The nexus between pharmaceutical company and health professionals
BY: Priyanka Saurabh
The Supreme Court (SC) is hearing a petition regarding the gifts delivered by pharmaceutical companies to doctors and has sought a response from the Central Government in this matter. In the petition regarding the nexus of companies and doctors for the sale of medicines, it has been alleged that several doctors have been prescribing particular medicine excessively after receiving gifts from the companies. This is a serious allegation and casts a shadow on the noble profession.
Common people know this already even if they can’t establish it. They know that there is a nexus of drug retailers, wholesalers, doctors, and companies that the pharmaceutical market has been making use of and therefore climbing the ladder of progress. Due to lack of control in the medical market, the arbitrariness is such that the salt which gets 10 tablets for nine rupees is being sold, after giving a branded tag, for ninety rupees. All this is done without any consideration for the ailing and the sick and such scams also create problems with the price of medicines in the market.
This nexus is growing by every passing day and for increased sales, companies have been making their gifts more lucrative and, barring some, most of the doctors aren’t able to refuse the alluring opportunities. Medical representatives also say that only 10-20% of doctors adhere to the MCI code of conduct, while in some cases doctors even seek “incentives” to push a product. Not only allopathy, but medical representatives of Ayurvedic and homeopathic companies have spoken of being under immense pressure to meet higher sales targets which leads to such a practice.
A report, in this regard, cited medical representatives as saying that company executives also monitor the business generated by doctors in which they have ‘invested’. Pharma companies are conducting training workshops or sessions for medical representatives, focusing more on sales skills and ‘management of customer (doctors) relationships’, rather than enhancing their technical knowledge about the product they are handling. The report also mentions a new trend – promotion-cum-distribution companies these days that create new entities which are franchisees of pharma companies that buy drugs in bulk from manufacturers, give their brand names and sell them directly to retailers. The incentives include gifts, cash, hospitality, and travel facilities extended to doctors as well as medical professionals.
The Medical Council of India has a code of conduct for doctors that prohibits them from accepting any gifts, cash, travel facilities or hospitality from pharma companies. Although there is a voluntary code for pharmaceutical companies known as the Uniform Code of Pharmaceutical Marketing Practice or UCMP, experts say that it is not a very effective mechanism for checking prevalent misconduct. What is worrying is that there is no law to punish those guilty of unethical conduct. As a result, patients are forced to buy expensive medicines. The central government is still sitting on a 2015 proposal to introduce a Uniform Marketing Practice Code for pharma companies, which provides for stringent penalties.
A year and a half ago, a draft of regulatory codes sent to the Law Ministry to rule out unethical practices under the Essential Commodities Act was rejected. Still, the health ministry, in response to a Right to Information report, said the draft being discussed poses a health threat to millions of people who fall prey to irrational prescriptions pushing drugs that could be dangerous to health. The increasing use of antibiotics is the main cause of antimicrobial resistance, one of the world’s biggest health threats. Bacteria naturally develop resistance to drugs over time, becoming superbugs, but large-scale or improper use accelerates this process dramatically.
There is a need for a mandatory code to identify and penalize unethical promotions on the part of pharma companies. Compulsory disclosure by pharmaceutical companies of drug promotion spending, drug testing in continuing medical education and health care is not just a consumer product and is more than that. The idea of putting patients first is rooted in our culture. This is a major drawback when the actions of large health systems, pharmaceutical companies, device companies, and insurance companies can have a greater impact on patients than the actions of individual physicians.
To tackle the problem, there is a dire need to bring in a new law under which pharmaceutical companies will be required to disclose the amount paid to doctors for research, lectures, travel, and entertainment. There should also be a code of ethics, under which pharma companies cannot give any kind of gift, money, or other benefits to doctors for promoting their medicines, nor should they organize meetings or conferences in such places which are associated with entertainment, sporting events or providing fun and leisure. There should also be an emphasis on the need to punish anyone for adopting unethical methods. Only legal intervention can work to break this immoral nexus of doctors and pharma companies besides awareness campaigns that could help patients to understand the system better.
The writer is a Research Scholar in Political Science, Poet, freelance journalist and columnist.