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Pharma Major

EthicalDoctor

Physician PharInteraction

Dr. Kishore Kumar UbrangalAssociate Professor,Dept. of Medicine,Yenepoya Medical College,Mangalore, Karnataka, India.sankish@gmail.com

22 Jan 2010

Association of Physicians of IndDakshina Kannada Chapter MeeMangalore

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Doctors and Drug Companie On display in the relati

onship between doctors anddrug companies are thegrandeur and weaknessesof the medical profession- its noble aspirationsandits continuing inabi

lity to fulfill them.

Also on displayare the power, social contributions,

and occasional venality of a very profitableindustrywhose products contribute in importantways to the health and longevity of the (Americapeople but that at times employsmethodsthat aredeeply troubling and even criminal.

Blumenthal, David,The New England Journal of Medicine,351(18), 2004, pp1885-1890

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Doctors and Drug Companie

Governmentalso plays a part as it tries withlimited successto help the profession staytrue to its own tenetsand to deter theindustry's most egregious excesses.

The spectacleis profoundly humanand, likemost such spectacles, seems never to end or

to lose its fascination .

Blumenthal, David,The New England Journal of Medicine,351(18), 2004, pp1885-1890

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Times Of India, 14-01-2010

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Times Of India, 14-01-2010

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The 1976Gallup Poll in the US

concluded that doctors werefirst inthe public's perception of honesty aethics; todaythey are fifth.

No such poll has been conducted inIndia, but one thing I am sure of,doctors will not be in the first three.

Dr Narottam PuriExecutive DirectorNew Business DevelopmentMax Healthcare, New Delhi

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Trade vs Profession Medicineis not atrade to be learned, but

a professionto be entered.

A profession is described by a specializedbody of knowledge that its members mustteach and expand, by a code of ethics and aduty of service that put patient care aboveself-interest, and by the privilege of self-regulation granted by society.

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Profession vs Industry(Trade a calling requiring

specializedknowledgeandoften long andintensive academicpreparation

a distinct group ofproductive orprofit-makingenterprises

From Merriam Webster Online; http://www.m-w.com/dictionary

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Pharmaceutical Industry (USA $12-$18 billion annually

Just marketing to physicians (andresidents)

60 million visits annually bypharmaceutical representatives

$1.54 billion on continuing medicaleducations (CME) Papin.K, Oldani M J, Griffiths j : Gifts,

drugs, and theFDA: cross-disciplinaryperspectives on physician-pharmaceuticalinteractions, MedEdPORTAL,AAMC, 200

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Thousands of Indian companiesproduce70,000 brandsof variousdrug formulations

compared toWHOs list of 250essential drugs.

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Drug PromotionWHO definition:

All informational and persuasiveactivities by manufacturers,distributors to induce / influence thesale and use of medicinal drugs.

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Drug Promotion A drug company's primary interestis to maximizesales of its product.

Physicians do not (or should not) share this goal,

they are the chief conduit for sales. Consequently,physicians have been the central targ

of marketing strategies, and they remain so evenafter the rise of direct-to-consumer marketing.

The pharmaceutical industry spends approximate$12 billion annually on gifts and payments tophysicians.

Studdert, David M.; Mello, Michelle M.; Brennan, Troyen A.The New England Jourof Medicine,351, 2004, pp 1891-1900

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Indian National Commission onMacroeconomics and Health, 2005

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Where there is anirrational drug, then there isbound to beunethical promotion.

The codes which deal with the promotion of drugs: International Federation of Pharmaceutical Manufacturers (IFPMA)

code of Pharmaceutical Marketing Practices- updated in 1994

Criteria for medicinal drug promotion-prepared by World HealthOrganisation (WHO) in 1988

Guidelines on IFPMA Code of Pharmaceutical Marketing Practices-prepared by OPPI.

International Code on Pharmaceuticals-prepared by Health ActionInternational (HAI)

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USABarefootscureamerica.com

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Research spending vsDrug Promotion

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How do doctors keep up withnew medicines?

A study in the UKfound that seniordoctors havent formally studied 85per cent of the drugs they prescribeto patients.

In India, with its 70,000 brandedformulations, the challenge is evengreater !

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How do doctors keep up withnew medicines?

How do they decide whether a recent entrant isworth the hefty price tag or find out aboutundesirable side effects?

An study on drug promotion in India, beingconducted by the Forum for Medical Ethics:

indicates that most doctors not only acceptsizable gifts from pharmaceuticalcompanies, but also swallow skewedscientific information.

H d d k i h

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How do doctors keep up withnew medicines?

Most rely on medical representatives,intuitionand sponsored conferencesatwhich participants are more interestedin drinking than learning,

Handpicked speakers at conferences andsponsored articles in journals can make

even pedestrian products sound likemiracle cures .

Dr V. Murlidhar of Sion Hospital, Mumbai ,Forum for Medical Ethics, NationalSeminar on Drug Promotion, Mumbai, Sept6, 2003

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Role of medical representative Rather than serving as dispensers of scientific

information, have been reduced to spies andsalesmen.

They routinely strike deals with chemists tofind out what local doctors prescribe, andthen make their calls armed with thisinformation and gifts .

Forum for Medical Ethics, National Seminar on Drug Promotion, Mumbai,Sept6, 2003

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Is your doctor a bunny, wolf,sheepor dodo? !

Classifying people as bunnies, wolves, sheepdodos may sound like a flaky party game.

But it's also serious business. "Medical representatives are sometimes train

to slot doctorsintofour groups:"

Dr Peter Mansfield , founder of Healthy Skepticism (an Australian generalpractioner, who for 20 yea rs has been trying to create global awarenessabout the reality behind the lab- coated facade)

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Bunniesare doctors who care mostabout their patients,

Wolvescare most about money,

Sheepwant to keep up with other doctors, Dodosare those who are burnt out.

Once the doctor's motivation is clear,it's much easier to sell a new drug.

Dr Peter Mansfield, Healthy Skepticism

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Unethical Drug Promotion-An EmergThreat For The Indian Society

National Seminar on Drug Promotion,Mumbai, India on 6 Sept, 2003

a study on the Promotional Practices ofPharmaceutical Firms in India,conducted by the Forum for MedicalEthics in collaboration with the DrugController General of India and theWorld Health Organisation (WHO)

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Unethical Drug Promotion-An EmergThreat For The Indian Society

Drugs are often promoted through dubious,even unethical practices .

This ext