Healthy Skepticism Library item: 770

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

How the drug cartel thrives
Sunday Herald 2004 Nov 21

Full text:

The drug comes first. The illness follows. That is the story of unethical drug promotion in our country. Gopal Dabade quotes from a revealing study undertaken recently.

Ask a pharma company how to promote a drug. “Create new diseases”, the answer is swift and clear. An example in recent times is osteoporosis. Companies cashed in on concerns among the huge elderly population on broken bones by conducting camps, testing bones for free and selling related drugs to majority of attendants (found to be osteoporotic to some degree!) with attractive discounts. An entire strip of ten tablets is sold (provided six months stock is brought by the patient) for Rs 100 (instead of Rs 140 market price). It is illegal simply because to store or sell medicines, as one needs a drug license. Similar camps are also held by insulin and hepatitis vaccine manufacturers.

There were many shocking discoveries that came out in the study supported by WHO and put into effect by the Forum for Medical Ethics, Mumbai (visit: www.issuesinmedicalethics.org for more details). The study highlights promotional practices of drug companies, often resulting in influencing prescription, supply, purchase or use drugs. It probed into the sales of drugs, reasons for surge in sales of certain medicines, influences behind their promotion etc.

Prepared based on interviews with doctors, drug companies, medical representatives, and chemists, the study is important for India, as our drug market is unique with 25,000 companies chasing $ 3 billion annual revenue and still remains unregulated. Indian consumers are largely ignorant about drugs and can’t distinguish between the 80,000 formulations afloat in the market. They often bypass physicians and purchase drugs straight from chemists, a situation peculiar to India.

Irrelevant
The study reveals most drugs are irrational and irrelevant, as WHO has prescribed just 370 as essential. The study has been aptly titled “Surviving the Indian Pharmaceutical Jungle”. It focuses on the extent to which drug promotion is done based on information and the role incentives play in this process. It finds the procedure to sell drugs isn’t any different from selling any home appliance: companies tempting doctors to prescribe a particular drug in return for gifts ranging from cutleries to cars. Drugs cannot be included in this common list of promotion because the person who consumes the drugs is not the one who chooses. So, as Dr K Weerasuriya, WHO consultant on Essential Drugs correctly and appropriately says, “If the one who decides does not pay and the one who pays does not decide, and if the one who decides is paid, will truth stand any chance?”

It also showed doctors relied more on information provided by medical representatives and had consistently failed to assess a drug’s importance by using their medical expertise, as they made no remarks on claims made by manufacturers. Secondly doctors received incentives of all types ranging from toiletries to luxury cars to foreign trips for sale of drugs.

Money drives
The study also found that chemists selling drugs over the counter are excluded from information sharing. This raises questions about drug safety. Chemists also received incentives for promoting drugs by means of foreign trips and purchase discounts. Buying medicines from different brands, chemists complain of unsold drugs and patients discontinuing the course of medication due to higher cost, which affected sales. Most of all, the association of chemists appeared to have demanded money from medical representatives and drug companies in return for information on doctor’s prescriptions.

Drug companies often relied on “Junk Science”, irrelevant scientific studies, to promote their drugs. There were even manipulations of scientific information for promotion. Contrary to their claims of high standards among medical representatives, there were complains from doctors that some of them couldn’t answer medical queries.

Some companies allege that doctors put pressure on them to sponsor medical conferences and threatened mass boycott of their products if they refuse. Such sponsorships also contributed to higher drug costs.

Medical representatives, for their part, complained of increasing pressure to meet targets. They pointed at discrepancies in information transpired verbally to doctors and those found in literatures.

While it is important to tighten regulation, as suggested by the study, monitoring constantly the process of drug promotion right from manufacturer to doctors and consumers is also vital. Only such a system would save the drug industry from gross commercialization and unethical practices.