When Reena Srivastavas four-year-old son did not recover from his month-long bout of common cold, his parents got worried. They changed his paediatrician, who subsequently gave him another set of medicines. The child has been cured, but Srivastava is now convinced that the first doctor had prescribed substandard drugs. And he did it, Srivastava believes, because he had a financial arrangement with the concerned drug company.
Many people feel that doctors prescribing medicines by their specific brand names may not always be ethical in their actions. There is an Indian Medical Association (IMA) code of conduct that states that physicians have to write prescriptions of medicines with their generic names, says Dr Narendra Saini, president elect of the Delhi Medical Association and spokesperson of the IMA. But most medical practitioners flout this rule.
However, doctors who do enter into unethical financial arrangements with pharmaceutical companies to push certain drugs may find it difficult to do so in future. At the recently-concluded general assembly of the World Medical Association (WMA) in Delhi, some new guidelines were adopted to curb the growing nexus between physicians and drug manufacturers and diagnostic companies. The guidelines recommend that pharmaceutical companies should make a full disclosure of the transactions they have with doctors, including that of inviting them for sponsored trips and conferences abroad.
The Medical Council of India (MCI) has, in fact, been working to formulate a legislation against malpractice by doctors. According to Dr Ketan Desai, president, MCI, the council is in the final stages of formulating its draft guidelines. We have sent our guidelines to all the associations and the state medical councils and have got an approval from most of them. Later this month, we will propose the amendments to the guidelines and ask the government to pass the guidelines as a law, says Dr Desai.
Its a welcome move, says Prabir Basu, member, State Consumer Protection Council, West Bengal, adding that once formally adopted, the new guidelines will give consumers a greater handle when it comes to filing cases against instances of such malpractice by doctors. At present, the aggrieved party can send a letter to the state medical council and then take up the case with a consumer court, says Saini.
However, till date, not a single case has been registered against a physician for getting influenced by a drug company and indulging in an unethical practice. Moreover, it is nearly impossible for a patient to prove that the medicine was completely ineffective and that the doctors intentions were malicious, says Basu.
The other aspect of the issue of doctors being hand in glove with drug companies is the worry that whatever these companies pay out to the medicos probably gets factored into the maximum retail price of the drugs. Such expenditures, considered by the companies as part of their marketing costs, are believed to be included in the maximum retail price of medicines, making them more expensive for the patients, says Tapan Ray, director general of the Organisation of Pharmaceutical Producers of India (OPPI). In other words, consumers get shortchanged twice over.
Of course, the problem is not particular to India, points out Ray. It is a global issue.
To address this problem, international pharmaceutical associations like International Federation of Pharmaceuticals Manufacturers and Associations (IFPMA) and Pharmaceutical Research and Manufacturers of America (PhRMA) have come out with their own codes of ethical marketing practices. They also have an appropriate grievance redressal mechanism to respond to complaints from consumers.
India is also taking baby steps to develop fair practices by the pharma industry. Apart from the OPPI, the Indian Drug Manufacturers Association (IDMA) has formulated its own codes of ethical marketing practices. The Department of Pharmaceuticals (DoP), Government of India, has also advised the industry to develop a Uniform Code of Marketing Practices (UCMP), which will be applicable to the entire pharmaceutical industry in India. This is believed to be in its final stages of release. Apart from advocating a full disclosure of all transactions between pharma companies and doctors, there will also be the provision for a grievance redressal mechanism, says Ray.
In a pioneering move last year, global pharma giant Eli Lilly and Company made a full disclosure of payments to physicians for various commercial reasons. The company indicated that it would expand such disclosure to include other forms of payments, such as gifts, entertainment and travel. Since then, other pharmaceutical majors like Merck & Co. and GlaxoSmithKline (GSK) have made similar disclosures.
However, the move to get public disclosures from Indian pharmaceutical companies may run into some opposition. Many are still sceptical about such voluntary disclosure of payment to the physicians, says Ray. Industry majors are worried that in the absence of a proper enforcement of the regulation, some will disclose while others will get away without disclosing anything at all.
But almost everyone agrees that there is a need for greater transparency in the dealings between drug companies and doctors. According to Dr Suganthi Iyer, assistant director, P.D. Hinduja Hospital, Mumbai, there is a need to regularise industry sponsorships of doctors. Medical associations can introduce subscriptions for doctors attending medical conferences. Over a period of time, doctors dependency on pharmaceuticals would be lessened, she says. The MCI too is vocal about the issue. Industry sponsorships should not be for an individual but a medical association or a team of doctors. This way no individual can be influenced, says Dr Desai.
The problem is that right now no doctor can be held guilty for not adhering to the IMA guidelines to curb the nexus between medicos and drug companies. We can just cancel their membership to the association. Cancelling their licence to practise is under the purview of the respective medical councils, says Dr Saini.
Hopefully, the new guidelines — strictly enforced or better still, translated into a law — will go a long way in checking the practice of doctors being influenced by drug companies to peddle substandard or needless drugs on unsuspecting consumers.