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.
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.
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.
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.
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”.