A child with frequent muscle twitching was taken to a hospital. The paediatrician concluded it as a case of worm infestation that can affect brain and prescribed about a dozen medicines. The parents were unconvinced and consulted another doctor who administered a simple drug. It cured the disorder.
The instance could be an example of wrong diagnosis or overdose of medicines being prescribed by certain doctors. It could also be a case of pharmaceutical companies influencing the doctor, a malpractice prevalent among sections of medical practitioners, going by disclosures made by associates in the pharma industry.
“The ‘pay for prescription’ malaise exists in Kerala as in other parts of the country. Huge money is involved in deals by pharma companies and it is one of the prime reasons behind the rise in drug prices,” says G. Madhu, president of Kerala Medical and Sales Representatives Association.
Monopoly pricing and misuse of medicine are largely attributable to the corrupt practices by some of the multinational drug companies, according to him. Pharma giants arrange foreign trips for doctors in the guise of continued medical education and seek favours in return, he says.
“Educating the patient about the pros and cons of the medicine being administered is very important; it is mostly avoided because of the influence exerted by pharmaceutical majors. The patient is virtually unaware of the indications and contra-indications,” says A.N. Mohanan, president of All Kerala Chemists and Druggists Association. India is a huge market and the marketing tactics adopted by big pharmaceutical companies amount to exploitation of vulnerable sections, according to him.
Manufacturers have been allowed to fix the prices of majority of drugs under the existing price regime. There are drug manufacturers who do not own manufacturing units, but make the product elsewhere through a special arrangement with companies that are engaged in executing the job on behalf of pharmaceutical companies.
Many of these manufacturing units are situated in North Indian states such as Himachal Pradesh, Uttarakhand and Manipur where a tax holiday had been allowed for the industry. Gurumajra in Himachal Pradesh has grown as a pharma manufacturing hub and several drug companies operating in Kerala get medicines through such arrangements and market them at a huge profit margin. Doctors’ services are utilised to get the drugs prescribed, he says.
The Drugs Controller, Kerala, P. Hariprasad, says that the malady of companies influencing medical prescription is a social evil. The pricing policy is one of the key issues behind the phenomenon. Less than 80 drugs have been brought under the national pharmaceutical pricing regime. Even in the case of each of them, several combinations are available in the market.
Some of the local companies marketing drugs in Kerala are doing it as Tamil Nadu-based companies, with offices in the neighbouring State, in order to escape scrutiny here. There had been a move to bring more drugs under the national pricing regime, but a market based pricing scheme is adopted in the exercise, he says.
N. Dinesh, president of Indian Medical Association, Kochi, says the ethical committee of the organisation pursues complaints on freebies given by pharma companies. “We will not say there is 100 per cent compliance (by doctors),” he says. The organisation had worked on complaints regarding research in medical institutions, but they could not be substantiated by facts, he says.
