Chronicle Pharmabiz Special
Doctors and pharmaceutical industry
Dr B G D Bujawansa
Discussing the relationship of doctors with the pharmaceutical industry is currently a global phenomenon. The pharmaceutical industry produces an intimately connected item in the practice of medicine, namely the drugs. On the other hand the pharmaceutical industrialist has an obstacle between him and his customer, namely the doctor. He bypasses the doctor with the drugs that can be dispensed without the prescription, known as over the counter products (OTC products) in pharmaceutical jargon.
As far as the drugs that need prescriptions for dispensing or perspiration only medicines (POM) the doctors prescriptions are important. It is natural for the industrialist to try to influence the doctor in these circumstances. As far as influencing the doctor takes place at the ethically acceptable level no problem will exist Dr. Sarath Gamini Silva, a much respected senior consultant physician attached to National Hospital of Sri Lanka, in his article "Doctors and Pharmaceutical Industry: A Conflict of Interest" published in 2001 dealt with many aspects of the Sri Lankan scenario of this relationship.
In Sri Lanka the State does little or nothing towards updating the professional knowledge of the doctors. We have about twenty Medical Associations and Colleges in Sri Lanka. They keep on updating the professional knowledge of their members quite actively. The doctors organising themselves in this manner is praiseworthy. However all these activities are sponsored by the pharmaceutical industry. This explains the silence of Medical Associations and Colleges about any malpractices in the pharmaceutical industry.
The Government Medical Officers Association (GMOA) is the most powerful out of these. Once it went on strike when the director of the Drug Regulatory Authority (DRA) was sent on transfer. The transfer was cancelled. They are silent about the current questionable omissions or commissions of the DRA which contributes to chaos in the pharmaceutical market putting the pharmaceutical industry in an advantageous position. When I was the President of the Independent Medical Practitioners' Association, I exposed alleged corrupt practices of drug firms despite their sponsoring events for the Association. My action was subject to criticism by at least a few members of the medical profession. This minority was however very aggressive in showing their displeasure. They used the same armoury used in cheap party politics of Sri Lanka like anonymous letters, anonymous faxes and creating splits in the Association.
All major events in Medical Associations and Colleges are sponsored by the pharmaceutical industry. The pharmaceutical companies try to outdo each other when sponsoring these events. As a result some events are held in five star hotels with cocktails served after the event followed by a sumptuous dinner. Sometimes free gifts are doled out at the meetings. The non-medical spouses who have nothing to do with the academic activity too are invited. The century old Sri Lanka Medical Library too is currently run by a multinational drug company. The passage leading to the library is decorated with advertisements from this company. This company took over the management of the library when it was on the verge of being closed due to financial problems.
All drugs for health camps conducted by some doctors are provided by the pharmaceutical industry. Most of medical research projects are funded by drug firms. Under the circumstances some doctors justify their "under obligation" feeling towards the pharmaceutical industry. This feeling is not towards the best interest of the patients. Some committees of medical associations having influence in taking decisions at National level, is sometimes influenced by drug firms. Even employees of some firms are in these committees.
Communicable Diseases Committee of one medical association has an employee of a drug firm, dealing with vaccines! A publication of this committee meant for the medical profession was printed by the drug firm. The launch of the booklet took place in a five star hotel. The publication has the potential of influencing vaccine prescribing, pattern of the doctors. The drug firm is the sole importer of some of the vaccines mentioned in the booklet. This is an example to show to what extent the pharmaceutical industry was infiltrated professional activities of the medical profession. I do not time the drug firm concerned. It is simply wisely exploiting the situation to promote their products.The pharmaceutical industry sometimes offers very personal favours to doctors. When a doctor is inducted as the president of an association or a college or delivers an oration it is traditional for him to host the gathering at a reception. This is very frequently sponsored by a drug firm. Thus the drug firm gets a powerful medical personality with high lobbying power into their favour. Many pharmaceutical companies offer gifts of liquor to doctors and deliver Christmas hampers to them. I have to confess that Christmas hampers have been delivered to my address too. At least one pharmaceutical company exists which provide tyres for vehicles, provide toilet suites, do up floors of houses with tiles or granite and, sponsor weddings of offspring of doctors. Majority of doctors do not accept any personal favour from drug firms. Many drug firms do not offer unethical gifts or favours even when demanded by doctors. It is nothing but fair to keep public informed about what goes on between doctors and pharmaceutical industry. My candid articulation on the subject should not be regarded as " washing dirty linen in public". Valid criticism by public should be seriously considered by both medical profession and pharmaceutical industry. This will lead to a process of self improvement beneficial to the medical profession, pharmaceutical industry and to the public.
(Source: Midweek Review)