Cos pay doctors for drug promotion [ Tritiyo Matra News ]

Cos pay doctors for drug promotion

Local December 03, 2016

Pharmaceutical companies are bribing doctors and drug retailers providing them with gift or financial inducement for sales promotion in Bangladesh.
The unethical practice by the companies are putting pressure on patients’ expenditure on medicine and causing threat to public health in absence of law and proper monitoring on drug market to stop the unethical practice, health rights campaigners said.
A study conducted by Bangladesh Health Watch, an affiliated organisation of School of Public Health at BRAC University in 2015, said that due to high competition aggressive marketing strategies were adopted by drug companies for greater market share, which sometimes crossed limit in Bangladesh.
The study on ‘Qualitative insights into promotion of pharmaceutical products in Bangladesh: how ethical are the practices’ revealed that pharmaceutical instituted a highly structured system geared to generate prescriptions and ensure market share.
‘Approaches such as inducements, persuasion, emotional blackmail, serving family members, etc. are used,’ it said.
‘The popular physicians are cultivated meticulously by the medical representatives to establish brand loyalty and fulfil individual and company targets’, the study said.
Many drug manufacturers have also employed their staffs to see how the doctors are prescribing their products.
Many staffs of different companies are seen in front of the chambers of doctors to capture photos of the prescriptions of the doctors.
Mamun Haque, a drug retailer in Phultala of Khulna, said that even reputed companies provided drug retailers with even rice and clothes to promote their drugs.
Health and drug expert said that such unethical practice was the main reason for drug price increase.
‘The price of drug would drop by 70 per cent if such unethical marketing are stopped,’ said Gonoshasthaya Kendra founder Zafrullah Chowdhury, adding, ‘the companies actually cut the pocket of patients to meet their marketing cost.’
Dhaka University pharmaceutical technology professor ABM Faroque said that the companies’ marketing costs increased for such practice and it ultimately increased the drug prices raising burden on patients.
Bangladesh Health Rights Movement chairman Rashid-e-Mahbub, also former Bangladesh Medical Association president, said that practice of bribing doctors in selling a company’s product and taking those bribe by physicians were unethical.
‘The companies may have policy for promoting their products, but the Drug Administration should take action against them,’ he said.
Faroque said that it was a sheer unethical practice that the companies would provide money or commission for prescribing products.
Directorate General of Drug Administration director Ruhul Amin said that no company could provide incentive to physicians as per the Code of Pharmaceutical Marketing Practices.
The code says, ‘No gift or financial inducement shall be offered or given to members of the medical profession for purposes of sales promotion.’
The code has been framed by the drug administration based on consensus among pharmaceutical companies, so they should follow it, Ruhul said.
He said that the good practices depended on will of companies, but there were no regulatory directives to this end.
‘The Drugs Act and the Drug Control Ordinance stipulate no punitive measure for violation of the code,’ he said, expressing the drug administration’s failure to force the companies to abide by the code.
‘Unfortunately, there is no control over drug companies in our country,’ Zafrullah Chowdhury said.
He said that in other countries, doctors had to inform their respective drug authorities if they were given gift worth Tk 25 or more by any drug company.
‘This is only to restrain the reign of pharmaceutical companies’ unethical marketing practice,’ he said.
Faroque said that the code of marketing practice should be updated and there should a punitive measure for violation of the code.
The experts said that the code and laws on drug should be amended in line with different international legal instruments and World Health Organisation guideline.
Article 19 of the Ethical Criteria for Medicinal Drug Promotion of WHO says, ‘Employers should be responsible for the statements and activities of their medical representatives. Medical representatives should not offer inducements to prescribers and dispensers. Prescribers and dispensers should not solicit such inducements.’
Article 7.5.1 of the Code of Practice of International Federation of Pharmaceutical Manufacturers and Associations says, ‘Payments in cash or cash equivalents (such as gift certificates) must not be provided or offered to healthcare professionals. Gifts for the personal benefit of healthcare professionals (such as sporting or entertainment tickets, electronics items, etc.) must not be provided or offered.’
Experts said that many countries enacted laws criminalising such unethical practices and similar enactment was needed in the country.
According to the Physician Payments Sunshine Act of the United States, doctors and companies have to report to the Food and Drug Authority about any payments or other transfers of value more than $10 and any small payments of other transfers of value less than $10 if the total annual value of payments or other transfers of value provided to a covered recipient exceeds $100.
The experts said that the unethical practices were going unabated in absence of law and control over the drug sector.
Even reputed companies are now engaged in the practice of bribing doctors and pharmacies to promote their products.
As an example, a recent official document of Sandoz division of Swiss drug giant Novartis, obtained by New Age, showed that it was bribing physicians in Bangladesh to promote its product Aclasta 5mg solution for infusion.
Aclasta, a brand of Zoledronic acid and a bisphosphonate drug given intravenously to treat osteoporosis, sells for Tk 30,000 per unit and it has a yearly turnover of about Tk 200 million in Bangladesh market, Novartis officials said
The document showed that Sandoz provided credit facilities and commission on prescription of the drug to a number of physicians in Dhaka and Comilla.
According to the list, signed by top officials including the managing director and country head of Sandoz, Sheikh Nahar Mahmud, there are a number of physicians who are provided with credit facilities ranging from Tk 3-4 lakh for 60 days and one unit of Aclasta free for prescription/purchase of every 10 or 12 units
Asked about the matter, Sheikh Nahar Mahmud declined to comment.
Sandoz division’s specialty care head Fazlarabbi Khan, who also signed the official approval, denied that Novartis or Sandoz provided such incentives to doctors.
When he was informed that his official document contradicted his claim, he said that the company provided dispensing doctors who buy their products or who were involved in big medical institutions.
Novartis officials said that the company came out from all sorts of unethical practices globally since October 2015 when it rolled out ‘Step Change’, an initiative by global chief executive officer Joe Jimenez, but Sandoz Bangladesh continued with bribing doctors.
Faroque said that multinational companies introduced the practice of providing gift or financial inducement in Bangladesh, but now local companies are also engaged in the bad practice to get market share.