Pharma wrap: Why we need to give teeth to regulation to curb unethical pharma marketing practices

The widespread practice of payments for prescriptions, where pharmaceutical companies pay doctors in cash or kind, to generate prescriptions and increase sales, continues unabated, as the government drags its feet to bring in a stringent regulation.

A study co-authored by Dr Arun Gadra and Dr Archana Diwate, titled 'Promotional Practices of the Pharmaceutical Industry and Implementation Status of Related Regulatory Codes in India', documents unethical practices and failure of regulations while also offering suggestions to improve the exiting regulatory framework.

The study is based on 50 in-depth interviews conducted across six cities, primarily involving medical representatives who are the front-line key persons on the field promoting drugs to doctors.

It highlights direct deals between pharma companies and doctors, citing some cases, for instance, where pharma companies pay installments on a doctor's car purchase. There were extreme cases, where a few doctors even ‘demand women for entertainment’.

The study's key findings point towards the trends in promotional strategies which have shifted from providing scientific information to doctors to merely focusing on business generation at all costs.

Use of tactics like inducement, emotional appeals, persuasions, serving family members, sponsorships for national and international conferences, pampering doctors, has become the norm. Newer, more innovative methods have come into practice over the years, such as providing prepaid cards, petro-cards, e-vouchers for online shopping on Amazon and Flipkart.

Doctors are categorised as core and secondary by pharma companies, the core ones being those who give business to the company. The core doctors who set the prescription pattern are sought after and well looked after too.

For pharma companies, the doctor’s education background doesn't matter as long as he or she offers good business to the company. Also, there is no hesitation in promoting allopath drugs to ayurveda, homeopathy and rural medical practitioners (RMPs).

The study also says that the roles in this quid pro quo are now getting reversed. Earlier, pharma companies used to induce or tempt doctors proactively. But doctors are now in the driving seat, making demands while the pharma companies oblige.

To be sure, not all doctors are involved in such unethical practices. The study found that around 10 percent to 20 percent doctors follow the mandatory regulatory ethical codes for laid down for medical practitioners.

The study says the Uniform Code of Pharmaceuticals Marketing Practices (UCPMP) to regulate unethical promotional practices is non-functional on the ground. Medical representatives are hardly even aware about the UCPMP.

The work conditions of MRs are also highly stressful, with them having to undergo continued pressure to perform in order to achieve targets.

The study calls for giving teeth to the existing regulation, rather than leaving it to voluntary compliance.

"With respect to promotion practices, we find that the government has put the responsibility of being ethical on to the doctors and the pharma industry despite knowing that voluntary self-regulation has not worked, that they are brazenly violated," the report said.

"It has still not made the UCPMP compulsory, as stated in 2015. MCI does not have jurisdiction over the industry and it is the responsibility of the government to take strict measure to curb the unethical practices of the industry," the study added.