The ethics of selling drugs are more complicated than, say, selling toothpaste. This is why consumer access to many pharmaceuticals is regulated – you cannot buy essential medicines over the counter that could be overused or abused. Of course, it goes without saying: pharmaceutical companies must market their products to beat the competition, make a profit and continue to produce medicines for patients. This usually involves offering pills to doctors, who also benefit from fresh information about drugs they might use to treat patients. But it’s when aggressive promotion crosses red lines that alarm bells need to ring, as it is now at India’s Supreme Court. The Federation of Medical and Sales Representatives Association of India (FMRAI) has taken a Public Interest Litigation (PIL) to court, accusing the distributor of Dolo-650 – a widely prescribed formulation of paracetamol for covid – of bribing doctors with “gifts” worth ₹1,000 crore to recommend the tablet. The basis of the complaint is an investigation by the income tax department, which carried out searches of the offices of the drugmaker a month ago. He alleged that doctors had been bribed with “travel expenses, perquisites and gifts”. Micro Labs Ltd, which makes the painkiller, has denied the allegation and will have the opportunity to defend itself in court.
The problem is not just with a drugmaker. The outrageous practice of pharmaceutical company “incentives” influencing medical prescriptions is well known. It is a case of industry self-regulation that has failed to curb reckless profit maximization. In 2019, for example, in response to a question about companies giving gifts to doctors, the government acknowledged in parliament that it had received complaints about “unethical” practices by pharmaceutical companies. The distorting power of this pill traffic is enormous. doctors to over-medicate patients or make them buy more expensive alternatives. All of this violates the fundamental maxim of health care: do no harm. While doctors are bound by a code of conduct that prevents them from accepting gifts from the pharmaceutical industry, pill distributors have In order to bring some semblance of order to the Wild West of drug marketing, the Center had introduced in 2015 the Uniform Code of Pharmaceutical Marketing Practices, a set of voluntary guidelines aimed at preventing pharmaceutical companies or their agents from tossing around the promise of gifts and money to healthcare providers to fatten their bottom line. The problem: these rules could be flouted without major consequences. A company for and guilty of doctor bribery would face a reprimand or at most expulsion by a pharmaceutical association of which he is a member. This is not enough to induce companies to promote pills solely on their therapeutic merits. In the Dolo-650 case, the FMRAI called for tougher regulation, perhaps through legal support for restrictions, along with penalties. The court asked the government to respond to the POA.
The trick would be to thread the needle in a way that clamps down on corruption without putting obstacles in the way of promoting legitimate sales. Ideally, physician ethics should defend patients against predatory business practices. But practitioners are often too flexible for us to rely on that. Pharmaceutical companies cannot continue to get a free pass for brazen corruption. This is a category where those who pay the most bills have no say in brand choice, which is reason enough for us to put it under scrutiny for unsavory practices. We need corrective measures.
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