Searches of the premises of a Bengaluru based pharma firm, the Micro Labs Ltd. by the Income Tax authorities in July 2022 and malpractices in the form of bribing medical practitioners for promotion and marketing of its products (drugs) to claim relief in taxes and consequential petition in the Supreme Court of India by the All India Federation of Medical Representatives Associations praying for ending such menace has put on the spotlight rampant malpractices out of the nexus between diverse medical practitioners and pharma industry, thus hazarding the lives of patients.Income Tax authorities unearthed a colossal expenditure, mostly in the form of cash, kind and services provided to the doctors of over Rs. 1000 crore in the promotion and marketing of the firm’s anti-fever drug Dolo 650 tablet, which was prescribed blindly by the entire diverse medical professionals (physicians) during the Covid 19 Pandemic. The apex court has sent notice to the Central government asking for its response. Union government has levied from July 2022 a 10 per cent tax deduction at source of marketing and promotional expenditure of pharma companies so that such expenditure is duly accounted for.
Medical corruptions include nexus between pharma companies and medical practioners that includes incentivizing (bribing) doctors for promotions and marketing of their products (drugs) in the form of precious gifts, funding their pleasure tours, financing education of their wards abroad etc. with a bearing on the ever increasing costs of medicine. Pharma companies have created ingenious mechanism to escape the viruses of law with impunity. Some other malpractices in the healthcare system are crass commercialism in private hospitals and nursing homes making it unaffordable to the general public, forcing patients to marked diagnostic labs, getting 40-50 per cent out of the costs of such tests as cuts/commissions, medical negligence, over-prescription of medicines, holding patients to ransom in the emergency wards/operation theatres compelling patients to fork out more and more money no matter by pawning their assets, even selling them to save precious lives of their loved ones,the patients, unscrupulously selling out sample medicines, meeting fixed targets of patients, to pharma, a marketing driven industry where profit is the only motive, increasing earnings, accepting free-bees from pharma companies notwithstanding centralized procurement of drugs etc.
Public hospitals and healthcare infrastructure remain underinvested and understaffed resulting in the doctors making virtue of necessities by way of shortages of medicines, stealing drugs from hospital stores and selling them to patients in their private practices. Even they sell out sample drugs to the needy patients.Cross sections of Medical Representatives reveal that they work under heavy pressures to market and promote medicines to individual doctors. There is no remedy in the circumstances. RSS Pariwar Union Government has been dragging its feet on a 2016 proposal to bring in a Uniform Code of Pharmaceutical Marketing Practices (UCPMP) with teeth in the form of penal provisions to tame the unscrupulously corrupt doctors. But there is no progress in this regard. Because it suits everybody, the political class, bureaucracy, medical professionals, pharma companies, crass commercialism of healthcare infrastructure, etc.
Problems that inhibit health outreach to every body include non-professionals manning drug pricing control leading to seeping corruption that help increase prices to 400-500 per cent higher than the actual drug manufacturing costs. This is due to deep-rooted nexus between the office of the Drug Controller and pharma companies. It will, therefore, be germane to state that the regulator (Drug Controller’s office) is a den of corruption. It is unable to control or ensure quality of generic medicines, forcing the ailing people to buy high cost branded medicines, thus making quality drugs unaffordable for the general patients. Generic medicines are not encouraged for lack of assured quality, making patients shell out a bigger price for medicines, which might cost a few rupees to manufacture.
Besides, commercialization of medical education and management is responsible for current mess-up of healthcare. Medical education has been made expensive beyond affordability and corruption seeped in for undergraduate and postgraduate medical education only for people with deep pockets in the private medical institutes, which have outnumbered public medical institutes. Such medical students or future doctors, committed professionally to the ethics and professional standards in terms of the Hippocratic oath, in reality, try to recover their investment, once they become professionally active. Added to this, corporate hospitals that lure doctors at fat salaries further muddy the waters, are always under pressure to generate more medical businesses guided by the profit of the enterprise. It is also true that no pharma firm can sustain without marketing its drugs. Marketing and promotion increase with cutthroat competition when demand for particular drug is high or when a drug is being bunched. Unlike the case of other products, the decision to buy a drug is not made by the consumer, but by the doctor, making it difficult for the patients.
Situation has reached alarming state with ever growing nexus among all stakeholders to the detriment of people’s interests that thwarts with impunity trickling down of healthcare infrastructure and its benefits to the people at large at the grass roots levels. To tackle such massive problems, a gargantuan task has to be undertaken in tandem by all stakeholders by increasing investment for expanding all round medical infrastructures, disciplining medical professionals with iron hands by promulgation of a penal law like the proposed Uniform Code of Pharmaceutical Marketing Practices, and effective enforcement of professional code of conduct under the regulatory mechanism. Other way forward may include instilling fear of law among doctors that for any misconduct, misdemeanor or deviant behavior, punitive action can be taken against such recalcitrant physicians. Medical education also needs to be expanded and made affordable and accessible to all including the poor. After all, it is proven world wide that the best doctors who made distinctive marks in curing humans came from poorer and first-generation medical professionals.
According to the National Medical Commission (NMC), there are 1.8 million (18 lakh) doctors in India of which 0.6 million (6 lakh) have migrated abroad for greener pasteur, showing the country’s inability to retain them, much less prevent brain-drain of doctors from India!