Relevance: Mains: General Studies 2: Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
In News: A recent report by a public health group on pharmaceutical marketing practices has revealed widespread use of bribes and inducement by Pharma companies to the doctors in order to increase the sale of their products.
- The medical representative respondents also disclosed that the pressure on them was “tremendous” adding to their stress levels as they were “tracked by their supervisors using iPads.”
- Medical representatives also cited that only 10-20% doctors follow the MCI code of ethics, while in some cases doctors even demand “incentives” to push a product.
- Medical representatives of not just allopathy, but even ayurvedic and homeopathic companies, reported being under massive pressure to meet high sales targets.
- The report cited medical representatives as saying that that company officials even monitor business generated by doctors on whom they have ‘invested’ money.
- Pharma companies are holding training workshops or sessions for medical representatives, focused more on salesmanship and ‘managing customer (doctors) relations’, instead of enhancing their technical knowledge about the product they are handling.
- The report also noted a new trend – the propaganda-cum-distribution companies these days float new entities that are franchisees of the pharma companies who buy drugs in bulk from manufacturers, give their own brand names and directly sell them to retailers and doctors at huge discounts and incentives including gifts, cash, hospitality and travel facilities
Indian pharmaceutical companies received a third of the warnings the United States Food and Drug Administration (FDA) issued for misbranding, selling unapproved medicines and violating Current Good Management Practices (CGMP) so far this year. According to section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act (FD&C Act) violations of CGMP by a drug manufacturer can result in its product being categorised as adulterated. Management oversight, non-conformity to standards, batch failures, contamination are some of the constituents of CGMP violations.
An unhealthy alliance between doctors and pharma firms
For doctors the Medical Council of India has a code of ethics which bars them from accepting any gifts, cash, travel facilities or hospitality from Pharma companies. However for the pharmaceutical companies there is a voluntary code known as Uniform Code of Pharmaceutical marketing practices or UCPMP which experts says is a not a very effective mechanism to check the prevailing malpractices.
What’s alarming is that there is no law to punish those guilty of the unethical practice; and the government refuses to blink.
Result: patients are forced to buy costly medicines.
In 2015, the government had notified the Uniform Code for Pharmaceutical Marketing Practices (UCPMP), crucial for an industry that until now had nothing to regulate it—neither a law nor any guidelines.
The Union government still sits on a 2015 proposal to enforce a uniform marketing practices code for pharma companies, entailing stringent penalties. A year and a half ago, a draft of regulatory codes which was sent to Law Ministry to reign in unethical practices under Essential Commodities Act was rejected. Yet, the Ministry of Health in a reply to a Right of Information (RTI) report said that the draft was being discussed.
The AMR Threat
The health threat is posed to millions of unsuspecting people, who fall prey to irrational prescriptions pushing drugs that may be hazardous for health.
Rising use of antibiotics is the main cause of antimicrobial resistance, one of the world’s greatest health threats. Bacteria evolve resistance to drugs naturally over time, becoming superbugs, but mass or inappropriate use dramatically speeds up this process.
The Way Ahead
- There is a need for a mandatory code for identifying and penalizing unethical promotion on the part of pharma companies.
- Mandated disclosure by Pharmaceutical companies of the expenditure incurred on drug promotion
- Ghost writing in promotion of pharma products to attract disqualification of the author and penalty on the company
- Vetting of drug related material in Continuing Medical Education
Health care isn’t just another consumer product. It is more than that. The Hippocratic ideals of putting patients first are ingrained in our culture and reflected in the regulation of medical licenses and malpractice law. But although Hippocratic ideals have long been the basis of expectations for medical professionals, they haven’t yet been formally applied to health care companies. This is a major shortcoming in an era when the actions of large health systems, pharmaceutical companies, device companies, and insurance companies can have even greater effects on patients than the actions of individual clinicians.