ABOUT AUHTORS
BALVINDER SINGH*¹, PAWAN JALWAL ¹, VIKASH KUMAR RUHIL ^2
1Shri Baba Mastnath Institute of Pharmaceutical Sciences & Research,
Baba Mastnath University, Asthal Bohar, Rohtak, Haryana, India
²P.D.M. College of Pharmacy, P.D.M. University, Bahadurgarh, Haryana, India
^*balvindersinghpharmaco@gmail.com

ABSTRACT
What started as imparting education to medical healthcare professionals, regarding pharmaceutical products by various pharmaceutical companies, has now become a grave, giant problem in the category of bribery and to be more precise, corruption in this 21st century. Now detailing of pharmaceutical company product has included giving free physician’s sample packs, prescription pads, pen and includes an entire range of latest electronic gazettes of mobile phones, laptops, tablets, AC, Refrigerator, LED TV, sponsoring a conference, refreshment to all expenses like return air ticket with free boarding and lodging in national or international tourist spot or hilly area. The real problem is that nothing comes free; all these expenses will add to cost of medicines and medical fraternity will heed least to quality of medicine. Now the market is flooded with abundant, spurious, sub-standard medicines; as pharmaceutical companies have the confidence of selling these products by shelling huge, attractive offers/gifts to some of greedy doctors, who fall prey to their lucrative offers. In this article, the aim is to probe this association or rather; we can call nexus between the medical healthcare professionals and various pharmaceutical companies. Various aspects are covered in this article, like….How this association works? What is the modus operandi and rationale of this association? Various angles of this association; from medical healthcare professionals, medical councils, pharmaceutical companies and society point of views are covered.

Reference Id: PHARMATUTOR-ART-2575

INTRODUCTION:
Since vedic era, human beings suffer from various ailments and diseases. To treat the patients, ayurvedic Vaidyas were there. With passage of time, this pious, holy alliance of doctor and patient is expanded and entered the third party of retail chemist. Slowly, the fourth and fifth party of Manufacturer and Distributor entered this triangle. In modern era, the Indian pharmaceutical industry of allopathic medicines started with a Calcutta based company named Bengal Chemical and Pharmaceutical Company; in the year 1901. This tiny step of manufacturing medicine in our country has now grown into a vast industry of Rs. 860 billion for the year ending March 2016; with more than 24000 pharmaceutical companies.(Saurabh,2017), (Sandhya,2017).
India has a vast population of more than 1.26 billion people. The number of doctors to cater their healthcare needs; are very few. There is lots of pressure of vast number of patients per doctor.

There are many divisions of medicine practice, like allopathic, ayurvedic, homeopathic, unani, siddha, acupuncture, acupressure, naturopathy etc. In this article, the allopathic medical health professionals will be considered, as this is the main and leading line of medical health professionals.

Initially, the pharmaceutical company’s representative met medical health professionals (Doctors) and imparts knowledge about new drugs/ medicines, launched by their pharmaceutical company.  With passage of time, this practice of imparting only knowledge of medicines was modified and supplemented with additional points like giving physician’s trial samples of new drugs/ medicines. These trial packs are supposed to be given to poor patients, free of charge, by the physician. By this, doctor will also check the quality of product by seeing the improvement in the condition of patient. This tradition of free sample is further augmented by occasional gifts on New Year, diwali, holi or other festival or on the occasion of new product launch. The small gifts include pen, writing pads, stethoscope, calendar, table top, paper weight or other utility items, which are helpful in the examination of patients by the doctors. Company’s name and medicine brand names are printed on these promotional gifts. With further passage of time, increasing patients number pressure, increasing number of more than 24000 pharmaceutical companies, the need or requirement of medical health professional changes. Now doctors do not get time for up gradation of their knowledge. The pharmaceutical company’s representatives, although tried their level best, but cannot provide all the required information. So the doctors have to conduct Doctor’s Associations meetings (Continuing Medical Education (CME)/ conferences), to discuss current progress in the field of medical profession and new medicines pros and cons. Other Doctors have to attend these medical conferences/ CMEs. Monetary inputs are required for organizing an event, as well as boarding and lodging of participating lecture delivering doctors and delegates.

