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It begins
with some teasers. A pen, a calculator, a vanity bag, a dinner set and so on —
things that cost no more than Rs. 2,500. It is the response at the receiving
end that changes the game in the nexus between pharmaceutical companies and
doctors.
In the
second stage, the doctors opt either for cash or goods. Some of the most
popular gifts are home appliances — a mixer-grinder, a television or a
refrigerator.
The value
of the freebies climbs up when the potential of the doctor is high in promoting
the drugs or in prescribing investigations at the diagnostic laboratories.
There has
also been an instance in which a company set up a home theatre for a doctor. A
plasma television or a car for which monthly installments are paid by the
pharmaceutical company are common these days.
However,
these gifts have become passé as some doctors have switched to all-expense-paid
trips abroad. In fact, it is learnt from the medical community that the Asian
locations are not preferred for these foreign trips sponsored by medicine
manufacturers. Europe and the U.S. are the destinations in demand.
Attending
medical conferences with family in various locales is the in-thing. While the
conferences are sponsored events, many doctors get drug companies to sponsor
their entire trip. Tickets, stay and local tours are all arranged for in a
package. The doctor may only be attending the conference for half a day,
perhaps.
“Drugs for
diabetes, hypertension and chronic renal diseases are the fast-moving drugs and
in large volumes,” said a former Health Services doctor. These drugs face the
toughest competition in the market because of the large varieties available,
and a doctor can be a big help in pushing up the sale of a favourite.
A
cholesterol lowering generic drug Atorvastatin is believed to have nearly 150
brands. And the price ranges somewhere from Rs. 40 to Rs.150 for ten tablets of
10 mg each. Likewise, a gastritis drug Pantoprazole has about 250 or more brands
and may vary in cost from something over Rs. 20 to about Rs. 100.
Another
category of drugs that face tough competition is antibiotics. Cancer drugs and
psychotropic drugs are others that require long-term use, bringing more brands
and competition and price ranges.
However,
it is a fact that not all medical practitioners take the gifts distributed by
pharmaceutical companies. A chest specialist and a general medical practitioner
in the city suburb said most of the doctors in rural areas went for affordable
medicines. “We have to look at the patients in total. There might not be
compliance to the prescription if the patient cannot afford the medicines,” one
of them said.
However,
doctors in urban areas may not know their patients’ backgrounds and may prescribe
costly medicines for some who may not be able to afford them, thereby
indirectly serving the interests of the pharmaceutical companies.
For the
doctors who prove a little tough for the pharmaceutical companies to lure,
there are gifts like free subscriptions to costly academic journals. Some
doctors fall for it as they are not the only or the direct beneficiary as their
department will have some good journals. In some cases, where a doctor may be
running a clinic at home or in a small hospital, these journals help him or her
stay connected to the fast-changing medicine field.
The
pharmaceutical companies took a step back in doling out these gifts quite
openly as the norms of the Medical Council of India had become stricter, said a
medical representative. Under the scanner are the doctors as well as the drug
companies.
Notwithstanding
the strict code of conduct for doctors under the Medical Council of India’s
code of ethics, the freebies given to doctors are many and at many levels.
A doctor
who would prescribe 100 iron tonic bottles a month would definitely be given a
preferential treatment over a doctor who prescribed 50 bottles a month, said a
doctor who had long moved away from active practice.
“It is a
well known fact that most pharmaceutical companies are spending more money on
marketing activity than their research,” says Dr. K. V. Babu from Payyanur.
Such
activities by pharmaceutical or allied health sector companies definitely lead
to a situation where a section of doctors prescribes unwanted costly medicines
or investigations to meet the "target” of diagnostic laboratories and
pharma companies, he added.
Promotional
activity is nothing short of bribery, says Dr. Babu and it was these activities
that brought in the amendment in MCI regulations 2009.
It is more
difficult to manage doctors than a hospital, says a hospital administrator who
has control over two hospitals. The doctors are not happy if the hospital
decides to have its own drug policy. They insist on having their meetings with
medical representatives, said the administrator. The laboratories too offer
commissions if we send in more work to them, he added.
A doctor’s
association is not unidirectional, but multidirectional, says Dr. Jayaprakash
R. from Thiruvananthapuram. There are pharmaceutical companies, diagnostic
laboratories and the neighbouring medical stores.
Recounting
his own experience about ten years ago, Dr. Jayaprakash, an associate
professor, Paediatrician and Child Psychologist, SAT, Government Medical
College, Thiruvananthapurm, said that when he sent a child for an EEG and an
MRI to a diagnostic laboratory, an executive from the lab came home offering a
commission of Rs. 3,000 for an MRI costing Rs. 6,000 and Rs. 200 for each EEG
costing Rs. 600.
“They
offered to open an account in my name. Medical ethics bound us not to even
accept the prescription pad of the laboratory. My standard norm is to write in
my prescription pad to please conduct the test with maximum reduced rate for
the patient. The laboratories provide half of the cost of the diagnostic test
like a CT or MRI to the doctor,”said Dr. Jayaprakash.
The nexus
between medical stores and doctors becomes important for both to keep the
business and the practice roaring, said Dr. Jayaprakash, who has authored a
book on medical ethics in Malayalam.
Medical
ethics is never discussed in medical colleges. IMA does nothing to train
members in medical ethics and there are usually no discussions on this issue.
The
pharmaceutical companies sponsor their leading practitioner as specialty
faculty at conferences. The expert speakers at the meetings are those who are
the largest promoter of a particular company who has agreed to sponsor the
event. Even after the 2009 amendment to MCI code of ethics, these practices
continue discreetly, said Dr. Jayaprakash.
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