[Answered] Highlight the graveness of the doctor- drugmaker nexus in India. What measures are required to keep this nexus at bay?

Drug firms offer freebies in cash and kind to physicians to incentivise them to prescribe ‘their drugs’. Further, Doctors are utilized for reputation-building exercises. Doctors have a commanding position and patients know little about the medicine. Patients will consume whichever medicine is prescribed. This unequal situation gets exploited.

Graveness of the doctor- drugmaker nexus:

• Unethical drug promotion adversely influences doctors’ prescription attitudesand harm human health by over-use, prescription of higher doses etc. For instance, during COVID-19, many doctors prescribed dolo-650 instead of the usual 500 mg tablet.
• This causes a severe financial stress for patients as doctors would be inclined to prescribe a branded drug rather than the cheaper generic version.
• It is against the spirit of competitionand can jeopardize the survival of small pharma companies which lack in financial resources in comparison to the big players.
• It induces the doctor to work in the interests of the company and not the patient which erodes patient’s trust on doctorsand the entire medical system.
• It has resulted in unprecedented rise in the irrational prescriptions of drugs, such as cough syrups, digestives and cognitive drugs that do not have any scientifically proven therapeutic merit.
• It pushes costly medicines over the generic versions that are priced around 40%-50% less than the branded medicines.

Measures:

• Making the Uniform Code for Pharmaceutical Marketing Practices (UCPMP) a legally binding code of ethics and should face the same penal action as is mentioned in the Indian Penal Codefor bribery and other similar unethical practices
• Mandatorily periodic disclosures of payments made by companiestowards doctors and professional bodies, directly or indirectly via other parties. It should be accessible to the public and include the amount, purpose of expenditure, and the party paid.
• A mandatory ethical marketing code will define boundaries for drugmakers and to prevent freebies from being masqueraded as product-related or educative material.
• To have special laws or provisions to prevent the corruption of pharma companies.
• The Government should consult all stakeholders, National Medical Commission, FMRAI, Doctors Associations and Pharma Companies etc. to establish a comprehensive framework to check such unethical practices.

It is high time we had strict regulations governing the relationship between doctors and drug manufacturers .To address this asymmetric relationship and promote ethical behaviour by Pharma companies, the Uniform Code of Pharmaceutical Marketing Practices (UCPMP) has been drafted the Government.