3. Competing interests Supervision and law enforcement in the Netherlands | 7 October 2010 public health needs <–> market driven phase IV study <–> seeding trials information <–> promotion clinical support <–> gifts clinical guidelines <–> disease mongering training <–> influencing

4. The Dutch way Introductie stafmedewerkers | 27 september 2010 Minister SG DG DG DG IG Public health Health care Long term care Medical products CBG CCMO Lareb

8. Regulators in the Netherlands Supervision and law enforcement in the Netherlands | 7 October 2010 health product Health Products (HP) Non-prescription Medicines (OTC) Prescription Only medicines (POM) Medical Devices (MD) regulator Inspection Board for the Public Promotion of Medicines (KOAG) - Minor violations of law All violations of Code of Conduct - - Code of conduct for pharmaceutical advertising (CGR) - - Minor violations of law All violations of Code of Conduct - Health care Inspectorate - Recurrent minor violations of law All major violations of law Recurrent minor violations of law All major violations of law -

9. Collaboration: how it could be done Supervision and law enforcement in the Netherlands | 7 October 2010 Suspected violation is reported to HCI / CGR / KOAG Case handled by HCI Case handled by CGR Case handled by KOAG Infringement is ceased Case closed

10. Real life: parallel tracks Supervision and law enforcement in the Netherlands | 7 October 2010 Suspected violation is reported to HCI / KOAG HCI / KOAG assesses case and decides on appropriate regulator Case handled by HCI Case handled by CGR Case handled by KOAG Infringement is ceased Infringement is continued / repeated Secondary handling by HCI Case closed Suspected violation is reported to CGR Case handled by CGR Infringement is ceased Infringement is continued / repeated Secondary handling by HCI Case closed All cases regarding promotion directed at health care professionals All cases regarding promotion directed at the public