A Mild Wrist Slap for Pharma in India

Last month, before coming to India (where I am now) I wrote about the drug marketing scene. The posting gave a link to an article in the Times of India that suggested to me that the Indian media were on the trail of the Pharma-Medicine story that is currently exploding in the U.S.

In Delhi I met with Rema Nagarajan, the reporter who wrote the Times of India story. Rema is well-informed about developments in the U.S., such as medical schools banning all gifts to medical students, house officers and faculty. Yesterday she had a followup article in the Times of India that suggests that the exposure of excessive pharmaceutical company influence over medical practice is heating up in India. India does not have the same level of consumer advocacy and consumer protection that has been developed in the U.S., but India is on its way in that direction.

Here are excerpts from Rema Nagarajan's article:

If you thought the government would crack the whip on pharmaceutical companies offering freebies to doctors for prescribing their products, think again. The department of pharmaceuticals has indeed taken note of the dubious practices reported by TOI on December 15, but in a surprisingly mild, almost apologetic tone.

Joint secretary Devendra Chaudhury wrote to the various associations of drug manufacturers on December 18 citing the TOI report, but the letter suggests he would be "grateful" if the associations acted on suggestions made by the department.

...The mild tone is despite the fact that the December 18 letter admits: "The allegations cannot be in any way treated as ethical and something that could be endorsed by society in general. This also puts the pharma industry in a bad light since the enhanced promotional expenditure of the pharmaceutical companies result in enhanced market price of the drugs, which has to be borne by the consumer."

Yet, it says the department would be "grateful if you (pharma associations) could kindly take action" on its suggestions and also take steps to "prevent such perception in the mind of the public and other bodies to obviate misuse of promotional expenditure" and to kindly "prevent allegations as well as media reports on this subject as have appeared".

The joint secretary says in the letter that "the matter being extremely sensitive and of great public importance I am constrained to write to you". With such a mild and apologetic tone from the government it is anyone's guess whether the pharma industry would feel the need to take any action.

Both the Organisation of Pharmaceutical Associations of India (OPPI) and the Indian Drug Manufacturers Association (IDMA) had released their own codes of conduct at the beginning of 2007. However, there is no single code applicable to all drug manufacturers, a fact that the letter points out. But again, this is followed up by a gentle nudge: "You may like to consider having such a code for your members"...

Establishing an ethical balance between medicine and commercialism in India will not be easy. Two very strong forces push against efforts to spotlight the problems and suggest solutions. Fist, there is tremendous trust in physicians, beyond what the profession deserves. (Rema quoted a Hindi saying in our discussion - "A doctor is like a God come down to earth.") Second, Pharma is a substantial component of the national thrust for rapid economic development. Successful enterprises aren't totally untouchable, but they are harder to tame than comparable enterprises in the U.S.

Preaching doesn't create an ethical health system. Public understanding of what constitutes good health system ethics and public demand for accountable performance are required. The media and political leaders are key "educators" for the public. I'll try to glean more about the societal learning process in India while I'm here.