Consumers International, which defines itself as “the global voice for consumers,” has just published an important report: “Drugs, Doctors, and Dinners: How Drug Companies Influence Health in the Developing World.” (For a summary of the report, see IndUS Business Journal.)
Drug company profits are declining in the west. For big Pharma, the developing world represents a desperately needed growth opportunity. Not surprisingly, Asia, Africa, and Latin America are seeing intensified drug marketing. “Drugs, Doctors, and Dinners” describes an ethical free-for-all, in which doctors are rewarded with dinners, trips to conferences, and even air conditioners, for their prescribing practices.
The situation is ethically complex. A young physician friend of mine in South Asia, well educated and highly intelligent, told me that he is the only member of the group of “top students” in his program who has remained at home. All the rest have migrated to England, Canada and the U.S. Earning capacity at home is limited, and achieving a middle class life style is difficult. Travel to a conference is a rare perk. An air conditioner can make office or home tolerable in the hot season.
In the U.S. we have powerful consumer organizations, increasing media sophistication about negative drug marketing practices, and relatively strong regulation. I recently speculated that we are approaching a tipping point for pharmaceutical ethics.
These counter forces are weak in the developing world. Regulation of marketing practices is limited. Enforcement is feeble. Industry self-regulation looks great on paper does little on the ground. The Consumers International report recommends banning drug company gifts to doctors. This, alas, is not likely to happen.
According to the Indian National Commission on Macroeconomics and Health 2005 report “ten of the top 25 drugs sold in India are non-essential, irrational, or hazardous.” Expensive drugs draw down the limited public and private funds. If the drugs are not needed the funds are simply being wasted. Searching the document for the word “irrational” will give a rich sense of the scope of the problem.
What should we expect and what can be done? I anticipate that as the pressure for more rational, cost-effective prescribing practices increases in western countries, the developing world market will get progressively more marketing attention from the drug companies, much as tobacco sales are shifting from the developed to the developing world. Organizations like INRUD (International Network for the Rational Use of Drugs) and the World Health Organization Essential Medicines Program play a crucial role in recommending positive actions and increasing developing world drug policy infrastructure.
But the economic forces are VERY powerful. Recommendations alone will not lead to improved pharmaceutical practices. If economic incentives can be altered, as the Gates Foundation and others have begun to work on, drug companies will shift their marketing efforts more in accord with population needs. But direct citizen advocacy in both developed and developing worlds will be needed as well.