The convergence of healthcare and commerce in India presents a profound ethical conundrum. As a dedicated advocate for ethical practices within our healthcare system, it becomes imperative to scrutinize the intricate relationship between Indian pharmaceutical companies and medical professionals. This collaboration, ostensibly aimed at advancing medical progress, often raises pertinent questions when financial incentives unduly sway medical decisions, potentially impacting the quality of patient care.
The visible extent of medical corruption in India remains palpable, echoing through conferences at luxurious destinations, scientific discussions overshadowed by extended family holidays, and lavish gifts exchanged. There's a disconcerting trend of escalating commission rates for doctors, soaring from 20% to an alarming 40%, often camouflaged through indirect channels like deposits into relatives' accounts. While not every doctor or pharmaceutical entity indulges in such practices, the undeniable reality persists: a significant number do resort to unethical means.
Even the Hon’ble Supreme Court expressed concern over excessive spending on promoting Dolo 650, a paracetamol brand that gained immense popularity during the pandemic. This intricate web of ties between pharmaceutical companies and doctors demands critical scrutiny, revealing practices that impact medical ethics and patient care.
Healthcare providers stand as pivotal architects of patient well-being. However, the ethical boundaries in our engagement with pharmaceutical companies sometimes become hazy. Inducements like speaking fees or sponsored trips might inadvertently influence prescription practices, raising concerns about the ethical compass guiding medical decisions.
Impact on Patient Care and Accessibility
The implications transcend individual treatment paths, extending to broader healthcare accessibility. A concerning trend emerges where the prioritization of costly medications over affordable alternatives jeopardizes access to essential healthcare. The escalating costs compel numerous patients in India to compromise on medications, aggravating prevailing health inequities.
More Indians are dying due to poor-quality healthcare than from the lack of access to healthcare services. A report, published in The Lancet, reveals that approximately 16 Lakh deaths in India in 2016 were attributed to inadequate care quality, surpassing the 8,38,000 deaths caused by the non-utilization of healthcare services. Other than that the percentage of preventable deaths in India due to poor-quality care turns out to be 81% cardiovascular, 61% neonatal, and 50% maternal deaths, among others.
The intertwining of pharmaceutical companies and doctors often results in prescribing costly medications, putting immense strain on those already struggling financially. This scenario widens the gap in healthcare accessibility, rendering these expensive treatments unattainable for the economically disadvantaged. The impact is significant, with families grappling to meet healthcare costs.
In the fiscal year 2018, the average Indian household allotted INR 3,632 towards healthcare-related expenses. This figure experienced a slight uptick, reaching INR 3,638 by FY 2022. However, the journey across these fiscal years depicted varied trends in healthcare spending.
Between FY 2018 and FY 2019, households witnessed a substantial 23.3% surge in health-related expenditures. This was succeeded by a marginal downturn of 0.5% in the subsequent year. Yet, the arrival of the COVID-19 pandemic in FY 2021 marked a notable decline, with reported healthcare spending plunging by 29.8%. This decline reflected the tremendous financial strain inflicted by the pandemic on households.
Despite the hardships, there was a subsequent rebound observed in FY 2022, with reported healthcare spending increasing by 16.3%. This fluctuating pattern echoes the economic challenges faced by households, particularly in meeting healthcare expenses, exacerbated by the unforeseen circumstances sparked by the pandemic.
Regulatory Framework and Ethical Standards
Ongoing efforts aim to address these ethical concerns. Inquiries conducted through the Right to Information Act offer glimpses into the extent of financial interactions between pharmaceutical companies and healthcare providers. However, certain aspects might fall beyond the purview of specific bodies, constraining the available information.
Recent inquiries through an RTI sought to unveil the quantum of financial allocations made by pharmaceutical companies for gifts or trips for doctors in India. Responses highlighted jurisdictional limitations, redirecting attention to the stringent guidelines outlined by the Indian Medical Council. These guidelines explicitly prohibit gifts or travel grants from pharmaceutical companies, underscoring the necessity for transparent disclosures to uphold ethical integrity.
In recent years, the dynamics between medical representatives and doctors have shifted dramatically. The pressure on these representatives to meet soaring targets has escalated to the point where failure to achieve them often results in termination. This intense pressure trickles down to the field, with area managers intermittently moving across districts, extending offers to doctors in a bid to meet these demanding goals. It has been observed; that what once involved one representative per company has morphed into one representative for each product.
The marketing tactics have become notably aggressive, with companies hosting brief conferences followed by elaborate family-oriented tours. Initially designed to update medical professionals on drug developments and treatments, these meetings have become a battleground for sales pitches rather than informative exchanges. While these encounters were meant to facilitate affordable treatment options, critics argue that the information disseminated during these conferences remains biased, favouring the pharmaceutical companies' agendas over a comprehensive educational dialogue for doctors.
Redefining Collaborations for Progressive Healthcare
The scrutiny of the relationship between the pharmaceutical industry and healthcare professionals within India's healthcare landscape is paramount. Upholding patient welfare, advocating transparent practices, and unwavering adherence to regulations is pivotal in fostering an ethical healthcare ecosystem tailored for India's diverse populace.
Transparency remains the cornerstone. Openly disclosing financial interactions fortifies patient trust. Educational initiatives targeting medical practitioners and pharma professionals play a critical role in promoting ethical decision-making, emphasizing evidence-based practices and prioritizing patient welfare.
Collaboration between Indian pharmaceutical industries and healthcare professionals stands as a cornerstone for the progress of medical advancements. Yet, the essence of the medical profession's integrity within India's healthcare tapestry lies in prioritizing patient welfare over commercial motives. This intricate association prompts an ongoing ethical assessment, emphasizing the significance of transparency, robust regulatory structures, and an unwavering commitment to ensuring patient well-being. Upholding these principles becomes imperative in safeguarding the ethical fabric of medical practice amidst India's evolving healthcare sphere.
(All views and opinions expressed in the article are the author's own)
