Can the medical profession and the pharmaceutical industry work ethically for better health care?
The Indian pharmaceutical industry is a leading sector of the economy, with drug companies well-represented among the blue chip shares on the stock market. Drugs are also an integral part of medical therapy. However, in my experience as a practising doctor and a health activist, I believe that our most important health concerns are not because of the industry but because of a skewed health policy.
In a developing country such as India, the major disease burden is of infectious diseases. Even with the changing disease pattern the world over, infective and environmental diseases are likely to form 50% of the disease burden. These diseases require primarily non-pharmaceutical solutions such as clean drinking water, a pollution-free environment and adequate nutrition. No amount of vitamins is likely to help the patient. As for the remaining 50%, lifestyle diseases will cost the economy dearly, unless preventive strategies are put in place, but these preventive strategies are primarily non- pharmaceutical. For example, the increasing incidence of diabetes and hypertension cannot be controlled by increasing the production and marketing of insulin. While insulin production is necessary, it must be accompanied by improving health care education and making people aware of proper nutrition. However, we find increasing aggressive marketing of anti-diabetic drugs with little emphasis on preventive strategies.
The influence of the pharmaceutical industry on the medical profession cannot be denied. This influence has increased uncomfortably over the past two decades. Aggressive marketing, which includes offering expensive gifts and foreign junkets, definitely increases the cost of medicines which must be borne by the patient. It also often leads to the unscientific use of expensive, hazardous medicines.
As for the sponsoring of medical conferences by drug companies, it is obvious that the companies recover the money spent on these activities through increased sales of their products. It is true that arranging a conference is a costly business and scientific exchange of information can further the cause of medical therapy. However, it would be worthwhile to do a study to ascertain how many conferences generate really useful scientific debates or information and further the cause of medical therapy.
It is simplistic to blame the medical profession. Recently, it was suggested that the Medical Council of India (MCI) should devise guidelines on the relationship between drug companies and the profession. To involve the MCI in this controversy is not only counter-productive considering its abysmal track record over the past 50 years, it may open new avenues for corruption. This is not a problem between doctors and pharmaceutical companies. Primarily, it is a problem of India’s health care policy. The definition of health, as propagated by the WHO in its Alma Ata Declaration, is holistic. Though the Government of India has accepted and is signatory to the Alma Ata Declaration, little has been done to promote the spirit of primary health care. Some concrete suggestions to ameliorate the situation are:
- Insist on using only the generic names of drugs. Bangladesh did this many years ago and its pharma-ceutical industry accepted it.
- Avoid large conferences, and the consequent dependence on the industry for sponsorship, by increasing the use of electronic media to exchange ideas and information.
- Create a fund by professional associations, with the support of the department of science and technology, to support local conferences.
- Remove the undue emphasis on drugs in our medical educational system.
- Set up strict guidelines for pharmaceutical marketing practices with a watchdog body consisting of consumer representatives.
- Start a debate to change the perspective and direction of health policy.
However, it would be naïve to expect policy-makers to implement these suggestions. In the prevalent environment of globalisation, health care—the right of every consumer—is being seen as a profitable business proposition, and one based on high-technology services. The government is encouraging this perception and the recent setting up of a Medical Tourism Council is symptomatic of the prevalent trend. This is when deaths due to malnutrition, malaria and dengue are being reported even from Mumbai.