Pharma oversell clearly needs to be reined back

The ethics of selling drugs is more complicated than, say, selling toothpaste. Which is why consumer access to many pharma products is regulated—you cannot buy critical drugs that could be over-used or abused over the counter. Of course, this much is a no-brainer: Pharma firms need to market their products to beat competition, earn profits and continue to produce drugs for patients. That usually involves pitching pills to doctors, who also benefit from fresh information on medicines they could use to cure patients. But it’s when aggressive promotion crosses red lines that alarm bells must ring, as they are right now at India’s Supreme Court. The Federation of Medical & Sales Representatives Association of India (FMRAI) has moved court with a public interest litigation (PIL), accusing the marketer of Dolo-650—a formulation of paracetamol widely prescribed for covid—of bribing doctors with “freebies” worth ₹1,000 crore to recommend the tablet. The basis of the complaint is a probe by the income tax department, which had carried out raids at the drug-maker’s offices a month ago. It alleged that doctors were bribed with “travel expenses, perquisites and gifts”. Micro Labs Ltd, which makes the painkiller, has denied the allegation and will get a chance to defend itself in court.

The issue is not only about one drugmaker. The scandalous practice of pharma company ‘incentives’ influencing medical prescriptions is well known. It’s a case of industry self-regulation having failed to rein in a reckless profit maximization. In 2019, for instance, in response to a question on firms plying doctors with gifts, the government acknowledged in Parliament that it had got complaints flagging “unethical” practices by pharmaceutical companies. The distortionary power of such pill peddling is enormous. It can push doctors to over-medicate patients or make them buy pricier alternatives. All of which violate the fundamental maxim of healthcare: do no harm. While doctors are bound by a code of conduct that bars them from accepting gifts from the pharma sector, pill marketers have operated with few constraints. In order to bring a semblance of order to the wild west of drug marketing, the Centre in 2015 had brought in the Uniform Code of Pharmaceutical Marketing Practices, a voluntary set of guidelines to prevent pharma companies or their agents from dangling the promise of gifts and cash to healthcare providers to fatten their bottom lines. The catch: These rules could be flouted with no major consequence. A company found guilty of doctor bribery would suffer a reprimand or at most expulsion by a pharma association it is part of. This is not enough to make companies promote pills purely on their therapeutic merits. In the Dolo-650 case, the FMRAI has sought a tightening of regulations, perhaps through legal backing for restrictions, complete with penalties. The court has asked the government to respond to the PIL.

The trick would be to thread the needle in a way that clamps down on corruption without posing hurdles for legitimate sales promotion. Ideally, the ethics of doctors should defend patients from predatory business practices. But practitioners are often too pliable for us to rely on that. Pharma firms cannot continue to get a free pass for brazen bribery. This is a category where those who mostly pay the bills have no say in brand selection, which is reason enough for us to put it under scrutiny for unsavoury practices. We need corrective action.