Inder Singh (L), US-based pharma executive specialising in analytics and Rajeev Ahuja (R), development economist, formerly with the World Bank, share their insights on the tussle between the two institutions
In its recent note directed at the Prime Minister Office (PMO), the Indian Medical Association (Doctors’ association that safeguards its interests) has sought a clarification if PM Modi met officials from the top pharma companies and if he made reference to pharma companies bribing doctors with women. And if yes, then IMA has asked PMO to either prove or apologise. The IMA note is not in good taste for the reasons given below.
First, while there is nothing wrong in IMA voicing its concerns, the contents of its note are problematic. Assuming (i) the meeting did take place as reportedly acknowledged by a pharma lobby and (ii) PM did make reference to the pharma companies bribing doctors with women (denied by the pharma lobby), PM’s reference is based on the findings of a recent study conducted by a public health group, SATHI. The study had suggested that medical representatives of pharma companies bribe doctors with foreign trips, expensive smart phones, and even women. Incidentally, the authors of the study are themselves from the medical fraternity. IMA can question the study — the research methodology used, the research findings, and even the integrity of authors. It can even commission an independent study to understand if the problem indeed exists and what’s the scale of it. Asking PM Modi to prove the findings of the study is not in good taste.
Second, PM reportedly informed the pharma leaders about how their non-compliance was forcing government to come up with strict laws. Pharma companies are supposed to comply with the Uniform Code of Pharmaceutical Marketing Practices that serves as their guidepost. Similarly, doctors are supposed to follow code of ethics of the Medical Council of India (MCI). The study finds that only a small percentage of doctors adhere to the Code of Ethics. Actually, the problem of pharma companies having financial relationship with doctors is a real one, present in other countries too. The history of pharma companies is full of cases of bribery and corruption. If the situation is any different in India, IMA would have done well in ‘educating’ the government with some facts and figures, which it doesn’t do in its note.
As for the law to check malpractices in marketing of medical products, there ought to be one, and a strict one on that. Several countries have laws to bring transparency and accountability into the financial relationship between pharma companies and the healthcare professionals. For example, in the US, where active promotion of pharma products is quite normal, the Physician Payment Sunshine Act imposes strict reporting requirement. The Act requires pharmaceutical manufacturers to report annually to the US Government on certain payments or other transfers of value to physicians and teaching hospitals. The federal government then makes the data available online that anyone can review. Further, there are federal laws that prohibit financial incentives other than token things like occasional meal for the entire office staff. In addition, some states like Massachusetts, Vermont, etc. have even stricter laws related to promotion compared to those from the federal government.
Although, industry associations as well as professional bodies do practice self-regulation to some degree by way of code of ethics, these can’t substitute for laws and regulations. Therefore, self-regulation practised by the industry needs to be complemented by necessary laws and regulations.
Last but not the least, the IMA note is critical of the Modi government and its policy and programmes. For example, it is critical of the government’s health sector flagship programme, Ayushman Bharat, which it considers to be a non-starter. Further, it blames the government of using crude tactics ‘to divert the attention of the people from the real issues in the health sector.’ It is unfortunate that IMA decided to use this note to vent their general angst against the government.
Evidently, there is a larger undercurrent to its criticism which probably has to do with the industry’s unhappiness with the Modi government. Why is the industry unhappy? Well, Modi government has been trying to bring greater accountability in this industry which has upset many stakeholders including the medical doctors. With its thrust on making healthcare affordable, the Modi government has pursued several policies such as capping of trade margins of some medical devices and pharmaceuticals, promoting generic medicines and so forth. This has negatively impacted the commissions and margins in the industry. Further, legislating the Medical Commission Act aimed at reforming of medical education in the country, is bound to increase the supply of doctors and is therefore bound to impact incomes of doctors who have gotten accustomed to operating in a monopolistic environment. For these and other reasons, the industry is probably unhappy with the government.
Healthcare industry in India needs to recognise that the Modi government policies are consistent with its vision of a new India. To realise this vision, the Modi government has sought support from all sections of society, including the healthcare industry. Everybody in the society, whether individuals or organisation, has something to contribute towards the building of new India. The best way the healthcare industry could contribute is by balancing its self-interest with the larger national interest.
Disclaimer: ‘The views expressed are in their personal capacity.’
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