Q: What is the connection between a doctor and a pharmaceutical company?
A: Pens, paper-stands, satchels....Pug puppies(!)
Check out the prescription your family doctor gave when you visited him last. Chances are it was on gifted stationary branded by a large pharmaceutical company. “That is how it always starts. In fact, every medical representative’s first weapon of choice is gifting a pen,” smiles Sekar Aloysius*, who started out as a rep, a decade ago.
It’s the unholy union that is an open secret in the West, but has managed to skim below the radar in India, without too many people raising a hue and cry over it. However, with whistleblowers beginning to cry foul over the purportedly large sums of money and consumer goods that are changing hands between medical representatives of pharma majors and doctors, the Union health ministry has begun to open its eyes and ears to the problem. While a governing policy on pharma marketing practices is “still in the works”, according to Union Health Minister Ghulam Nabi Azad, several doctors are still reaping the ‘regular’ perks that they have received from pharma companies.
The stories about the various bribes and favours that doctors and specialists have taken, usually do the rounds, when drinks are served at medical conventions. “I know this psychiatrist in Besant Nagar, who asked for a gift that really stunned the marketing manager of a pharma company,” discloses Dr Ramanujam*, an orthopaedician.
Apparently, after years of taking monetary kickbacks for prescribing the company’s drugs, he asked the rep to procure three pug puppies for his daughter. “The pharma guy didn’t know whether it was an April Fool’s Day joke. He came and asked me where to get pugs, and I guided him,” he adds. Subsequently, the much-respected psychiatrist complained that they were bought without ‘pedigree’ papers and threatened to switch companies, till the required papers were rushed to him.
Talking about cash bribes, it’s not quite the under-the-table wad of notes image that usually comes to mind. The network is much more subtle, reveals Aloysius. “The request is usually made through the assistant who directs us to the preferred pharmacy. At the pharmacy, we supply our company’s drugs and mark it with the clinic’s name. Based on the monthly ‘sales performance’, 10-20 per cent of the money is given as a donation.”
This margin goes up multifold if the doctor prescribes drugs beyond “expectations”, he adds.
The better known the doctor’s expertise is, the better the pill-pushing power is, believe major pharma companies. A majority of high-profile doctors are sometimes seen chairing discussions and public discussions on disease control and the drugs that can ‘save’ people — coincidentally, the programmes in fancy hotels are almost always paid for by the pharma companies making the drugs.
“Naturally, these events make it seem like a big specialist is endorsing a certain drug, so the companies are only too happy to oblige,” says Dr Ramanujam.
What has emerged as the second highest form of bribery is the sponsoring of doctors to attend international symposiums, Continuing Medical Education (CME) programmes and workshops. When in the late 80s medical practitioners like Dr Kurien*, a cardiologist from Vellore, accepted sponsorship from a large pharma company, to attend a CME programme in the UK, he did feel a twinge of guilt. “I knew that they expected me to prescribe their drugs after they sponsored that super-expensive trip. I can say this in my defence: not only was it impossible to afford such a trip then on my salary, all the knowledge gained has allowed me to save hundreds of lives,” he claims. He also adds that the well-known heart pill, was and still is a market leader, thus washing away his guilt to a good extent.
“This is justified to a certain extent,” says a senior doctor connected to the Medical Council of India MCI). “You see, no doctor who is honest, would have been able to afford the cost of international programmes in that day and age. So he is justified to an extent.”
On the flip side though, plenty of physicians accept these ‘refresher course’ offers to locales like Bali, Singapore, Ireland, Kenya, China and even France without much ado. “Most often they take seven-day tours with their family and don’t bother attending even a single session of the course. Honestly, the reps don’t mind because they have solid bargaining power once they photograph the doctors having fun with their kin, at their expense,” says Dr Michael*, a senior government doctor from North Chennai. What riles him the most is the fact that the doctors don’t learn anything after taking these ‘expensive refresher courses’.
“What you are offered is directly related to what the medical rep or company thinks you are worth to him,” says a seasoned surgeon, who has been running a private hospital and practicing in the State for two decades. “People think that specialists and extremely skilled doctors take the biggest bribes, but you’d be surprised at how much a common GP in Tondiarpet asks for these days,” he adds.
Ironically, even today, in places like Gummidipoondi, Tiruvallur and some suburbs, doctors with small practices choose ‘appliances’ over hard cash. The surgeon adds, “There is a fear that taking money and pushing drugs will land them in trouble and finish their careers, if a villager dies.” So, preferred on the list is ceiling fans, air-conditioners, water coolers, cushioned chairs and sometimes even medical equipment. “They justify it by saying that these are items that are received for the benefit of the patients who wait to get treated,” says Aloysius. “But I have never once seen any of those doctors install an air-conditioner in their waiting rooms,” he smirks.
So what is the MCI, the government’s unofficial watchdog doing about this? “We admit that corruption in the medical profession is a reality,” says Dr H S Rissam, senior cardiologist and Member of the Board of Governors of MCI. “But rest assured, it is only a miniscule minority of doctors who are taking bribes. The majority of them are good, ethical and god-fearing people who still wish to do serve the community.”
Rissam, who authored the bestselling medical thriller, The Scalpel, which spoke about this bribery nexus among other things, adds that the MCI are “Cognizant” of the issue and “has people who are committed to eradicating unethical practices.”
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