big pharma

Why there is a problem with pharma companies sponsoring medical conferences in India

Ethics codes forbid individual doctors from accepting gifts from a drug manufacturing company. Surely it is not acceptable for them to do so collectively.

In January alone, at least seven major medical conferences are scheduled to be held in various cities across India, most of them accepting monetary sponsorship from pharmaceutical and medical device manufacturing companies. This practice of Indian medical conferences being sponsored by pharmaceutical companies has prompted questions from activists.

Jan Swasthya Abhyan, a non-profit organisation, has demanded an inquiry into the recently concluded Global Healthcare Summit 2016, held in Udaipur in Rajasthan between December 28 and 30. The NGO has alleged that the organisers of the conference, the American Association of Physicians of Indian Origin, have violated medical ethics and codes of pharmaceutical marketing practices by taking sponsorships from major pharmaceutical companies. The code disallows doctors to accept anything in cash or kind from a drug manufacturing company.

However, Dr Anwar Feroz Siddiqi, the association’s honorary advisor, refuted the allegations. It is a standard practice around the world for pharmaceutical companies to sponsor medical conferences, he contended. “We strictly follow the guidelines,” said Siddiqi. “I don’t think a doctor’s clinical decision is based on who is paying for dinner or lunch.”

The aim of drug and medical device manufacturing companies to sponsor such conferences, according to Siddiqi, is to promote their products by having a booth in the venue. “By sponsoring, the company at most may get an advertisement of their product in the journal” published by the American Association of Physicians of Indian Origin, he explained.

However, Dr Narendra Gupta, the national organiser of Jan Swasthya Abhyan, said that the real concern was the lack of transparency on the nature of sponsorships.

Citing the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation 2002 and Uniform Code of Pharmaceutical Marketing
 Ethics, announced by the Department of Chemicals in 2014, Gupta argued that “both prohibit pharma companies or their associations, representatives to sponsor any travel 

facilities or extend hospitality to health care practitioners and their families under any pretext, even if it’s for attending conferences”. Gupta said he was astonished that the conference was organised in collaboration with the Union Ministry of Health and Family Welfare and Medical Council of India.

Jan Swasthya Abhiyan has demanded that the government bodies disassociate themselves from the conference. Despite repeated attempts, officials did not respond to queries from Scroll.in.

Lavish extravaganzas

Most medical conferences, especially those organised by national associations of doctors, tend to be extravagant affairs. For instance, the organisers of the All Indian Congress of Obstetrics and Gynaecology 2017, which will be held in Gujarat this month, is estimated to cost between Rs 17 crores to Rs 20 crores.

Public health and bioethics expert Dr Anant Bhan pointed out that the success of medical conferences is gauged by the frills associated with them. “This is worrying,” said Bhan, adding that the focus should be on the academic substance and not just on hospitality.

But Dr MC Patel, the organising secretary of All Indian Congress of Obstetrics and Gynaecology 2017, says he finds nothing wrong in accepting sponsorships. “There are two methods of generating revenue for a medical conference – sponsorships and registrations,” said Dr Patel. “If we do away with sponsorships, the registration fees will go up and we won’t have delegates for the conference,” he said. He added that under the current code, an association is allowed to accept sponsorships, unlike individual healthcare professionals.

Screen grab of the All Indian Congress of Obstetrics and Gynaecology 2017 trade brochure.
Screen grab of the All Indian Congress of Obstetrics and Gynaecology 2017 trade brochure.

This, experts said, is a major loophole that allows the relationship between the pharmaceutical industry and doctors to thrive. The nature and extent of sponsorship is evident from the All Indian Congress of Obstetrics and Gynaecology 2017 trade brochure, which states any trade partner can become a platinum sponsor by paying Rs 3 crores. It spells out specific details on the kind of promotion companies can get in exchange for money.

However, Patel insisted that the money received through sponsorships is not used for travel and accommodation of delegates attending the conference. “We have to invite foreign faculty and the money is needed for their hospitality,” he said.

Surprisingly, of the listed trade sponsors for the Healthcare Summit 2016 whose logos are displayed on the official page of the conference, two denied sponsoring the event. The Organisation of Pharmaceutical Producers of India and Unichem, an Indian pharmaceutical company, in an email response to Scroll.in, denied sponsoring the summit. The organisers, on being questioned, claimed their logos were included by the tech team by mistake.

Screen grab of the conference website before the complaint was made.
Screen grab of the conference website before the complaint was made.

Meanwhile, Abbott, Pfizer and Medtronic, also listed as sponsors on the website, are yet to respond to the email sent out by Scroll.in. Pfizer and Unichem’s logos were taken down from the website on January 3. (The story will be updated once they respond).

Sponsorships help the company officials to network with doctors who are going to prescribe their drugs or use their medical equipment, said an official working with an Indian pharmaceutical company said on condition of anonymity. “Competing companies will go to any extent to ensure that doctors who are key influencers will prescribe and use their products,” he added.

