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Pharma's bad practices take new forms

Consider the recent case in Punjab where the Punjab Medical Council pulled up 10 doctors and sent them notices for allegedly receiving payments from some leading pharma companies. The list included the who's who of Indian and global pharma companies.

twitter-logo E Kumar Sharma        Last Updated: November 26, 2015  | 12:19 IST

E Kumar Sharma, Associate Editor
It is sad but true and it hurts. Each time there is talk of a doctor being bribed by a pharma company, the issue gets treated and dismissed by most people as "a perennial problem and a global issue" with no easy fixes.

Sure, there are no easy solutions on moral issues, as ethical behaviour is an individual attribute that cannot be taught. But then, if there is no voluntary restraint then it needs enforcement. Much like cheating in schools. Children do cheat and they do get punished. One could argue that cheating has not stopped but then at least there is fear of being caught.

Consider the recent case in Punjab where the Punjab Medical Council pulled up 10 doctors and sent them notices for allegedly receiving payments from some leading pharma companies. The list included the who's who of Indian and global pharma companies.

Apparently, the voluntary code has not worked. For, effective from January 1 this year, the Department of Pharmaceuticals had implemented a voluntary "Uniform Code of Pharmaceuticals Marketing Practices" aimed at checking the practice of giving freebies to doctors to promote sale of medicines. In fact, the very next day, many felt the voluntary code may not work and this was carried in these columns.

Having said that, one must also say there are many doctors who are honest and very upright with some not entertaining any pushy medical representative. In fact, talking to some of them and others makes it apparent that the world has changed and it is not direct cash inducements anymore. Several indirect and third-party linked routes have been built, linking some doctors with pharma companies.

Consider this: Doctors are getting appointed as consultants to provide inputs for their drugs or to be part of a patient survey on certain new drugs. On the face of it, it looks benign and well-intentioned. But look deeper, say doctors, and many of these are direct inducements to doctors, including pushing the use of their drugs.

Other than this, there is now a trend of third parties sponsoring medical events. Or, getting foreign trips of doctors and their families sponsored through a third party. Say for instance, a company 'X' appoints a travel agent 'Y' and instead of a direct cheque to a doctor to fund a foreign trip, as used to be the case earlier, get the travel agent to do the necessary arrangements for the doctor with the transaction not traced to the company. The travel agent will then indulge in some innovative billing to the concerned company mixing the trip with other company travel.

To deal with all of this, doctors point out there could be a simple way out through better disclosures. For instance, it should be made mandatory for every company to reveal the details of the doctors appointed as their consultants. Plus, make it mandatory for companies and doctors to reveal every conference financing detail.

For example, at the time of registration, the doctor should share the account from which the funding of the travel was done. Finally, the law seeking disclosures from both the companies as well as doctors should also ensure both the giver and the taker are punished.

One could again argue that there could be implementation and execution challenges in a large country but then with a strict law there will be at least the fear of being caught. If one is not honest by nature, he or she could at least be made to carry the burden of honesty.

As for the Punjab case, Dr Gurinder Singh Grewal, president of Punjab Medical Council, expects the process of taking action against erring doctors to be completed by November. "We need to give them 21 days time to respond. Then we will have the ethics committee call for a meeting with the doctors and question why action should not be taken (against those erring)," says Dr Grewal.

The action could include banning erring doctors from practising for a certain period of time. And has the council written to the companies? To which he says: "We have written to the Ministry of chemicals for they all come under the ministry."

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