Drugmakers could face new marketing restrictions in India, should new rules come into force.
A set of marketing rules would limit the amount drugmakers can spend on gifts and trips offered to doctors and pharmacists to Rs 1,000 (US$15) per gift.
The proposals propose stringent penalties. Violating the rules would result in a marketing suspension against the relevant company for at least a year. The full length of the suspension would be commensurate with the severity of the offence. On the other hand, the suspension could be alleviated by paying a hefty fine – between Rs 500,000 and Rs 100 million (US$7,800-1.56 million), again depending on the severity of the offence. Penalties would also include the confiscation of the company’s highest-selling brand medications, for use in government hospitals.
“An entrenched conflict of interest in Indian healthcare”
Some pharma companies effectively bribing to prescribe their products is not a new problem in India. The issue has facilitated what the Times of India describes as an “entrenched conflict of interest in Indian healthcare [which] endangers patients” as pharma companies undertake a range of illicit practices to boost profits and quash competitors.
The effect on patients, meanwhile, can be incredibly damaging. In one instance, a doctor wrote a repeat prescription for corticosteroid drops to treat a young girl’s conjunctivitis (he was receiving kickbacks to do so.) The girl wound up needing surgery for cataracts due to prolonged use of the drops.
The average doctor in India makes around $14,000 a year. Many make a lot less than that. Cash, goods and services beyond their pay grade is an understandably attractive prospect for many doctors.
Some pharmaceutical companies are more than happy to oblige. The range of offerings is eclectic, as a 2012 Reuters report outlines. They include cash payments (typically disguised as grants and consultancy fees) and foreign trips, to antique pens, cookware and shoeshine kits.
Marketing to doctors
Legal action related to this kind of bribery is rare. More often than not, doctors encounter legal challenges over their relationships with big pharma and not the other way round.
In 2015, for example, 44 doctors were brought up before an ethics committee on charges of “accepting illegal gratification from pharma companies.” A committee member at the time said, “all major pharma companies bribe doctors to ensure that their drugs capture the market.” This statement is apparently unsupported. International companies have extensive, often well enforced, policies prohibiting corruption.
Previous attempts to crack down on the issue, meanwhile, have often run aground. A Uniform Code of Pharmaceutical Marketing (UPCM) was introduced in January 2015 and supposed to become mandatory after six months. A number of extensions were subsequently granted against the code – the last one in September 2016, for an indefinite period.
Even the new legislation does not appear to be too tough on pharma companies. The option of drug companies being allowed to turn a marketing suspension into a financial penalty, for example, may not prove an effective deterrent. Many pharma companies could simply choose to pay the fines and continue marketing.
Encouraging, therefore, as the steps to introduce the legislation may be, it may require even more in future to resolve the issue.