Indian Journal of Pharmacology 2002; 34: 227-228 EDITORIAL

DRUG PROMOTION : CAN SELF-REGULATION WORK?

"All advertising is inherently unethical. That's how you mittee of Medical Journal Editors suggested that edi-
sell things" said a New York attorney. Selling drugs is tors must take full responsibility for what appears in
like selling any other commodity. Pharmaceutical com- their journals. Many journals appointed committees
panies choose to spend more on medical drug pro- to examine advertising material before publication. Yet
motion rather than on research and development this was beyond journals in many developing coun-
because drug promotion is what earns them money. tries who were eager to grab the money that adver-
There have been numerous studies which have in- tising (ethical or unethical) brought in.
controvertibly stated that drug promotion influences
Even though it has been proven time and time again
prescribing practices, a fact that is not acceptable to
that drug advertising in India is unethical, nothing
many doctors. If drug promotion were not so suc-
much is being done to curb it. The annual conferences
cessful, would the companies spend billions market-
of the various national bodies of medical specialities
ing their ware?
are a glaring example of how deep the rot has spread.
The World Health Organization (WHO), in an attempt Today no medical conference is organised without
to support and encourage the improvement of health getting financial support from the pharmaceutical in-
care through the rational use of drugs and to curb dustry. In return for the lavish financial assistance,
unethical marketing practices, came out with a land- companies are allowed to select speakers, choose
mark "Ethical criteria for medicinal drug promotion" the topics for discussion, advertise their brand image
in 1988 and has recommended their implementation and so on, a situation akin to the indoctrination done
to its member countries. This document defines drug in terrorist camps. If this situation is allowed to con-
promotion as "all the information and persuasive ac- tinue we shall have a nation full of doctors who rely
tivities by manufacturers and distributors in order to on the drug companies to dictate what they should
induce the prescription, supply, purchase and/or use prescribe.
of medicinal drugs". It also suggests what can be con-
sidered appropriate hospitality and gifts. There is evi- Unfortunately, though India had a head-start in this
dence that drug utilization problems are increasingly direction with the constitution of the Drug Enquiry
encountered in many developing countries due to the Committee in 1930 under the chairmanship of Sir
unethical marketing practices of the pharmaceutical R.N. Chopra which scrutinized the pamphlets of drugs
industry. Unfortunately the guidelines drawn up by which made spurious claims, we have not made a
the WHO, are flouted in practice with impunity since dent in this direction. The Drugs and Magic Remedies
there are no effective legislative measures to sup- Act which came into force in 1955 and was amended
port them. in 1961, 1967 and in 1992 have not been enforced
due to the apathy and general disinterest of the health
The International Federation of Pharmaceutical care fraternity and the industry refuses to be cowed
Manufacturer's Association which had first suggested down by legislative enforcements. Hamdard
a self regulatory code of pharmaceutical marketing Dawakhana was asked to recall 40 drugs. But they
practices in 1981, adopted the revised version in 1994. chose to file a writ in Supreme Court in 1959 on the
There seems to be obvious double standards in adop- grounds that their right to free speech and right to
tion of the code. While in the developed countries, carry on trade and business were violated. The
these firms often publish reasonably ethical adver- Supreme Court however, dismissed the petition. The
tisements which are published in medical journals, drug industry fast learnt to take advantage of the loop-
the very same companies promote the same drug holes in the law and continued with unethical market-
for different indications in developing countries. The ing practices. The problem became so serious that
information is also insufficient, sometimes contains S. Narayen, Commissioner, FDA Maharashtra, in the
unproven scientific claims and is published by many foreword to a book on the Drugs and Magic
medical journals from these countries. In an attempt Remedies act by S.W.Deshpande in 1994, admitted
to get a grip on the situation the International Com- that 'economic liberalization seems to give the
228 EDITORIAL

impression that manufacturers have the right to sell which is followed worldwide. Interns are now being
and the market place is what must decide the rules taught to "take control" of these interviews and use
of the game. In the dizzy of activity, various ploys are them to get reliable information. Videos have been
used to sell the product. Some of these not only mis- made with the assistance of the WHO and are being
lead the consumer but can also be harmful'. used to train interns on some aspects of dealing with
medical representatives. It is too early to judge what
The internet is perhaps one of the greatest boons to impact these interventions will have, but it must be
the medical establishment. Doctors are able to check kept in mind that tiny drops of water make a mighty
the validity of information given to them by drug com- ocean.
panies and therefore it is now being reported that drug
companies are hesitant to tell outright lies as before. These efforts, though isolated and small at present,
But the industry relies on the fact that doctors are will nevertheless reach a critical mass which shall be
busy people who would not find the time to counter self propagating one day. It is hoped that in future we
check information they have received. The ever inno- shall have a new generation of doctors who demand
vative marketing executives have come up with yet that all drug promotion be ethical. Unless this demand
another brilliant ace in the form of direct-to-consumer comes from the medical establishment who refuse to
(DTC) advertising. This is the advertising of branded take lavish gifts, eat lunches and dinners sponsored
drugs through popular media. In India we are already by drug companies, and attend CME programmes
exposed to television advertisements for inhalers in paid for by the companies we can never expect drug
bronchial asthma, insulin for diabetes mellitus. This companies to self regulate.
is a scaled down, modified version of DTC advertis-
ing. If DTC is approved, then drug companies will dic-
tate what doctors prescribe through their patients.
A small silver lining is perhaps the efforts of a few
VIJAY THAWANI
medical colleges where undergraduate students and
interns are taught to critically analyze drug promo-
tional material and are sensitized to the "tricks of the Department of Pharmacology,
trade" of the pharmaceutical companies. The "one Shri Vasantrao Naik Govt. Medical College,
on one" interview with the medical representative is Yavatmal-445001.
perhaps the most powerful tool of drug promotion e-mail: thawani@nagpur.dot.net.in

REGIONAL RESEARCH LABORATORY, JAMMU

l Applications are invited for Dr. I.C. CHOPRA MEMORIAL AWARD for the year 2002
(Cash award of Rs. 10,000 along with a medal and citation).
l Indian nationals with proven contributions in the field of Drug Development & General/
Biochemical Pharmacology are eligible to apply.
l Application form and other terms and conditions for the award are available from: Director,
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l Last date for receiving the filled in applications in all respects is September 15, 2002.