Where’s my share of the pie?

Brand reminders, which started as token of friendships; has moved from air fresheners to air tickets, says Dr Nobhojit Roy

The Patents Bill has been introduced and it heralds a new era for the Indian pharmaceutical industry. Some feel that the golden era is over for the largest and most advanced pharmaceutical industry in the developing world, which has lowered prices, made drugs widely available and served as a model for other developing countries.

Drugs were exported to more than 65 countries including the US and other highly regulated markets. While at the crossroads, it is a good time to reflect and acknowledge that industrial supremacy needs to go hand in hand with corporate responsibility. The entrepreneurial flair and success of a section of the domestic industry has been nullified by the state of the Indian drug market today, rife with abuse. Irrational prescribing of fake and substandard drugs had reached dimensions of a public health problem.

Let us examine the players in the market. At the top of the heap, the manufacturers blame each other. While they express serious concern about the growth of spurious drugs, me-too drugs and low-quality drugs in the market, they themselves took advantage of the laxity of regulation and the prevailing environment of incentive driven trade practices.

Post-marketing surveillance was the “standard of evidence,” bypassing the more cumbersome clinical trials. Discovering ‘new’ diseases, defarnation campaigns killing cheaper drugs for more expensive cousins (by highlighting obscure side-effects) and bypassing the Drug Price Control Order (DPCO) with irrational combination were the well-known strategies of the best of companies. It is ironical that only some 35 per cent of Indians can access essential drugs, while we boast about a flourishing Indian pharmaceutical corporate world. Perhaps, the pharma industry can take a few tips in professional ethics and corporate responsibility from the Indian IT industry.

The ethical marketing codes, when compared to the marketing practices, indicated the failure of the drug industry in regulating itself. Currently, the industry relies on adverse publicity to achieve compliance with its code. It is evident by the fact that neither the Organisation of Pharmaceutical Producers of India (OPPI) nor the Indian Drug Manufacturers Association (IDMA) have ever blacklisted a single company so far. The response of the industry is to shoot the messages and ignore the message. But, while the manufacturers are blamed for poor business practices, there are other stakeholders claiming their pound of flesh.

Consider the Indian doctor fraternity. Brand reminders, which started as token of friendships; has moved from airfresheners to airtickets. Most doctors claim that their own judgement about drugs and brands is never obscured by incentives, but that other colleagues have ‘given in’ to the pressure of incentives. This has been labelled by experts as the ‘theory of unique invulnerability’.

Further, doctors unable to influence pharmaceutical companies to sponsor their events on an individual basis resorted to boycotts and other forms of strong-arm tactics through their associations. Pay up or else! This means that the role of the pharmaceutical companies in financing professional activities was being strengthened. The practice of giving incentives was being reinforced instead of being outlawed, promoting a culture of ostentation within the medical fraternity, which promises to keep it dependent on the sponsorship of pharmaceutical companies for its own development. This threatens to affect their autonomy as a profession, but who cares. Their associations, like the IMA are themselves mired in corruption controversies. In such a scenario, it is difficult to fathom how such association would be able to convince their members to refrain from unethical practices in their individual capacity. At least the straight forward and obvious measures must be implemented if physicians want to retain the widespread public trust that they still enjoy.

The Chemist Association, on their part, claims it is a ‘parallel’ government! In no other place in the world, are the chemist so all-powerful. They can make or break a new product trying to enter the market. Pay up or else! They have brought the mighty manufacturers down to their knees. It started by paying Rs 300 for doctor profiling and prescription audits. It is no surprise that their demands are spirally upwards and now you need an ‘No-Objection Certificate’ from them for every new launch. They threaten to paralyse the business across the country, if the companies try direct to consumer (DTC) marketing and try to save on the 30 per cent marketing costs, bypassing them. The Medical Representatives in this game, remain the weakest link in the chain and are pitted against themselves in an ever-increasing upward spiral of sales targets.

And who is footing the bill for all this greed? The consumer, of course. Pay up or else. But not for long. The consumer will get organised and rise like the Phoenix and the hammer of law will strike down from above. While regulation remains laughable, public accountability is coming our way. Without apportioning blame, let us look responsibly at ourselves, before we bite deeper into the pharmaceutical pie.

The writer is with Centre for Studies in Ethics and Rights, Mumbai