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A PIL in the Supreme Court last week by the Federation of Medical and Sales Representatives Association of India has again put the doctor-pharmaceutical firm relationship under scrutiny. FMRAI alleges gifts were the catalyst for the high incidence of prescription of Dolo 650, an analgesic, when Covid was raging. The hearing will resume next month. The broader issue, however, embodies a universal regulatory challenge. Two unique features of healthcare account for it. Demand for it is often urgent and there’s a huge information asymmetry between doctor and patient. It puts doctors in a commanding position. Patients who need quick advice and know little about medicine are perfect patsies for prescriptions influenced by pharma companies’ inducements. The opioid crisis in the US was a particularly shocking demonstration of this. Pain-management pills were prescribed by doctors across the US, their addictive and harmful after-effects hidden or ignored. It took years for the crisis to be officially acknowledged. Litigation and finally bankruptcy filings by drug manufacturers followed. But it’s an open question whether the regulatory failure was addressed fully.
In the US, as in India, there’s no shortage of rules. For pharma firms there’s a voluntary code on marketing practices, in place since January 2015. The Indian Medical Council regulates the conduct of doctors through powers flowing from statutory legislation. But both these regulations are bound to be toothless because misconduct is expected to be addressed within the fraternity. Costs of such a system can be very high in India, where out-of-pocket medical expenditure is 55% of citizens’ total spend, as compared to the global average of 18%. Plus, plugging medicines marketed by companies that are making doctors happy can lead to over-prescription, with potentially serious consequences.
The answer is not heavy-handed regulation. GoI should aim to neutralise doctor-pharma “deals” by effectively using its existing programme of bulk purchases and sales of generic drugs – Pharma Inc pushes branded drugs. Bulk buying provides a price discount of 50-90% over branded medicines. However, it’s not very effective because GoI distribution is limited. The smartest solution is to use the existing network of private chemists. Certainly for commonly prescribed drugs, such as analgesics, awareness and availability of generics can substantially reduce the scope of shady persuasion of doctors. A doctor’s diagnosis and her prescription can’t be undermined. But the misuse of this authority can be minimised.
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This piece appeared as an editorial opinion in the print edition of The Times of India.
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