The Pharmaceutical Research and Manufacturers of America (PhRMA), the most influential industry association of multinational drug companies in the US, had recently revised its code of business ethics, following which the companies decided to stop offering gifts or other incentives to promote drug sales.
"Most of the multinational companies want their subsidiaries in other parts of the world, including in India, to follow the ethical practices they follow. Our members are implementing the code of ethics brought out by our association in January last year," said Tapan Ray, director general of the Organization of Pharmaceutical Producers of India (OPPI).
PhRMA, which represents leading American pharmaceutical research and biotechnology companies, also insists its members to follow ethical marketing practices and focus on ways to educate the doctors on various treatment options than to promote a particular medicine.
The Indian Drugs Manufacturers Association (IDMA) and Indian Medical Association have also enacted its own code of conduct to restrict unethical marketing practices in drug distribution and healthcare practices.
OPPI and IDMA had conducted some joint awareness programmes on the issue among doctors and the industry. OPPI has set up a two-level committee to look into the complaints against erring members, said Ray.
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However, intense competition in the market force most of the companies to violate the code of ethics, say industry sources.
Usual marketing practices followed by most of the large and mid-sized companies include valuable gifts, arranging foreign trips with family and complimentary tickets and memberships for social activities to doctors.
Many companies arrange family holiday programmes for doctors within India and abroad as part of continuous medical education (CME) programmes.
Normally, December-January period, a lean season for drug manufacturers, is also the time for many doctors to go on vacation and CME programmes, note industry sources.
PhRMA, which is one of the largest and most influencial lobbying organizations in Washington, has, however, directed its members not to siphon funds for bribing the doctors under the guise of CME programmes to help doctors enhance their knowldge base.
"It is not fair to accuse the medical representatives on bribing the doctors, as these kind of deals are directly done by middle to upper level management, which maintain constant contact with the doctor community," said D P Dubey, general secretary of the Federation of Medical and Sales Representatives' Associations of India (FMRAI).
The association's two lakh members in the country resorted to a one day strike on April 24 this year to protest against unethical marketing practices followed by their employers.
"It is not fair to accuse the physician community as a whole for accepting bribes and gifts from companies to write their prescriptions. Most of the doctors do not go beyond free physician samples offered to them," said an Indian Medical Association office bearer.
We also follow ethics in our profession and there may be some aberrations. But it is not fair to accuse the community as a whole," said an Indian Medical Association office bearer.
In the US where almost half of the global drug sales take place, there are non-profit organizations such as No Free Lunch, which urges medical school students not to accept free gifts or meals from the drug industry. Rules in the pipeline such as Physician Payments Sunshine Act, make it mandatory for doctors to detail the payments received from companies.
Pharma companies are also being pressurised to divulge the details of their spending for doctors.
"The change has to happen with the mindset of the management, doctors, sales representatives and all other involved in this system. It requires bold decisions, sense of social responsibility and ethical living. Companies are functioning in extremely competitive enviornment and it is very difficult to effect the changes quickly in the current circumstances," said Dr. R B Smarta, Director of Interlink Marketing, a pharmaceutical and healthcare consultancy which framed the code of ethical practices for IDMA.
"It is a burning issue with the industry and in the recent past we were more focussed on policy issues such as the fixed dose combination problem. Soon we will come up with more strategies to weed out unethical marketing practices plagued with the industry," said Daara B Patel, secretary general of IDMA.