Doctors AND corruption?

By Kumudini Hettiarachchi and Tahnee Hopman, Pic by M.A. Pushpa Kumara

The allegations are not only numerous but also very serious. The common charge is that pharmaceutical or drug companies are influencing -- in harsher terms resorting to bribery and corruption to get -- practising doctors to prescribe “certain” brands of drugs whatever the illness of the patient.

Samples of drugs not just a few but boxfuls, souvenirs and prescription pads are handed out, charged a spokesman for the People’s Movement for the Rights of Patients (PMRP), who declined to be identified.

Going from souvenirs to more serious issues, the spokesman alleged that the annual convention of the Sri Lanka Medical Association (SLMA) held in March at a five-star hotel at a cost of several millions of rupees was funded by two pharmaceutical companies.

“There have been allegations that scholarships are given to doctors and family members. In addition to this, doctors are said to be given all-expenses-paid pleasure trips and cruises. There had been one to Goa in January,” said the spokesman.

When asked why the PMRP did not investigate such serious allegations, the spokesman said it did not have the resources to do so. The 10-year-old PMRP which says it is fighting for patients’ rights has a 25-member National Committee and a few hundred other members, The Sunday Times learns. It also has seven patrons including many retired medical academics.

Explaining that the theme of International World Consumer Day held worldwide recently was ‘Unethical promotion of medicinal drugs’, the spokesman said the corruption issue in the health sector has come under debate the world over.

“Among the Fortune 500 companies, five are top pharmaceutical companies. It has been said that in 2006, US$ 50 billion was spent on drug promotion alone. There is little regulation or monitoring of activities,” he said.

These are the very allegations that The Sunday Times checked out, interviewing face-to-face, on-the-phone and on email, the different players in the health sector – pharmaceutical companies and some of the main colleges of the different specialities in the medical field.

Conceding that these are issues the pharmaceutical industry is mindful of, which need remedying, the President of the Sri Lanka Chamber of Pharmaceutical Industry (SLCPI), Adrian Basnayake, says this is the very reason why they have formulated a Code of Pharmaceutical Marketing Practices for member-companies. “I cannot deny the fact that the industry has its faults, but then, corruption is deep rooted in every aspect of society here. But this industry is one of the most regulated industries in operation.”

The self-regulatory SLCPI which has a membership of around 60 pharmaceutical companies is the successor of the Pharmaceutical Traders’ Association, set up back in 1961. Of around 200 pharmaceutical companies in the country, about 100 handle 80% of the market, it is learnt.

The old Code which came about 10 years ago dealt more with promotional claims (such as this drug is “better”, acts “faster” or is “safer”) but the new one brought in last month deals more with corruption and issues such as sponsorships, The Sunday Times learns.

What of pharmaceutical companies hosting sessions for healthcare professionals?

The particular event, as specified in the Code, will have to be held at a suitable venue, one that is not too extravagant, according to Mr. Basnayake. “It is completely unacceptable to host a three-day stay at a luxurious hotel for doctors if the actual programme lasts only a few hours,” says Mr. Basnayake citing the example of a medical session or any such event being held at a golf resort being taboo. “Spouses and family members of participating doctors cannot and should not be sponsored by the pharmaceutical company. For personal tokens or gifts to doctors by pharmaceutical companies, the accepted upper monetary limit worldwide is US$5.”

And if there is a breach of the Code? “We’ll name and shame them,” he says, adding that any such conduct will result in severe disciplinary action. “The companies will be blacklisted.” Countering charges that drug companies spend more on marketing their new products than on research on new drugs, the SLCPI President is adamant that there is no evidence to prove this. Whereas a substantial amount of money is spent on marketing, this amount does not exceed investments on research. “Promotion is an expensive process because the best, most effective drug is of no use whatsoever if a physician is unaware of its presence in the market.”

Explaining that 97% percent of research in this particular field is carried out by private pharmaceutical companies, he queried as to who has produced new anti-hypertensive, cancer, malaria drugs and vaccines. Marketing, however, is also essential because if not for marketing, doctors would not know of the latest and best drugs to use.

Adrian Basnayake

Going back in time, Mr. Basnayake says that some of the world’s major pharmaceutical companies have been in Sri Lanka since the 1950s. The pharmaceutical explosion in India (1970-1980) took place long after that.

Why is it that Sri Lanka which has reached world standards in garments, tea etc, has not been able to do so in pharmaceuticals, he asks and answers: Because there is strong anti-pharma sentiment whipped up by certain interested groups. Otherwise, Sri Lanka could have been a drug manufacturing country and internal prices would have been much lower.

