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New Delhi, Aug. 17: Drug companies may have to disclose to income tax officials on demand the names of doctors who have accepted gifts from them in a fresh government move to curb unethical promotional practices that may hurt patients’ health and pockets.
The income tax department has said drug companies cannot claim money spent on gifts to doctors or their professional associations as deductable business expenses. It has also said doctors who accept gifts need to declare their equivalent value as taxable income.
The circular from the tax authorities earlier this month is being viewed by many within the medical profession as yet another step to curb what some have long decried as unethical practices to influence the choice of medicines prescribed by doctors. The Medical Council of India, the country’s highest medical regulator, had three years ago issued guidelines prohibiting doctors from accepting gifts from pharmaceutical companies above the value of Rs 1,000.
“This is a positive step, but what we really need is mandatory public disclosure of the names of doctors and companies,” said Amar Jesani, a physician and executive director of the Centre for Ethics and Rights, Mumbai.
Acceptance of gifts is a violation of the MCI’s code of professional conduct, Jesani said, but without the knowledge of who’s giving and who’s taking, it’s difficult for the council to punish doctors.
A public disclosure would allow complaints to be filed with the MCI for action.
Anecdotal accounts from doctors and members of the health care industry suggest that drug companies have been promoting medicines through incentives — “brand-reminders”, as executives call them — that have steadily grown in value.
A study published five years ago in the Indian Journal of Medical Ethics found that a pharmaceutical company had offered doctors in Mumbai a cellphone for prescribing 1,000 tablets of a specific brand of medicine, and a motorcycle after 10,000 tablets.
Jesani and others believe the MCI 2009 guidelines have had little impact on the practice.
In June this year, Jyoti Mirdha, a Congress MP from Nagaur, Rajasthan, wrote to Prime Minister Manmohan Singh expressing what she said was her “deep concern on the continued, persistent violation” of the code of ethics of the MCI by doctors.
Mirdha backed her concerns with a set of documents listing the names, air ticket numbers, and the itinerary of 10 doctors and their families whom she claimed were “holidaying in England and Scotland” on a trip financed by a drug company based in Mumbai.
The three-page itinerary, a copy of which is available with The Telegraph, has the name of the drug company printed on the left-hand corner of each page.
The August 1 circular will empower officials scrutinising tax returns of drug companies to demand a list of all doctors who have received gifts from the companies, and determine whether the doctors have themselves declared them as their business income.
Many believe the new rules will have some impact unlike the MCI guidelines of 2009. “The knowledge that a legal tangle can result from accepting a pharma freebie is a deterrent for doctors who’re generally wary of courts and legal procedures,” said Nobhojit Roy, a surgeon in Mumbai, and chairperson of the Forum for Medical Ethics, a society set up by doctors concerned about unethical practices in their profession.
But Chandra Gulhati, a pharmacology specialist and editor of the Monthly Index of Medical Specialities, India, an independent journal of drugs, says the MCI guidelines and the income tax action make up two of four possible steps to curb unethical promotion.
“We also need an amendment to the companies act to make it mandatory for pharmaceutical companies to disclose the identities of the doctors or medical associations who have received gifts or support of any other kind on their balance sheets,” said Gulhati.
A fourth step would be for drug regulators to prohibit unethical promotional practices.
Gulhati and others have often warned in the past that incentives could influence some doctors to prescribe expensive drugs when cheaper alternatives are available or unnecessary drugs such as vitamins or tonics, or even antibiotics when patients do not require such formulations.
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