The recent warning of the US government issued to the drug industry those incentives to health professionals has evoked strong reactions from the industry and medical professionals here. A state drug regulator has urged that the warning be issued by the Indian government too.

Senior medical professionals and industry leaders here believe there should not be any incentive system that would reduce the profit of the companies by raising the prices of products. The price is actually paid by the patient, a fact which neither the industry nor the doctors bother to take cognizance of. The patient has very little choice in the matter as he is neither familiar with the medications nor is he capable of objecting to it.

It may be recalled that the US government had warned pharmaceutical companies on last Monday that they must not offer any financial incentives to doctors, pharmacists or other health care professionals to prescribe or recommend particular drugs, or to switch patients from one medicine to another.

The warnings came as the US government informed the industry that many practices commonly used in the marketing and sale of prescription drugs could run afoul of federal fraud and abuse laws.

Specifically, the government said that drug makers could not offer incentive payments or other "tangible benefits" to encourage or reward the prescribing or purchasing of particular drugs by doctors, health plans or companies that manage drug benefits for employers and insurers.

Uttam P Khobragade, Commissioner, Food & Drug Administration, Maharashtra, says, "Indian pharma companies should stop the business of incentives. This will be in their own interest as this will promote healthy competition, reduce cost and also will be in the interest of the public as consumers will exercise their choice while purchasing a medicine. Also doctors will prescribe only such medicines which are more effective in their opinion."

Khobragade believes the Central government can definitely issue such a directive to pharma companies and direct the state FDAs to implement them. To implement such directives it is absolutely necessary that these FDAs should be given power to carry out inspection of nursing homes and doctors who also dispense drugs in addition to conducting diagnosis. He says it is practicable to stop incentives if the administration has the will.

Linkage of incentives to sales is the most unethical part of prescription drugs, or what is euphemistically called ethical drugs. Medical representatives are directly involved in the business as they form the front façade of the pharma company as far as the medical professionals are concerned.

According to a medical representative with a company that boasts of the best sales growth in the country, the very sales of products depend on the kind of incentives and the speed with which it is delivered. Such representatives are also respected a lot when they land up at the clinics.

Some industry professionals have told this correspondent that they are fed up of the demands raised by the medical professionals some of which are as absurd as asking for a car to travel from Santa Cruz to Colaba. According to a medical advisor, all the companies have to come together and then decide to stop the incentive programme as otherwise it may backfire on those who take the initiative.

Asked what would be the impact if the Indian government chose to follow in the footsteps of the US government, Dr Gopakumar Nair, former president of IDMA, said, "''Apothecaries Oath" "Ethics in Medical Profession" etc. have become a thing of the past. Any action taken by the government is of no use as it is infamous for "toothless" laws, lots of laws and no enforcement. A governmental action is probably of no consequence.

Dr Nair says a "Code of Ethics" was adopted by both the industry bodies - OPPI & IDMA. Even if IPA doesn''t have one, all IPA members are members of IDMA except two, who are OPPI members. If the 100 large companies agree to this through consensus and if this consensus is supported by governmental action and support, this practice which has penetrated the Indian marketing of "Ethical" medicines, can be controlled."

Dr Nair believes the practice cannot be eliminated. The medical profession should also wholeheartedly and sincerely support it. This subject had time and again come up for debate and action advised. The result: it has always been shelved.

Over the years, the market competition and the "aggressiveness" of promotion to the medical profession has only intensified. It has now become a "no-holds barred" fight for "market share."

"Our organization does not believe in offering any incentive for prescribing or switching patients. As an organization we hope to abide by code of IFPMA, says an Indian head of a multinational company here.

"I believe that our focus has been primarily on providing information, education and clinical research. It is science-led marketing. We have deliberately chosen not to launch any me-toos exactly for the same reason. Our future portfolio also is comprised of products which will be break-through and will succeed only if we are able to communicate the science behind the product," he notes.

According to him, as the patents law comes in, each molecule has only one brand, and it will force companies to depend on science rather than incentives.

"This is a much accepted business practise as is the case with doing business with governments. It is very difficult to change habits as also police against these activities, whether in India or globally," a senior analyst said.

According to a health activist, "Pharma companies are very smart. They spend money on incentives because it is very cost-effective for them to do so. The ROI (return on investment) is excellent. Doctors are very susceptible to inducements."

He suggests that things will improve only if individual doctors agree to follow their conscience. Asked if this is practical in the Indian context, the activist nodded, but added, "How far the rule will be followed, however, is anyone''s guess."

Asked if pharma companies should support the business of incentives which actually raises their costs, an eminent clinical trials expert said it should not be done, as these costs will be passed on to the consumers. "This is especially reprehensible in countries such as India. Doctors can reform and refuse incentives. Unfortunately, most doctors welcome them and actively seek them."

The expert suggests that pharma companies can legitimately advertise their products in medical journals. This should suffice. Unfortunately, in the rat race, they wish to maximise profits the easy way - by pandering to the whims of doctors at the cost of the patient.

He also believes that umbrella organisations like the OPPI for the pharma companies and IMA for the medical profession can take a strong stand and lead the way. "Where there is a will, there is a way. In this case there is no will on either side - the pharma industry and the medical profession," he adds.