The pharmaceutical companies have been accused of massive enticements to secure prescriptions from a very long time. You all might have observed this trend right from the beginning of your internship or postgraduate program. Remember, these companies are catching you all right at the start of your career. The more you grow and develop the capacity to generate more business; heftier will be your enticements. And yes, it’s business as usual for them. Needless to say that many doctors do resist these temptations but a sizeable doctors do not. Those who do not resist have seen a phenomenal increase in value of enticements they are offered over the years.
The free for all enticements are inching towards an end. The pharmaceutical marketing is going to get a huge makeover in the coming days. The give and take policy employed by certain pharmaceutical companies might see an end. If you have been getting attractive gifts, entertainment tickets and expensive travel facilities from pharmaceutical firms, gear up for a life without all these freebies. The government is all set to tighten the noose around the erring companies in the coming days but before that there is a six-month window period allowed for companies to execute UCPMP voluntarily.
So what exactly is UCPMP?
Uniform code for Pharmaceutical Marketing Practices (UCPMP) is a voluntary code adopted by pharmaceutical industry to curb unethical practices. An interesting fact about this code; you all should know is that it existed from 2012 but most of the companies had turned a blind eye to this voluntary restraining code.
You might have known or experienced companies blatantly violating these rules. Bigger and smaller companies, both without hesitation were involved in flaunting ethics to secure prescriptions. The extravaganza was so obvious that the government was forced to step in.
If we start dissecting the present code, the opening statement presents us a clue that government is serious about it this time.
“the implementation will be reviewed after a period of six months from the date of issue, if it is found that it has not been implemented effectively by the Pharma Associations/Companies, the Government may consider making it a statutory code.”
The pharmaceutical companies till now have succeeded in persuading the government against any such statutory code but any serious violations this time around might well change the government’s attitude.
What went wrong?
You might have been wondering why the government waited so long to act on these practices. It was an open secret for many years that these enticements were controlling the prescriptions. There could be two reasons, which can explain the change in stance of government.
The extravaganza was visible all over
The first reason seems quite plausible and most of you have guessed it right by now. The case of a phenomenal growth of an Ahmedabad based firm and the investigation into firm’s activities resulted in over 300 doctors being questioned. The government might have shown a classical knee jerk reaction and issued a threat of a strict statutory law. IDMA is an organization, which represents domestic pharmaceutical firms. In The Times of India article about ending freebies culture, Indian Drug Manufacturers Association (IDMA) general secretory Daara Patel opines that the code is too strict and they are in consultation with the government and further questions,“if the companies don’t educate about a particular medicine or disseminate information; how will doctors know about it.”
Look, the MNCs have a obligation to avoid gifts
The second reason could well be lobbying from a certain group of pharmaceutical companies itself. In August 2014, Business Standard carried out an article where in it mentions the association; Organization of pharmaceutical Producers of India (OPPI) has urged Department of pharmaceuticals (DoP) to make the UCPMP a statutory code. OPPI Director General Ranjana Smetacek had quoted that UCPMP would bring in transparency and a level playing field in marketing. OPPI represents “research based” pharmaceutical companies; in short the foreign Multi National Companies (MNC’s) in India. Is there a lobby within pharmaceutical companies; with one association pitting against other? The answer seems to be a positive one.
Though many MNC’s have been accused of unethical promotional activities in every other country, they are mainly related to promotion of offline indications. But the pressure on them to hold back on any unethical practices is growing steadily. With their research oriented approach and innovative molecules, they can afford for entirely scientific marketing.
A Delhi based industry executive points out in a business world article that foreign MNCs have a compulsion for ethical behavior as their Indian actions can be questioned under the Bribery Act 2010 of UK and the Foreign Corrupt Practices Act of US. These laws make it difficult for them to compete and are voicing their support to ensure a level playing field.
Freebies get a strict “no” in the code
Freebies played a central stage for many companies to secure prescriptions. You might have observed the freebies including many expensive and luxurious appliances. Hold your breath, these freebies might not be forthcoming in the coming days. The code makes it clear in no uncertain terms that any type of gifts or monetary compensation should not be given and so are the entertainment appeasements like movie tickets to healthcare professionals and their family. The companies will have a second thought about doling out any such freebies in the coming months.
Travel facilities may persist
The code bans companies and its associates from offering any kind of hospitability including travel, accommodation to any of the scientific activities, but mentions that it applies to all those who travels as a delegate. And if you are travelling as a delegate to a company sponsored event, be ready to shell out your own penny. But there is a slight catch here.
The ensuing paragraph also mentions “where there is any item missing, the Code of MCI as per Indian Medical Council (Professional conduct, etiquette and ethics) regulation prevails”.
So, as long as the activity is scientific, you need not have to think about spending much. The funding of scientific activity, of late is rerouted through associations of doctors and the Code of MCI has a clause wherein these associations can accept the donations from pharmaceutical companies. The result is that the scientific activity funding will stay; although in an indirect manner.
The implementation burden
Finally, the burden of implementation rests with the managing team of the pharmaceutical companies. The penalties for non-compliance include removing of the erred company from the pharmaceutical association to initiating process of recovery of illegal enticements from the healthcare professional. And be ready to give back the enticements you receive; if ever these laws are strictly implemented. As the code clearly makes the company responsible for the violations, the freebies might well begin to trickle down significantly as the companies try to do a wait and watch game for the six months before the government takes a call on the code.
You may be wondering why there is so much fuzz about these new codes if it is aiming at curtailing unethical practices. For this, you need to understand the importance of interaction between pharmaceutical industry and healthcare professional, which plays an important role in integrating the laboratory research into patient’s healthcare. So, the need of the hour is the healthy relationship between healthcare professionals and pharmaceutical companies. The present code poses substantial threat to such meaningful interactions. The dissemination of accurate scientific information will result in better patient outcomes. More stringent measures, which make scientific funding more transparent like compulsory declaration of interests in any forum, will be a welcome move. The need for curbing unethical promotional activities is much necessary, but the laws should not be too restrictive for scientific promotional activities.
Dear Sir
A very well written article.
MNCs are also worried about the code. I work for a MNC & we flout every possible law, its just that the image created by MNCs makes people believe that MNCs promote ethical practices. Following are the ways by which MNCs bribes Drs.
1. Travel/Stay for Conferences : One clause in MCI guidelines for Drs permits Drs to work as adviser/consultants. This clause has been misused by every MNC in India. The method is simple. Get an advisory agreement signed by Dr wherein Dr would act as an adviser to the company & company would take care of all his travel/stay requirements during all international/national conferences. Such is the misuse of this clause that one of the MNC has Ten Thousand Drs as advisers. Every Dr who wants to travel is appointed as an adviser.
2. Printing of Drs stationery on the pretext of Printing Patient Awareness materials : The printing industry in India is totally unregulated & being small scale businessmen, these printers would give any bill. MNCs would show to authorities that X amount has been spent on printing patient awareness material however it would actually be a stationery of Dr for personal use. Many times these printers would give cash by keeping some margins for them, if you give them Cheques in their names. This we do routinely whenever we have to buy electronic items for Drs.
3, Supplying directly to pharmacies attached to Drs at heavy discount: A Company like ours supply products directly from our depot to Drs or pharmacies attached to them. Usually a chemist gets 20% margin on any pharma product however when company supplies directly to Drs from depot with additional discounts, the margin goes up to 50% also. Since all MNC brands are expensive the actual value profits are very high. Drs are of course tempted to use more & more of our brands.