‘CODOMOLINDON’. This is a word, in fact a trade name of a drug (a tablet containing Codeine and Acetaminophen) which I can never forget. This drug name is permanently in my mind since 1981. Actually, this drug was prescribed by a doctor to my ailing mother and it was available at a few selected drug stores only. Whenever ‘Codomolindon’ would run out of stock at these drug stores, it was impossible to get the medicine from some other medical store. And I had to run from pillar to post to explore the possibility of obtaining the medicine. Even as we requested the doctor to prescribe an alternative to this drug, he was always giving the plea that ‘Codomolindon’ is the only remedy for the illness of the patient. The point I am trying to explain is that even as there were many substitutes available for ‘Codomolindon’, the doctor was adamant not to prescribe the substitute.
Why the medicine was available at few selected medical stores? Why the doctor was adamant not to prescribe an alternative to ‘Codomolindon’? These were a few questions which continued to haunt me for long till I came to know about a lifelong nexus between a section of doctors’ community and pharmaceutical companies. In fact, our doctors’ community is today referred as medico-marketers by the pharmaceutical companies.
I came across some findings of an international survey by the University of Queensland's School of Medicine in which the promotional tactics by pharma companies have been described as a global phenomenon and  have stated “the need for the doctors to recognise these tactics and should instead use information sources that are independent of pharmaceutical companies." Today drug promotion is a controversial topic amongst doctors and this issue is gaining a higher profile in the general public because of the potential conflict of interest it presents to doctors. Our doctors’ community is a victim of promotional tactics by pharmaceutical companies. They influence some doctors and harm their prescribing capability.
Drug promotion is not unethical. But the way it’s being done today has made it unethical and it has emerged as a life threatening phenomenon for the whole society. World Health Organisation (WHO) describes drug promotion as ‘all informational and persuasive activities by manufacturers and distributors to induce/influence the sale and use of medicinal drugs.’ It has an important bearing on the balanced use of drugs; on drug price-control mechanisms, the manufacture, availability and use of essential drugs, on equity of drug distribution and the cost of health care—all making it a central public health issue.
Most of the time, pharmaceutical manufacturers claim that their newly introduced formulation is superior in respect of therapeutic efficacy to the existing formulation. Sales professionals produce their promotional documents and distribute the free samples along with eye catching visual-aids to target the increase of sales. The health professionals are initiated by such misleading documents and information to prescribe the product without justifying their claims.
The current situation has raised a question mark on the relationship between doctors and pharmaceutical companies. It has ignited an unending debate. Scores of examples galore which suggest that the financial ties between a large section of doctors and the drug companies be completely banned and carve out ways and means to establish so that healthy alliances between the two gets possible with the common aim of improving health of a patient. However it is also a fact that the influence of drug company money on doctors is not always a corrupting one.
We have thousands of pharmaceutical companies in the country producing over 70,000 brands of various drug formulations. Since the private sector represents 80 percent of the health expenditure, a doctor has automatically been an influential prescriber. These drug companies spend around 25 per cent of their annual sale in promoting medicines. If statistics are to be believed each doctor prescribes drugs worth over Rs 50,000 per annum.
Representatives of these drug companies give gifts – brand reminders - to doctors, to keep their brand in the doctor’s memory. These gifts vary from desktop items to minor medical equipment. Even as  these brand reminders from drug companies to doctors is an old aged practice, today the situation has started changing rapidly and brand reminders are increasingly being replaced by gifts of greater value. These range from jewellery to electronic items such as air conditioners, washing machines, microwaves, cameras, televisions, and even automobiles! Pharmaceutical companies even offer larger incentives to consultants and specialists who are considered good prescribers, as verified by chain of chemists.
To ensure that the incentives actually work in generating more prescriptions for a particular brand of a medicine, many drug companies link the incentives with the number of prescriptions generated by the doctor. These companies even fix targets for doctors, with incentives like a cell phone handset for prescribing 500 tablets, an air cooler for prescribing 1500 tablets, a car after 10,000 tablets were prescribed! So the drug companies spend more on medical drug promotion rather than research and development because drug promotion is what earns them huge profits.
This problem of unethical drug promotion is a huge problem threatening the society and not the private practice which is being highlighted as an issue to be banned. Authorities have to counter this unethical drug promotion practices by the doctors.  There is need to subject the relationship between doctors and pharmaceutical companies to intense scrutiny. Relationship between doctors and the drug industry should be with the common aim of improving human health and safe and effective medicines. There should be check and balances on the pharmaceutical company promoting their products in the state.
Why can’t there be treatment guidelines issued by the government for the doctors in terms of prescribing medicines and conducting periodic prescription audits? There is need to frame comprehensive legislation to make all health care professionals accountable to the system and ensure that the drug companies comply with the National criteria for drug promotion as well as WHO Ethical Criteria for Medicinal Drug Promotion.
No doubt, prescribing drugs is an important skill. It not only reflects the physician's knowledge of pharmacology but also his/her skill in diagnosis and attitude towards selecting the most appropriate cost effective treatment. Hence medicines prescribe by physicians should be continuously assessed and refined accordingly.
Here is a word for the drug consumers also. As consumers, they have to be more vigilant about the prevailing market situations, availability and standards of drugs.

(The views are of the author and not that of the institution he works for. Feedback at sajjadbazaz@greaterkashmir.com)

Lastupdate on : Sat, 15 Jan 2011 21:30:00 Makkah time
Lastupdate on : Sat, 15 Jan 2011 18:30:00 GMT
Lastupdate on : Sun, 16 Jan 2011 00:00:00 IST