Freebies to doctors: Why has the ethical code not been enforced?

The Federation of Medical & Sales Representatives Association of India, or FMRAI, has moved the Supreme Court with a petition. It wants the apex court to direct the Centre to formulate a Uniform Code of Pharmaceutical Marketing Practices to curb alleged unethical practices of pharma companies. The NGO, which had moved the court in March, wants an effective monitoring mechanism, transparency, accountability and consequences for violations of the code.

Now, during the course of the hearing, the petitioner has accused the makers of Dolo-650 of bribing doctors with freebies worth 1,000 crore rupees to recommend the pills. On its part, Micro Labs Ltd, which makes the drug, has denied the allegations as baseless. About a month ago, the income tax department had conducted raids at the drug maker’s offices for alleged tax evasion.

Another petition, which had reached the Supreme Court recently, had claimed that pharma companies were giving freebies such as gold coins, LCD TVs, fridges, laptops and more to medical practitioners, who, in turn, would create awareness about their drugs and health supplements.

The government too has acknowledged in Parliament that it has received complaints of unethical practices by pharma firms. The impact is that doctors might over-medicate you, the patient, or push you towards buying more expensive alternatives. Doctors, on their part, are bound by a code of conduct that prohibits them from accepting gifts from pharma firms. But, the firms continue to operate with minimum constraints.

And, big money is involved. According to a Citizen Civic Action Group analysis, between 2008-2009 and 2016-17, the seven largest Indian pharma firms spent Rs 34,187 crore on marketing. At present, there is no regulator for pharmaceutical marketing practices. Unless the code gets statutory backing, there will be no associated monitoring or regulating body. 

To rein in these firms, the government had brought in the Uniform Code of Pharmaceutical Marketing Practices in 2015.

The code was brought in as a voluntary set of guidelines that would prevent pharma firms and their agents from plying doctors with gifts and cash to increase their sales and profits. But, it has been found that these rules are being flouted without any major repercussions. 

It falls upon pharma associations to enforce the code and they don’t have the power or the incentive to punish erring firms. This code is yet to be legally implemented. That could change with the Supreme Court hearing the petition. It has now asked for Centre’s response.

So, why is it still a voluntary code and not legally binding on companies?
 

Ramesh Sundar, the president of the Federation of Medical and Sales Representatives' Associations of India, told Business Standard that the government had been dragging its feet for several years on implementing the UCPMP. 

A previous Business Standard report said that sector watchers believe that the code is caught up in a tussle between the Department of Pharmaceuticals, or DoP, which comes under the Ministry of Chemicals and Fertilizers, and the Union Ministry of Health.

Malini Aisola, co-convenor, All India Drug Action Network, said that ethical marketing and promotion should be brought within the ambit of the new Drugs, Medical Devices, and Cosmetics Act being formulated. If that happens, the role of the nodal ministry, which would administer the statutory provisions, would shift to the union health ministry. But, the DoP does not want to give up its turf.