There is a greed or hunger of more sales in various pharmaceuticals companies. This leads to various ponzy, lucrative schemes of offering big gifts, from latest and sophisticated electronic gazettes like mobile phones, laptop, tablet, AC, refrigerator, LED TV etc. to hard cash. This also includes sponsoring CME / Conference’s refreshment to boarding and lodging, in national or international tourist spot or hilly area; with to and fro / return air tickets for doctor as well as spouse.As we all know that nothing comes for free. These freebies always come with a string. The pharmaceutical companies, on one hand take the promise from doctors for prescribing their products; and on the other hand will not bear the cost of these freebies. These pharmaceutical companies will simply pass on this burden to poor and ignorant patients. These poor patients think that their respected doctors have prescribed a very good quality costly medicine, that’s why they have to shell out extra money.

In this paper, the point of views of Pharmaceutical companies, Doctors and Medical Council of India will be discussed.

Pharmaceutical Company’s Point of View:
In today’s era, most of the companies, including pharmaceutical companies are doing business to earn money and more money. That’s the harsh truth. There are more than 24000 pharmaceutical companies. They follow the principle of “Everything is fare in war and competition”. They simply want to achieve their goal.

The real motto of ‘Service to Mankind, poor patients’ is lost somewhere, amid profit and other monetary gains. There is cut throat competition. Every company tries their level best to achieve maximum sales volume of their medicines, month after month, year after year…(Albert,2014), (Baines, 2010), (Bansal and Das, 2005), (Centad, 2010), (Maria, 2016), (Saurabh,2017), (The George Washington Univ., 2009) For achieving this target; they hire best marketing professionals from top to bottom i.e. from general manager/ marketing manager to medical sales representative. These companies also try to come out with latest niche products, superior and best quality products by using fully automatic machinery with all latest Good Manufacturing Practices. They come out with one of best product with International Level quality. In this whole process, the cost of product shoots up and profit comes down.

Now see the irony, some small fishes spoil this game, just as one rotten apple spoils other apples of the basket. These so called small fishes are bad pharmaceutical companies. They uses cheap raw material/ APIs, do not comply with Good Manufacturing Practices (GMP) and try to follow short cuts for smaller-smaller gains. They will try to bribe the major player; here the respected honest doctor.

As Doctors are also human beings, few doctors will also join and help these game spoilers. What started as small number of bad players, have now rapidly engulfing the Pharmaceutical industry. Many a times the bigger pharmaceutical companies also succumb to the pressure and treads into wrong path.

Medical Health Professional Point of View (KRC, 2011):
Medical Health Professionals (Doctors) thoroughly explore knowledge about medicines during their studying in MBBS/ BAMS/ BHMS/ BUMS/ MD/ MS/ BDS/ MDS etc. Then they start practicing their knowledge by diagnosing the patients and prescribing best medicines, accordingly. During their course study, they only study generic names of medicines, whereas various pharmaceutical companies keep different brand name of same medicine; so as to differentiate between themselves. Now, every pharmaceutical company’s representative meets same doctor for their respective brand promotion of that single medicine. For example, let us say a doctor is approached by more than ten companies to promote their Aceclofenac medicine’s different brands. On an average, a doctor is visited by more than 10 medical representatives, everyday.

Generally pharmaceutical company’s medical representative detailed the medicine from visual aid/ power point presentation on laptop/ tablet etc. In the end of detailing, based on the interest shown by the doctor, where medical representative feels that doctor can prescribe that medicine brand, the doctor is given physician trial sample medicine packs, small gifts like pen, writing pad, key chain, table top, calendar, stethoscope etc. The purpose behind giving these small gestures as gift is that these small souvenirs will serve as soft reminders of these products and company, even after the visit of the medical representative.

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