The recent controversy following the Income Tax raids on Bengaluru-based Micro Labs, makers of popular paracetamol brand Dolo-650, underlines an unhealthy alliance between doctors and drug manufacturers.
The search for a cure is likely to move the needle on making the Uniform Code for Pharmaceutical Marketing Practices (UCPMP) a legally binding code of ethics. This code – governing the conduct of pharmaceutical companies in their marketing practices – is yet to be implemented. Sector watchers following the matter closely for years say the UCPMP is caught in a kerfuffle between the Department of Pharmaceuticals (DoP) – under the Ministry of Chemicals and Fertilisers – and the Union Ministry of Health.
“The DoP is complicit with the industry in not making the UCPMP legally binding on companies. It falls upon pharma associations to enforce the voluntary code. They neither have the power nor the incentive to punish companies,” alleges Malini Aisola, co-convener, All India Drug Action Network.
Aisola adds that a previous attempt to create a legal instrument by DoP was rejected by the Law Ministry as ‘unworkable’ under the Essential Commodities Act. Thereafter the DoP consciously tried to shelter companies by promoting the voluntary code, notwithstanding evidence of its colossal failure. “Ethical marketing and promotion should be brought within the ambit of the new Drugs, Medical Devices, and Cosmetics Act being formulated.
We have repeatedly been making this recommendation. The nodal ministry to administer the statutory provisions would shift to the Union Health Ministry and this is where DoP does not want to forfeit its turf and permit for regulation in this area,” observes Aisola. The incident of Micro Labs has brought the focus back on an inconvenient truth: drug firms offer freebies in cash and kind to physicians to incentivise them to prescribe ‘their drugs’.
“Mostly, drug firms would offer branded souvenirs like pen stands, calendars, diaries or and sanitisers to doctors. The idea is to ensure top-ofthe-mind recall of their brands. The Indian market is price-controlled. Therefore, the differentiator here are the brands and this is common practice,” says a sales executive at a pharmaceutical firm.
He says these freebies, however, do not ensure doctors will prescribe their drugs. It is simply a marketing strategy that other sectors harness as well. “Around 95 per cent of the items being gifted have a value less than Rs 500.
It does not constitute a bribe. It is done to make the doctor remember a brand among the hundred others with a similar price point,” defends an executive. “Doctors are more for reputationbuilding exercises – for example, getting help to get their articles published in journals, or speaking at prestigious conferences. If a doctor is taking time out to attend a conference, he gets an advisory fee,” says another executive.
Usually, reputed senior doctors or those with oratory skills are chosen as guest speakers, but companies often take a battery of doctors to these conferences. In its defence, the industry says these are done as knowledgebuilding and knowledge-sharing exercises, but cases of doctors being gifted high-value items like laptops are not unheard of either. Aisola says often doctors are made lead investigators in clinical trials, or made part of committees for which they earn a hefty fee. Civil society organisations are hence rooting for a statutory UCPMP.
“The UCPMP is the subject of an apex court case. We have suggested the Government mandate periodic disclosures of payments made by companies towards doctors and professional bodies, directly or indirectly via other parties, which should be accessible to the public. The disclosures should include the amount, purpose of expenditure, and the party paid,” adds Aisola.