End the nexus

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One of the key issues facing India’s healthcare sector is the unholy nexus between profit-driven pharmaceutical companies and doctors. It often works to the detriment of the patients who are denied access to full information. Prescribing costly branded drugs, instead of generic ones, and unnecessary diagnostic tests are some of the practices that undermine the right of patients to exercise their options. A doctor’s prescriptions should be based on evidence of what is best for patients rather than commercial influences. However, it is widely known that pharma companies shower expensive gifts and sponsor all-paid foreign vacations for doctors who, in a quid pro quo arrangement, prescribe costlier drugs. The Central government’s latest proposal to end this practice is a welcome step. A new regulation is being proposed to check unethical practices of pharmaceutical companies and doctors. It prohibits companies from offering cash, gifts and paid vacations to doctors. The penalty for violations could range from hefty fines to temporary suspension of marketing of a drug. There is an urgent need to correct the information asymmetry that currently exists between doctors and patients. Healthcare is one area where government regulation is necessary to protect the interests of patients who are often at the receiving end of the exploitative operators. The proposed Essential Commodities (Control of Unethical Practices in Marketing of Drugs) Order 2017 is expected to bring the much-needed relief to the patients.

Stringent policy measures are required to ensure that all the players conform to ethical standards. Though the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, clearly prohibits a medical practitioner from receiving benefits, in cash or kind, from pharmaceutical companies, these rules are observed more in breach than in practice. The Medical Council of India (MCI) has been largely ineffective in regulating the practices of doctors. The government must, therefore, step in to create a framework to target and punish companies indulging in unethical marketing. It should be made mandatory for the pharma companies to disclose complete information on marketing expenditure, more specifically the expenses on doctors. This will bring in the much-needed transparency in the system. Similarly, the government’s determined push for generic drugs is laudable. These will encourage the prescription of multiple single ingredient drugs, instead of the current trend of combination medicines. Besides, the rational use of medicines will reduce the threat of antibiotic resistance. The universal and mandatory availability of low-cost generic medicines will help the Central and State governments plan their free drug supply programmes through state-run hospitals and retail pharmacy outlets. This must be coupled with measures to ensure quality of medicines, strict compliance with regulatory norms and adequate legal provisions.