Promotional activities hurting drug prices

Dr Arun Mitra

With every passing day there are new innovations in the field of medicine. New drugs and devices are coming out. It is therefore important for the medical professionals to be regularly updated through continued medical education (CME) programs. Academic bodies hold their annual national meets as well as state and local CMEs. As the advancement is very rapid, the number of such events has increased manifold in the past few years. Various state councils made it mandatory for the medical professionals to attend such CMEs and obtain credit hours for renewing the registration. The medical council also gave broad guidelines about organizing such events. The clause 1.2.3 of the Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations, 2002 states ‘A physician should participate in professional meetings as part of Continuing Medical Education programmes for at least 30 hours every five years, organized by reputed professional academic bodies or any other authorized organization. The compliance of this requirement shall be informed regularly to Medical Council of India or the State Medical Council as the case may be’.
The clause “6.8 of the Code for the medical professionals relationship with pharmaceutical and allied health sector industry says that ‘a medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives; shall not accept any travel facility inside the country or outside, including rail, air, ship, cruise tickets, paid vacations etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME programme etc as a delegate; a medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext; a medical practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext’.
Similarly the Uniform Code of Pharmaceutical Marketing Practices (UCPMP) clause 6 and 7 prohibit any pecuniary benefits to the person qualified to prescribe drugs. It also prohibits any type of grant in aid to the persons of medical profession to participate in the conferences in the form of travel grant or accommodation facilities.
Most of the conferences/CMEs are sponsored by the pharmaceutical and device making companies. In some cases they spend exorbitant amounts on these events. The organizers of the events give permission to the companies to hold stalls on payment to display their products. Invariably these events are now-a-days being held in 5-star hotels and so the charges of the stalls are also expensive. In one such event the rate of a stall for a three day period was found to be astonishing. The stalls were divided into various categories. Platinum stall, size 10X10 meters @ Rs. 90 lakh and above; Diamond stall 10X6 meters @ Rs. 75 lakh; Gold stall 6X6 meters @ Rs. 50 lakh; Silver 6X3 meters @ Rs. 35 lakh; Bronze 3X3 meters @ Rs. 20 Lakh. Then there were other less important stalls with charges ranging from Rs. 3 lakh to Rs. 25 lakh. These companies take stalls at several conferences every year. It is easy to make out the amount spent. Obviously the companies paid for these stalls to get the orders from the visiting delegates and earn profits. Whatever one may say there is always a human factor that one is obliged to prescribe the product of the promoters.
Most of the expenditure on healthcare is on drugs, which accounts for nearly 67 percent of total healthcare cost. It is, therefore, imperative that the drugs should be cheap. India had been a hub of manufacture of cheap bulk drugs by the public sector pharmaceutical units. The IDPL in particular played a vital role in this including in the national health programmes. This type of exorbitant expenditure on promotion adds to the cost of drugs.
It is true that medical education and medical practice have moved a long distance from the days of Gurukul, where the disciples used to observe strict discipline living under most arduous conditions. Change is an obvious and natural pattern of life. But it is also understandable that education does not need to be obtained sitting in the high profile expensive halls of five-star hotels. Such approach automatically makes the entry of market forces in to the system. As a result, right form education to the delivery of healthcare, profit becomes the norm. A doctor thus is forced to act according to market rules shedding social responsibility.
It is time the medical organizations come forward to speak against such market oriented healthcare. They should enforce the ethics for not accepting pecuniary benefits of any kind from the medical companies and organize such conferences/CMEs on their own expenses. The companies which spend so much on the stalls and promotional aspects are not naïve. They invest. When the expenses cross a limit they increase the charges of their products. Ultimately it is the consumer, the patient who bears the brunt.
Successive governments have failed in implementing these codes. Even after so many years the UCPMP is still voluntary. It has to be made mandatory. Medical association too should be brought under the ambit of such codes. The health professionals should realize that it is not fair to have lavish food and drinks at the expense of someone. After all medicine is not a luxury. (IPA)

Monday, 28 January, 2019