This topic is almost never addressed by those involved or by some external observatories. In this short review of the problem, I want to bring arguments for two important problems: the internal organization of scien­tific medical societies and the sponsorships of pharmaceutical companies. They are very important for a democratic thinking of doctors and society in general.

Here we reproduce the Guidelines for the establishment of a professional association (UNESCO, 18 August 1995): “Democratic process associations are normally governed by democratic processes and should be seen to be democratic. Each member should have, and be seen to have, the ability by his or her VOTE to influence the management and decision-making processes of the association. These democratic processes are important, because they enable members to arrive at a consensus within the association, and they provide authority for those who speak outside its meetings on its behalf. Funding associations are funded in a variety of ways. Nearly all associations have membership fees and these may be the only support of the organization. Foundations that support educational or cultural objectives may make funds available but these are usually for specific projects that the association will carry out”⁽¹⁾.

Another problem that can negatively affect the activity of scientific medical societies is that of the relationship with the pharmaceutical industry. This subject has been studied in detail in the democratic world, revealing itself beyond the problem of conflict of interests (COIs) which is immediately visible, and the “distal interests” (DI) which targets persons or societies. “DI lies beyond the immediately visible COIs and the consequences of immediate decisions. They are «distal» in time or place: «DI in time» means consequence of the decision in future scenarios, while «DI in space» means those that impinge on other institutions or bodies. In more developed countries, these relationships are governed by stricter regulations, adherence to codes of conduct by both parties and stronger institutional oversights. In contrast, in developing countries such as Sri Lanka the regulatory environment is lax and the demarcation of interests between the pharmaceutical industry and the medical profession is considerably blurred. Therefore, establishing clear rules of engagement between the stakeholders should be considered as an attempt to clear the muddy waters. The paper proposes a set of guidelines to capture these approaches”⁽²⁾.