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Selling Right

Medicines affect the well being of nations, and this puts a massive responsibility on the pharma industry to market its products in an ethical manner. Here's what members of the industry say. By Deepali Gupta.

Due to its sensitive nature, pharma industry is one of the most regulated industries, and most governments keep a close watch on it. Marketing ethics for pharma products however, is one aspect that cannot be covered in legislation.

Internationally, prominent associations in the industry set down these ethics regulations, and as a result of peer pressure most comply. The line between appropriate and inappropriate, nonetheless, is so fine, that it has to be left to the individual company's discretion. And little can be said or done about when information translates to incentive and when that transforms to a bribe. This fortnight we brought together three panellists F X Cutinho, Director Marketing, Indoco Remedies, Dr Nagral, Consultant at Jaslok Hospital and an active member of Indian Journal of Medical Ethics, and Dr K G Nair, a senior cardiologist to comment on the matter.

Should pharma companies be allowed to market their products?

The question is whether or not pharma companies should be allowed to market their products at all, considering that any such option in the healthcare industry may have serious repercussions on national health.

Nagral: The pharma industry like any other needs to market and sell its products. However, it needs to be more pedantic about the factual correctness of the information provided. A number of drugs circulated in the Indian market today provide wrong information. Tonics for instance have no scientifically proven value to make people more energetic. The claim is therefore not evidence based. There needs to be an understanding from both parties about what is appropriate or what is illegitimate. There are some situations where the consumer would not be happy with marketing practices a pharma company uses. For the sake of public transparency there needs to be some guidelines in the open.

What are the regulations in place?

Indian regulations do not entail curbs on marketing techniques or methods adopted by companies. However, apart from the fact that legislating ethics is close to impossible, would regulations suffice to prevent against malpractice?

Cutinho: Currently regulations restrict us from advertising through public media. That is it. We use conferences, official and recognised means of sponsorships to bring attention to our brands.

For certain OTC products, we provide a scheme as an incentive for chemists to stock the product. Companies in other industries adopt similar promotions. So why exclude pharma companies?

Besides, not all the regulations work. Even if there are regulations those who want to flout them always find a way. For the rest of us self-imposed rules are sufficient. In this industry, a very small number, maybe about 0.2 percent players, are unethical. Plus malpractice can arise only in specific segments where the competition and product overlap is high.

Is high spending synonymous with malpractice?

Nair does not mince his words when deriding malpractice when it comes to marketing. He declares sponsoring trips, expensive gifts, and vacations to doctors are wrong.

Nair: If there has to be spending, companies should provide equipment that are inexpensive and still useful to the doctor such as books and journals. There should be a fixed amount of spending.

It is not as though the international community does it perfectly. There are many Americans and Europeans who get travel grants from drug companies, but they disclose it. Without transparency, there is no value in any paper presented.

Nagral agrees. Disclosure is critical so that listeners can objectify the purpose and findings of any study.

Does it affect doctors? How can it be neutralised?

While a number of members in the industry agree that a large proportion of onus lies on the doctors too, is there a solution to prevent malpractice and ensure ethical marketing? Perhaps there are guidelines or publications already available in the developed markets that we could adopt.

Nagral: Everyone likes to believe that promotional activities don't affect doctors. Unfortunately, it's tough to prove but there have been studies to prove that a drug launch with heavy promotion changes the prescription practice.

Medical associations should set codes on what physicians should accept and what not.

Individual companies should not sponsor conferences. A neutral body (e.g. the IDMA or OPPI) should consolidate the finances and disperse travel grants. Associations need to rise to the occasion and monitor ethical marketing.

Scientific information, effects and adverse effects, needs to be objective, and be published by objective sources. For example, in the UK Government publishes the British National Formulations, which gives clear indications about every drug. We have no equivalent. For any information on new drugs we rely on the makers of the drug.

editorial@expresspharmaonline.com