Ethical Matters Poised at the unique crosswire of good profits and good health, the pharmaceutical industry has a potential to maintain a healthy balance. Yet its behavior is often under the scanner along with that of the medical community. Ethically compromised, uncontrolled practices within the medical and pharmaceutical sectors may need a careful reappraisal, and a regulatory restraint. For the lack of a world body defining policies, individual, regional challenges surface. While the developed world grapples with an agenda of putting regulations in place, most developing countries struggle with effectual implementation of the existing code. In an exclusive poll run by Brandcare with nearly 180 respondents in the Indian pharma sector, we present a glimpse of the way this industry thinks, acts, and also examine the current trends pointing to change.
Do you agree that Indian pharmaceutical industry needs to improve its control on ethical practices?
100% respondents agreed Indian pharmaceutical industry needs to improve its control on ethical practices.
Do you agree that HCPs in India need to implement better ethical practices?
Here too, 100% respondents agreed that the medical community needs to improve its ethical practices too.
Of the companies forming the Indian pharma industry, the MNCs have better implementation of ethical practices. Do you agree?
A large proportion of surveyed respondent, around 67% agreed that MNCs have better implementation of ethical practices in India. Their attitudes toward ethics are rooted in culture and business practices.
Do you agree that government needs to play a more responsible role in overall implementation of the ethical agenda?
80% mandate on government intervention in tightening of implementation
On what areas do companies need to implement better ethics?
As compared to the HCPs in the developed countries, how do our HCPs compare in practicing ethics?
At par – 22%
Do hospitals in India need to improve their ethical standards?
97% of respondents agreed that hospitals need to improve their standards.
How does retail score on adherence to ethical practices?
Will including ethics as a part of the curiculum at MBBS, pharmacy courses help improve the overall adherence to good practices?
An unequivocal mandate on all aspects! The overall sentiment is that of good intentions. It’s now essential for the industry that its good intentions are followed up by concrete actions that can consequently create a wave of change. Individually or collectively, we all are responsible.
The Current Regulators in place
Indian regulators have been attempting to effectively regulate and monitor the professional conduct of medical practitioners and pharmaceutical companies for a long time.
The Department of Pharmaceuticals (DoP) Government of India has formulated the uniform code of pharmaceutical marketing practices (UCPMP). The code covers claims and Comparisons, Audio visual promotional material, sampling, gifting, sponsorships, MR’s conduct and Mode of Operations.
Medical Council of India amended its guidelines in 2009 to regulate the conduct of medical practitioners. The MCI amendments look at two broad areas. First, they address the issue of gifting and sponsorship. The other area addressed by this amendment is clinical trials. Unfortunately, the MCI itself lacks credibility among the profession, has been surrounded by controversy and has spent a large part of its recent existence trying to shake off charges of corruption*
Several studies in this category are available like the Ernst & Young study- titled ‘Pharmaceutical marketing: ethical and responsible conduct’. It is based on a survey conducted among healthcare professionals (HCPs) and pharma marketing professionals to understand the effectiveness of DoP and MCI guidelines.
The MCI amendments have triggered introspection even at the academic level.
Academic Introspection of Ethics
At the Medical Level
Indian Journal of Medical Ethics says that ethics is now at the centre stage of medical education and probably intensifying (1, 2). While in the past the curriculum did have a modicum of ethics, it remained for the students to imbibe lessons from their seniors. Many felt that their role models fell short of their expectations. The Journal says that formal ethics teaching is being introduced in institutions like the St John’s Medical college in Bengaluru and universities like the Rajiv Gandhi University of Health Sciences (RGUHS) and the Maharashtra University of Health Sciences (MUHS).
The course will include elements of ethics, professionalism and communication skills.
At the Industry Level:
The Industry is doing its bit too. The International Federation of Pharmaceutical Manufacturers’ Association code of pharmaceutical marketing practice states that the detailers (medical representatives) must be adequately trained and possess sufficient medical and technical knowledge to present information on their company products in an accurate and responsible manner. The undercurrent of this is also for the pharmaceutical manufacturers to reassess their hiring and training practices of representatives. The overall downward slide in the quality, commitment and ethical responsiveness of the representative community is perhaps a reflection of the industry’s aggressive profit seeking agenda. Assuming that companies charter their ethical guidelines to met a collective goal, its implementation will be a challenge unless hiring and training is addressed. Just as medical colleges gear up to train the new medicos in areas of ethics, the pharma industry needs to revisit its training agenda too.
At the Retail Level:
Chemists and Druggist’s Association needs to take it upon themselves to train their members on ethical discharge of their duties.
What’s up globally?
Ensuring ethical drug promotion—whose responsibility?- The Lancet, Volume 362, Issue 9385
In France, from February to April, 2003, an extensive media campaign purportedly sought to increase public awareness of cardiovascular disease risks. In newspapers and magazines, an advertisement displayed a corpse in a morgue, along with the caption: “A simple test of blood cholesterol could have avoided this”. A 30 s television commercial depicted a couple celebrating a birthday, followed by the husband’s collapse. His wife then watches while he is taken away in an ambulance. Finally, a voice declares, “You may think you’re healthy, but too much cholesterol in your blood can cause a heart attack.”
The article ran it down saying “The implication is that smokers, obese individuals, or those who live a sedentary lifestyle can safely continue to smoke, remain overweight, or take little exercise, provided they take medication to reduce their cholesterol values. Of all the major factors accepted as cardiovascular disease risks, only cholesterol is addressed. “ “We conclude that this experience underscores the need for health authorities to urgently increase their vigilance with respect to drug promotion”.
No Free Lunch is a US-based advocacy organization that holds that marketing methods employed by drug companies influence the way doctors and other healthcare providers prescribe medications. The group has about 500 members, mostly physicians, although nurses, physician assistants and a few dentists also belong. About the same number have taken the No Free Lunch pledge, vowing not to accept any industry gifts, money or hospitality.
National PharmFree Day The American Medical Student Association (AMSA), the nation’s largest, independent medical student organization, with nearly 50,000 members, announced National PharmFree Day, the first annual day of action where medical students, residents and physicians spoke out against the pharmaceutical industry’s biased marketing practices. Medical students held events nationwide promoting honesty, integrity, humility and accountability in medical education and beyond.
While this article just scratches the surface of a mindboggling enormous issue involving pharmaceutical companies, their employees, regulators, medical professionals, hospitals pharmacies, world health bodies and politicians, at the core of it is a consumer who bears the brunt but is comparatively oblivious. It’s for us to start a change, for there will be occasions when we might need to cross the cubicle from a professional to a consumer. God forbid!
Director- Brandcare Healthcare
Brandcare Healthcare Communications is a leading healthcare advertising agency based out of Mumbai, Over the last decade we have helped companies and brands traverse the changing pharma landscape and emerge as category leaders.
We would like to express our gratitude to all the respondents of this survey without their valuable response this study would not have been possible.