“Park-Davis and Pfizer which are pharmaceutical companies which used to manufacture in Sri Lanka, sold up in the 1980’s because of this. Interested groups influence different governments from time to time to put the industry down,” he says. “We are now known for having an aggressive and vicious anti-pharma lobby.”

Pointing a finger at the People’s Movement for the Rights of Patients (PMRP), Mr. Basnayake is of the opinion that it frequently makes unsubstantiated allegations about corruption in the industry.

“But no one has made a complaint to us about corruption, with some kind of evidence,” he says, adding that the PMRP consists mainly of doctors and represents only a “small subset” of patients.

The Chamber has a disciplinary committee which, if a formal complaint is received, will investigate, The Sunday Times understands.

From the viewpoint of those all important-people, the patients, not only should there be no unethical influencing of doctors by the pharmaceutical companies but it should also appear to be so.

Transparency and good governance within the health sector are the keys.

A question of ethics

How can doctor-colleges find funding for their activities? Is it ethical to get their sessions funded by drug companies? The link between doctors and drug companies is inextricable as the world needs pharmaceuticals.

Explaining that all organizations in the health sector such as international agencies and those working for the good of the masses cannot fund themselves but have to depend on sponsors to meet the costs of services provided to the public, many respected doctors were of the view that all parties concerned should, however, know the boundaries of give and take.

Most doctor-colleges do not have a way of generating their own money. The service to the people by the doctors is not limited to treating them but also expanding the doctors’ knowledge and learning the latest developments in the health field, The Sunday Times understands.

“As long as sessions etc are sponsored by the drug companies officially, through the colleges and everything is above board and there are perimeters such as only company names being displayed but individual products not being advertised, there is no problem,” said a senior doctor, whose view was echoed by many others.

Meanwhile, with regard to sponsorships of individual doctors to attend sessions abroad, amidst allegations and counter-allegations, a simple way to overcome criticism of undue influence will be for pharma companies to regularize their systems and do so officially through the different colleges of doctors. The colleges could then make selections on merit and merit alone.

Role of pharmaceutical companies in health sector

This is what a cross-section of the pharmaceutical companies had to say:

Q: Over the past year, has your company sponsored any medical sessions, congresses or workshops?

GlaxoSmithKline (GSK): Yes, we have. Medical knowledge continues to expand rapidly with the development of new medicines and systems of treatment. It is important that the medical profession in Sri Lanka is regularly updated on these developments. As an innovator company with wide pharmaceutical expertise around the world, GSK plays an important role in providing continuing medical education through medical associations in Sri Lanka.

Astron Limited: Yes, we do, on a regular basis, as they pertain to awareness and education.

A. Baur & Co: Yes, we sponsor any medical educational event and our sponsorships are strictly within the Code set by the SLCPI.

Harcourts Pvt Ltd: Yes, we do and there is no corruption involved. We fund such sessions because colleges do not have adequate funding. Everything is done officially, through the colleges and not through individual doctors.

Hemas Pharmaceuticals Pvt. Ltd: Our involvement has only been in a small way, we do not target specific doctors; rather any funding is done through the colleges.

Akbar Brothers: We haven’t sponsored events.

Q: Does your company sponsor doctors to attend congresses or workshops abroad?

GSK: Yes, because it is part of medical education.
Astron: No.

Baurs: Yes, all to attend medical educational congresses.

Harcourts: We do, once again as part of supporting medical education.

Hemas: As a company which is just an importer and distributor for many principals,we do not sponsor any individual doctor.
Akbar Brothers: No.

Q: How many spouses or family members have your company sponsored, to accompany these doctors being sent abroad for workshops etc?

GSK: We do not sponsor spouses. It is not permitted by the GSK Promotion and Marketing Code.

If a spouse comes along with a doctor who is sponsored, the doctor pays all expenses of his/her spouse. In fact we do not invite spouses for meetings organized by us. As spouses are normally invited for inauguration sessions and dinners of medical associations we do not sponsor inaugurations and dinners.

Astron: No, never.

Baurs: No, none.

Harcourts: We don’t sponsor spouses or family members, on principle. We also have no budget for that. We’re 100% ethical.

Hemas: We do not sponsor spouses or family members. We are an ethical company.

Akbar Brothers: We don’t.

Q: Does your company sponsor any form of medical research?

GSK: Yes we do. We have sponsored the annual Sri Lanka Medical Association-Glaxo Wellcome Award, to undertake medical research in Sri Lanka. The SLMA calls for applications and selects an awardee annually. We have also sponsored an International Study on Allergy and Asthma in Children (ISAAC) in Sri Lanka.

Astron: We do our own research in our lab.

Baurs: We don’t engage in medical research.

We don’t think that even our principals have done so in recent times.