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Bitter Medicine: The Corrupt Business of Prescriptions

Meetings in exotic locations, hours of scientific discussions that turn into four-day family vacation packages, expensive gadgets and gold coins as gifts, cash in bank accounts – the extent of medical corruption in India is unacceptable. is where everyone can see it. that.

The threat continues to grow. The infamous 40% commission (allegedly demanded by a government contractor in Karnataka) appears to be making inroads into the healthcare sector as well.

“The commission given to doctors[for prescribing certain drugs]has increased from 20% before to about 40% today. It goes into the doctor’s relative’s account,” said Sharan*, a medical and sales representative with 22 years of experience.

Not all doctors are corrupt and not all pharmaceutical companies sell their products through unethical means. However, it cannot be denied that many doctors and medical companies are taking unfair measures. Even the Supreme Court frowned upon the costs of promoting Dolo 650, a brand of paracetamol that has become popular during the pandemic.

Last month, when the Dolo-650 manufacturer was informed that it was spending about 100 billion rupees on giveaways, the Supreme Court bench of Justices DY Chandrachud and AS Bopanna heard a petition on medical corruption and decided to It was described as a “serious problem.” To the doctor, according to the Central Committee of Direct Tax. “This is not music to the ear. Even I was asked to take the same medicine when I had Covid,” Judge Chandrachud said.

The bench was listening to a federal petition for the Association of Medical and Marketing Representatives of India (FMRAI). This called for the Uniform Code of Pharmaceutical Marketing Practices (UCPMP) to be made statutory. .

Until such regulation is enacted, the federal court will ask the Supreme Court to “develop guidelines for managing and regulating unethical marketing practices by pharmaceutical companies, or otherwise determine that the Supreme Court deems appropriate and reasonable.” I requested that such modifications/additions be bound to the existing code. “

FMRAI argued that in India, pharmaceutical companies spend a lot of money on promotion to get doctors to prescribe their products and boost drug sales.

“According to a study, the top seven companies together spent Rs 3418.695 crore on marketing in eight years, making medicines more expensive. out of reach,” says the FMRAI petition to the Supreme Court.

Although called “promotions,” these giveaways include direct or indirect benefits, sponsored international travel, hospitality, and other benefits provided to physicians as gifts or entertainment. increase. “The medical person introduces the doctor to the product, and her senior sales manager negotiates with the doctor by providing cars, equipment, international travel, etc.,” he says.

There are two broad categories in which this nexus between medicine and marketing persists.

The first is drug overuse or overprescription. He does this in three ways: prescribing more medicine than necessary, prescribing medicine for longer than necessary, and prescribing more medicine than necessary.

The second category is prescribing irrational drug combinations. Such drug combinations, prescribed for heavy-handed promotional tactics, are usually unsupported by the medical literature and may pose a health hazard.

Hundreds of these combinations have been banned several times by governments, but pharmaceutical companies have continued to flood the market with them.

A study published in the World Health Organization bulletin found that 229 (58%) of the 395 fixed-dose combination drugs (FDCs) sold nationwide are on the World Health Organization’s “not recommended” list. I was. Thirteen of the top 20 antibiotic cocktails sold in India have been classified by WHO as neither evidence-based nor recommended.

Pressure on medical personnel

Healthcare professionals, meanwhile, are expected to meet burgeoning goals. “If these targets are not met, we will be fired. Area responsible for multiple districts because the targets are high Her manager works intermittently in each district and also offers doctors.” he says Sharan.

The Coimbatore-based doctor said pressure from medical personnel has diversified over the past two decades. “I personally know a doctor who banned him from meeting with medical personnel. When I started, the company had one representative. We have people in charge,” she said.

She noted that marketing has become increasingly aggressive over the years. But the tour is planned for several days.”

The initial purpose of pharmaceutical company representatives’ meetings with physicians was to keep health professionals up-to-date on recent developments in drugs and treatments. Especially for private practice physicians, meeting a sales representative is important to know the price of the drug so that they can prescribe affordable options for their patients.

The companies also claim that the conferences they host assist professionals in continuing medical education.

Critics argue that the information doctors learn from these meetings is one-sided.

“Patients are only casual buyers and the products are sold to doctors, so they are selling more expensive medicines instead of cheaper ones,” said a former Public Health Foundation of India. said public health researcher Prasanna Saligram.

Are governments unaware of such malpractice? What are they doing to address the problem? The Pharmaceuticals Agency under the Federal Ministry of Fertilizers has repeatedly informed parliament that it has no plans to make the UCPMP mandatory.

rule

The Code, which came into effect in 2015, does not give departments the authority to deal with complaints about unethical practices. processed by The ministry held several meetings with industry groups regarding implementation, but there was no further follow-up or action.

However, thanks to some increased awareness, some companies have changed their marketing strategies. “In the past, many companies offered overseas travel or sent medical equipment to doctors’ homes. It’s getting tougher over the years. Doctor’s office or clinic,” said the Bangalore-based doctor.

Common practice is to sponsor scientific conferences that comply with NMC guidelines. Pharmaceutical companies sponsor these events and have booths outside the halls to showcase their products and provide information.

However, in specialties such as oncology and cardiology, new drugs are expensive and marketing is predatory.

Companies now sponsor panel discussions where doctors present scientific information related to new drugs. These presentations don’t directly advertise the drugs, but doctors talk about prescribing.Outside the hall, companies display these products. “Doctors who present information receive incentives that vary between Rs 10,000 and Rs 10,000 for a one-hour session, depending on the company and the doctor’s profile,” the doctor said.

In February, the Supreme Court ruled in a separate ruling that it was “clearly prohibited by law” for pharmaceutical companies to offer gifts to doctors. , observed that practitioners are prohibited from accepting such gifts or giveaways.

“When it is demonstrated that doctors’ prescriptions are manipulable and motivate us to take advantage of freebies offered by pharmaceutical companies from gifts such as gold coins, refrigerators, etc., it is of great social importance and concern. LCD TVs are meant to fund trips abroad for vacations and attendance at medical conferences,” Bench noted.

Despite such observations, the threat is thriving due to the lack of effective oversight of doctors prescribing certain brands of drugs, said a Narcotics Inspector at Thiruvananthapuram. There is also no provision for legal action against doctors who prescribe this brand.

In 2017, the federal government proposed new regulations and a draft of the Drugs (Marketing Control) Order 2017 was sent to the Ministry of Justice for approval. “But the same was not enacted for reasons that the Ministry of Justice knows best. Thus, the UCPMP as it exists today remains voluntary in nature, which makes its implementation impossible.” summed up FMRAI.

(Based on information from Mrityunjay Bose, Mumbai, ETB Sivapriyan, Chennai, and Arjun Raghunath, Thiruvananthapuram)

(*Some names have been changed upon request)

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