Who will break the pharma-physician nexus in Pakistan?

KARACHI: This summer hundreds of physicians and surgeons visited the Northern areas of Pakistan, some in small groups while many along with their families, stayed at five-star hotels and enjoyed the scenic beauty of the country while several others also embarked on pilgrimage to holy cities of Makkah and Madina to perform Hajj but ironically, all these recreational and religious trips have been financed by different pharmaceutical companies of the country, The News has learnt.

“Several of my friends, consultant cardiologists and gastroenterologists are in the Northern areas alone or with their families; all on the expense of different pharmaceutical companies. I have commitments here in Karachi so a pharmaceutical company has arranged for week-long recreational trip for my spouse and kids at a family resort on newly-constructed Motorway. After seeing my patients in the night, I join my family at the picnic resort”, said Dr. Ahmed (name changed on the request), a consultant physician, while disclosing how pharmaceutical companies bribe health experts in Pakistan.

But these recreational trips within the country and or abroad are not the only favours given by pharmaceutical companies that are used to influence physicians and surgeons as some local and multinational companies even pay cash to some of their favourites, who provide them extra business or their ‘favours’ result in huge financial benefits for these pharma companies, insiders claim.

“Earlier this year, head of a medical institution went abroad along with his family on his own expense. When he returned, he asked the travel agent to generate six invoices of his family trip abroad. These invoices were provided to six different pharmaceutical companies and they all reimbursed him the amount incurred on the trip. Of course, it was pre-decided that he would be compensated for the foreign travel along with his family, and in return, their medicines and supplies would be purchased, irrespective of their quality and standard”, Dr. Irfan, (named changed) who works on a managerial post at the medical institution, disclosed.

And what a patient gets in return for the favours given to a doctor by the pharmaceutical company is a heavily-load prescription where several unnecessary drugs, including a combination of painkillers, antibiotics, multivitamins are suggested which often result in serious health consequences instead of providing any relief. 

“Daily I see patients who come to me with severe adverse effects of the drugs that are unnecessarily prescribed to them by the physicians. This practice is getting insane”, Dr. Ahmed informed.

Authorities say ‘bribes or favours’ given to doctors by the pharmaceutical industry is an open secret and a well-established fact but deplore that due to these illegal practices, poor patients are suffering as they are not only paying huge sums of money for their well-being but instead of getting treatment and cure, irrational use of drugs is resulting in serious health consequences for them.

“In exchange of favours from pharmaceutical companies, doctors over-prescribe drugs to innocent patients and I call it poly-pharmacy where a patient is prescribed unnecessary painkillers, multivitamins and antibiotics where they are not needed. These medicines are poisons and should be given in milligrams as per the specific need of a patient but when they are given irrationally, just to meet the target of pharmaceutical companies, they result in serious health consequences for the patients”, Former Chief Executive Officer (CEO) of Drug Regulatory Authority of Pakistan Dr. Muhammad Aslam said.

In order to curb the illegal and unethical practices in the health sector, Dr. Aslam said, he had managed to prepare a ‘code of ethics’ for both pharmaceutical companies and the physicians where harsh punishments and fines had been proposed to curb unethical practices by the pharma industry and doctors to safeguard the interest of patients.

“In August 2017, we had managed to prepare a code of ethics to regulate the relationship between the pharmaceutical industry and doctors, and in this regard the Pakistan Medical and Dental Council (PMDC) was also involved to take action against doctors who would be found indulged in unethical practices. These unethical practices include acquiring monetary benefits from the pharmaceutical industry,” former DRAP chief recalled.

Dr Aslam said under the proposed code of ethics which was submitted to the national health ministry by him three years back, doctors serving at public and private hospitals would not be contacted by pharmaceutical companies directly for foreign tours; instead, managements of the hospitals would decide to send doctors to international conferences, seminars and trainings.

“We proposed severe penalties and criminal cases against pharmaceutical companies and their managements for bribing doctors, involvement in unethical practices and tax evasion if they are found to be indulged in unethical practices”, Dr. Aslam said and urged the new health minister Dr. Zafar Mirza to get that code of ethics implemented in letter and spirit.

Pharmaceutical industry demands regulations

Demanding action against those who are indulged in ‘bribing doctors by arranging family trips and paying cash’, Pakistan’s pharmaceutical industry representatives deplored that unfortunately there exist on regulations regarding pharma-physician relationships in Pakistan and urged the regulators, DRAP and PMDC to come up with some regulations in consultation with the pharmaceutical industry to end this menace.

“We want regulator to draw a clear line between what is ethical and what is unethical and illegal while introducing our drugs to doctors. We don’t have to reinvent the wheel in this regard. We have rules and regulations of US FDA and European countries and all we need is to implement them in accordance with our needs”, said Zahid Saeed, the Chairman of Pakistan Pharmaceutical Manufacturers Association (PPMA) while talking to The News.

PPMA Chairman said they were in favour of having rules and regulations for the sales, promotions and marketing of the drugs but added that any such rules and regulations must be framed and implemented in consultation with all the stakeholders, including the pharmaceutical industry.