Doctors prescribe medicines to the patients, but may do so by accepting incentives or bribes from the pharma companies. It is in the interest of the patients to break this nexus. The recent case where a paracetamol preparation was prescribed of a particular company in the treatment of Covid19 has revived this debate. The existing regulations are ineffective when it comes to control this nexus.

There are provisions of the MCI (Professional Conduct Etiquette and Ethics) Regulations, 2016. These discourage accepting commissions from pharma companies. However, very few doctors follow these provisions. Despite the punitive measures recommended ranging from censure to suspension from medical registers for 3 months to a year, there is no effective curb on the nexus.

There are voluntary codes (say Uniform Code of Pharmaceutical Marketing Practice – VCPMP, 2015) which too are ignored.

In the most common and harmless form, it consists of sending practitioners branded stationery, calendars or desk knick-knacks to keep their products on top of the mind in a crowded market. Pharma companies have adopted innovative ways of incentivising — from e-retail vouchers to car loan EMIs. They rope in even medical practitioners from alternative therapies to promote allopathic products. The doctors are paid travel bills to attend medical conferences or given fees to act as investigators on clinical trials or in endorsing key research papers. The MRs of pharma companies have little or no knowledge of the regulatory codes.

Ultimately, the patients bear the cost of treatment. Besides they face risks to life, health and efficacy of therapy. Most health expenditure is from the pocket of the patients, and not from insurance. The collusion of doctors and pharma companies is to be seen in this context.

Regulations do require a re-look to break this nexus. It is to be defined what constitutes considerations in exchange for promoting drugs. You cannot plug all possible cases of considerations but some specific qualifiers can be spelled out to prevent abuse. The whole thing just cannot be voluntary. The Pharma companies must be made accountable for giving inducements to doctors. The Centre has to give the matter a serious thought. Laws cannot act as strong deterrent.