issue 2 adequately cover the possibilities and more specific guidelines are not needed.

Summary:

Endorsements include services and are not restricted to products. Restrictions would not apply to services or products determined to be member benefits, but rather to services and products directed to the public.

In addition, such name lending must be decided by the Council and not a Committee. The Council is cautioned that defects in products can appear much later and a "safe" product can overnight become a liability and/or damage the reputation of the Academy and its members.

It is recognized that carefully addressing procedures 1-4 under Issue 3 is a significant effort, the difficulty of which will preclude the name lending in many (if not all) cases. Overall, the Committee felt that in most instances the risk/benefit ratio is such that the Academy will be best served avoiding lending our name for profit.

IV. Use of Advertising in AACAP Publications

Advertising supports the publication of the JAACAP, AACAP News, and Annual Meeting publications. The percentage of advertising versus content allowable is governed by the AACAP's status as a 501(c)(3) and no further restrictions are deemed necessary at this time.

Members of the Academy and the public are aware of advertising and have the ability to discern it as such and not as an endorsement of a product or service by the Academy.

Guidelines for Editors and Staff when accepting advertising:

  1. Staff should always exhibit some caution when accepting advertisements, i.e., does the Academy want to be identified with a particular service or product.
  2. Editors of Academy publications should make the final decision regarding appropriate and questionable advertisements.
  3. All ad copy should be in good taste and clearly identifiable as an advertisement.

V. Use of Corporate and Non-Profit Logos

Logos are specifically designed to attract attention and instill an identity or market message in the mind of the consumer in the absence of any further detail or information. Use of such advertising or product recognition (logos) implies an association/relationship between the Academy and the for-profit or not-for-profit corporation.

Use of Logos will be restricted in the following manner: 

  1. The practice of placing a for-profit corporation's logo on Academy materials in return for financial support in the form of grants, underwriting support, or in-kind gifts will not be allowed in Academy publications or on Academy products.
  2. For-profit corporation support will be acknowledged in text only, i.e., "The publication and distribution of this material is made possible...." without the accompanying logo.
  3. The use or placement of Not-for-profit organization's logos will be considered on an case by case basis.
  4. A for-profit corporation may apply for an exemption to this policy, which would be referred to the Corporate Contributions Policy Committee for review.

VI. Exhibits at AACAP Activities

Exhibits at Academy activities provide an organization with the opportunity to promote goods and services to Academy members. The presence of such organizations does not imply the Academy's endorsement of these goods and/or services.

The following are guidelines for organizations exhibiting at Academy activities:

  1. All demonstrations, sales activities, and distribution of circulars and promotional materials will be pre-approved by the AACAP in writing, and confined to the limits of the exhibitor's booth, except that which is specifically authorized by the Academy.
  2. Any advertising premium or novelty giveaway must be an item that can be used in the professional activities of the booth visitor.
  3. Exhibitors will display only goods manufactured or dealt with in their regular course of business, unless otherwise approved by the AACAP.

VII. Media Events in Conjunction with AACAP Activities

The Committee recommends that the TV and Media Committee use its expertise to produce guidelines to govern media events at Academy meetings. Guidelines should protect the Academy from becoming an agent of a public relations firm or corporation. The Committee will review draft guidelines from the TV and Media Committee if requested.