Monday, March 31, 2008

Drug promotion in India: disconnecting medicine from health by means of money

Doctors can be a vulnerable population too. And when they are vulnerable, it might be their patients that ultimately pay the price, literally and figuratively. That seems to be one of the morals to be drawn from a recent article in Business Week about pharmaceutical companies providing offering industrial strength incentives to physicians in India. If a doctor is not that well-off him- or herself, how could he or she not let his or her clinical judgments be influenced by goodies such as jewelry, electronic goods, cars, or free trips (spouse included) to international conferences? As reported by the Indian Journal of Medical Ethics awhile back, probably the most vulgar example of drug promotion is the use of 'rate cards' for Indian doctors in small towns and cities: a doctor can get a cell phone for prescribing 1,000 tablets per month of a particular medication; 5,000 tablets gets the doctor an air-conditioner, while dispensing 10,000 tabs can score the physician a motorcycle.

While cruising around town on the motorcycle, the physician may (or may not) wonder how many of patients actually needed the medications he or she prescribed, and what the public health or environmental effects are of the unfettered dispensation of pharmaceutical drugs. But the blame should really go upward; it is not a simple matter of doctors with character flaws. Governmental bodies ought to be reining in the excesses of big pharma in India. But then again, multinational companies like Novartis seem to have more clout than the local regulatory agencies. India is increasingly looking like a biomedical wild west: it's not just the organ trade, or the medical tourism, or the production of fake medicines, but now the increasing disconnection between medical practices and health -- fueled by the quest for profits.


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