A prominent national daily last week reported on the front page how a leading Indian pharmaceutical company is openly enticing the physicians to create more prescriptions for its pharmaceutical products. The brochure circulated by the company to physicians has been offering foreign trips, expensive consumer durables and other incentives for prescribing more of its drugs. Perhaps offers like this by the pharmaceutical companies may not be anything new to the medical profession but such deals are rarely reported by the media. Most large and medium scale pharmaceutical companies are indulging in same unethical practices to push their products. This is a well known fact in the industry circles. The main reason for this unhealthy practice among the pharma companies is the fierce competition as the number of products in most therapeutic groups is quite large. The growing competition among the pharma companies is also forcing them to offer huge commission to the pharmaceutical trade. The chemists, therefore, keep only expensive products in any therapeutic group although low priced products of other companies are equally effective. One such case can be quoted here. Most doctors prescribe Simvotin, a Ranbaxy brand of widely used cholesterol drug, simvastatin, priced at more than Rs 10 a tablet of 10 mg. Brands of the same drug costing Rs 2 to Rs 3 manufactured by other companies are not prescribed by doctors and are not kept by chemists in Mumbai. The only reason for this is the fact that the doctors are better rewarded for prescribing and chemists are paid higher commission.
The price of this unholy alliance of pharma companies, physicians and chemists is paid by the patients. And it is hitting almost all classes of patients as 75 percent of the drugs marketed in the country are outside price control. The entire cost of promotion of drugs and huge commission to the trade are loaded on the price of the drug. Pharma companies classify these expenditure as marketing costs in the balance sheets. In the case of certain pharmaceutical products, the promotional costs and trade commission constitute to as much as 80 per cent of the cost of the medicine. How such highly unreasonable costs are loaded to the price of a drug and can go unnoticed by NPPA? The World Health Organization, in an attempt to support and encourage improvement of healthcare through the rational use of drugs and to curb unethical marketing practices, came out with a landmark "Ethical criteria for medicinal drug promotion" in 1988 and has recommended its implementation to member countries. This document defines drug promotion as "all the information and persuasive activities by manufacturers and distributors in order to induce the prescription, supply, purchase and/or use of medicinal drugs". It also suggested what can be considered appropriate hospitality and gifts to physicians. The WHO guidelines are flouted in practice with impunity since there are no effective legislative measures to support them. Both IDMA and OPPI also have ethical codes for marketing of pharmaceuticals. These codes are also being ignored by the member companies. The government has to, therefore, come forward and evolve a suitable mechanism to monitor and curb unjustifiable promotional expenditures by the pharma companies if it has any intention to stop fleecing the patients by pharma companies.