The links between pharma companies and doctors are not restricted to India. An infographic created by The Law Firm used recently released data regarding disclosed payments made by the biggest pharmaceutical companies in the US. “In just over a year, these companies spent $3.49 billion in disclosed payments to doctors, hospitals and other companies,” The Law Firm said in a statement.

Source: The Law Firm, US
Source: The Law Firm, US

Hazardous for health

Experts in medical ethics say that the restrictions on pharma companies from sponsoring doctors would also reduce healthcare costs. However, despite the code of ethics in the Indian Medical Council Rules, a 2010 parliamentary committee report pointed out that there “there is no let-up in this evil practice and the pharma companies continue to sponsor foreign trips of many doctors” and continue to shower “high-value gifts like air conditioners, cars, music systems, gold chains etc. to obliging prescribers who then prescribe costlier drugs”.

The clinical decisions of doctors are influenced by the relationships they have with pharma companies, alleged Bhan. “If there are two drugs, equally efficacious, the doctor influenced by a particular company may prescribe their drug instead of another, which might be costlier,” he said.

Many critics have observed that doctors after attending sponsored conferences are likely to write irrational prescriptions. A study published last year on the interactions between doctors and medical representatives noted, “The majority of the doctors said that MR [medical representative] influences their prescribing but at the same time majority of the doctors said that MR exaggerates the benefits of medicines and downplays the risks and contraindications of medicine.”

Many doctors compare medicine with other industries where it common for interested parties to get together at conferences. “If there is a conference on hospitality, industries interested in the sector will participate,” said a doctor from Mumbai. “Similarly, pharmaceutical companies are needed for medical conferences.”

The argument is flawed, said Dr MC Gupta, a doctor turned lawyer who was associated with All India Institute of Medical Sciences in New Delhi in the past. “Unlike other sectors, in medicine, the decision of taking a drug is taken by the doctor and not the patient,” he said. “Hence, we have to ensure that their decision of prescribing a drug is not influenced.”

It is more of a moral and ethical problem, Gupta pointed out, as the current pharmaceutical code is voluntary in nature. “The government has to intervene and make the code binding on the drug industry,” he said. After all, he underlined, the association which is accepting sponsorship is also made of doctors and the “influence is inevitable”.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

When did we start parenting our parents?

As our parents grow older, our ‘adulting’ skills are tested like never before.

From answering every homework question to killing every monster under the bed, from soothing every wound with care to crushing anxiety by just the sound of their voice - parents understandably seemed like invincible, know-it-all superheroes all our childhood. It’s no wonder then that reality hits all of a sudden, the first time a parent falls and suffers a slip disc, or wears a thick pair of spectacles to read a restaurant menu - our parents are growing old, and older. It’s a slow process as our parents turn from superheroes to...human.

And just as slow to evolve are the dynamics of our relationship with them. Once upon a time, a peck on the cheek was a frequent ritual. As were handmade birthday cards every year from the artistically inclined, or declaring parents as ‘My Hero’ in school essays. Every parent-child duo could boast of an affectionate ritual - movie nights, cooking Sundays, reading favourite books together etc. The changed dynamic is indeed the most visible in the way we express our affection.

The affection is now expressed in more mature, more subtle ways - ways that mimics that of our own parents’ a lot. When did we start parenting our parents? Was it the first time we offered to foot the electricity bill, or drove them to the doctor, or dragged them along on a much-needed morning walk? Little did we know those innocent acts were but a start of a gradual role reversal.

In adulthood, children’s affection for their parents takes on a sense of responsibility. It includes everything from teaching them how to use smartphones effectively and contributing to family finances to tracking doctor’s appointments and ensuring medicine compliance. Worry and concern, though evidence of love, tend to largely replace old-fashioned patterns of affection between parents and children as the latter grow up.

It’s something that can be easily rectified, though. Start at the simplest - the old-fashioned peck on the cheek. When was the last time you gave your mom or dad a peck on the cheek like a spontaneous five-year-old - for no reason at all? Young parents can take their own children’s behaviour available as inspiration.

As young parents come to understand the responsibilities associated with caring for their parents, they also come to realise that they wouldn’t want their children to go through the same challenges. Creating a safe and secure environment for your family can help you strike a balance between the loving child in you and the caring, responsible adult that you are. A good life insurance plan can help families deal with unforeseen health crises by providing protection against financial loss. Having assurance of a measure of financial security for family can help ease financial tensions considerably, leaving you to focus on being a caring, affectionate child. Moreover,you can eliminate some of the worry for your children when they grow up – as the video below shows.

Play

To learn more about life insurance plans available for your family, see here.

This article was produced by the Scroll marketing team on behalf of SBI Life and not by the Scroll editorial team.