- Introduction – mention the current context.
- Mention the scenario fuelling unfair market practices.
- Discuss implications.
At the peak of the Coronavirus pandemic, Dolo-650 mg tablets became a prominent drug. The manufacturer, Micro Labs, saw its profits soar. In early 2022, the company came under income tax scanner for evasion of tax. Later on, Federation of Medical & Sales Representatives Association of India (FMRAI) accused the manufacturer of distributing freebies worth INR 1000 crores to doctors to prescribe Dolo-650 mg. The sales of Dolo-650 went up by 289.6% during the same period. The incident has brought into attention the use of unfair marketing practices by Pharma companies to lure the doctors to prescribe their drugs.
- In healthcare, the decision of the patients is driven solely on the recommendation of the doctor. There’s a huge information asymmetry between the doctor and patient. This unequal situation gets exploited.
- To address this asymmetric relationship and promote ethical behaviour by Pharma companies, the Uniform Code of Pharmaceutical Marketing Practices (UCPMP) has been drafted the Government. It is a guidance for pharma companies on do’s and don’ts while marketing products. However, it is a voluntary code. Despite requests by multiple lobbies and NGOs, the Government has not made the UCPMP mandatory.
- Critics argue that Pharma Companies lobby with the Department of Pharmaceuticals to keep the Code as voluntary.
- Pharma companies need to inform and update doctors about their products. But there is a thin dividing line between legitimate promotional activities and illegitimate incentivisation.
Implications: Unethical drug promotion can adversely influence doctors’ prescription attitudes and harm human health by over-use/over-prescription of drugs, prescription of higher doses, or for longer period, and prescription of an irrational combination of drugs.
For instance, during COVID-19, many doctors prescribed dolo-650 instead of the usual 500 mg tablet. Taking 2-3 dolo-650 a day for the period of the fever would not necessarily cause harm. But excessive use of paracetamol is linked to severe liver damage. Dolo-650 is contraindicated for those who have liver disease, kidney disease and suffer from chronic alcoholism.
Apart from health concerns, this causes a severe financial stress for patients, as doctors would be inclined to prescribe a branded drug rather than the cheaper generic version. Also, it is against the spirit of competition and can jeopardize the survival of small pharma companies which lack in financial resources in comparison to the big players.
It induces doctors to work in the interests of the company and not of the patient, eroding patient’s trust on doctors and the entire medical system.
The matter is sub judice and it may be too early to say if Micro Labs indulged in unfair marketing practices. However, it is an issue that can no longer be ignored. The Government should consult all stakeholders, National Medical Commission, FMRAI, Doctors Associations and Pharma Companies etc. to establish a comprehensive framework to check such unethical practices.