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Let us deal with the question of Ethics first, before we go further.
The dictionary definition of Unethical says:
- Lacking moral principles, not adhering to proper rules of conduct
- Not in accordance with the standards of a profession
Business definition in my view should be:
- Getting undue advantage over competitors through misuse of resources
- Disrupting the rules of level playing field for all
I believe we are unnecessarily stuck with a set of activities referred to as Unethical, while we accept some others as ethically acceptable. Some cases in point.
Pfizer faced a court case in USA over allegation that they fabricated research papers in connivance with some consultants and got them published also. The product was Neurontin (gabapentin) and intent was to show clinical benefit where it was not. The court found Pfizer guilty and Pfizer paid 325million US$ to settle the suit. This is a classic case of creating advantage which actually was not there. (link given below). Please note that this was not the only case where Pfizer was trying to sell a drug in off-label indications. There were in all four such cases.
Astra Zeneca, GSK and several other large MNCs have faced legal suits over unacceptable practices.
A fully paid sponsorship to US for attending a major medical conference costs around a million rupees per person. It is considered ethical while paying half a million cash to a customer is considered seriously unethical. Is there a difference between the two? don’t mind the academic part. Attending conferences worldwide is more leisure and less academics. In both cases, the investor is creating undue advantage for himself and may not be given allowance in the name of academic service.
A fully paid sponsorship to local conference would cost between 100,000 – 150,000 rupees. An iPhone would also cost a similar amount. Is there a difference between offering the two? Not really. It is about violating the rules of level playing field.
The point is that it is rationalization only. Any activity that gives undue advantage to one player over the other is unethical, be it packaged as academic service or patient service or personal service. All of this has to be labeled Unethical.
Marketing is about getting ‘mind space’ and Pharma had always done it with two means; distinctive merit of the product and follow up by the salesperson. Surveys from around the world show that the doctors attach significant weight to the consistent visits by the Pharma salespersons. The point has even been amply highlighted in a non-fiction book titled ‘Hard Sell: The Evolution of a Viagra Salesman’ by Jamie Reidy. The author emphasizes upon the strength of follow up and relation building in Pharma selling, albeit in a negative light. The book was later made into a Hollywood movie; ‘Love & Other Drugs’ starring Jake Gyllenhaal and Anne Hathaway.
Innovator Pharma companies secured Mind Space by virtue of innovation merit and Salespersons’ manners who were adequately trained. Generic companies had none of these tools and had to resort to other means. It may be admired that they brought in ingenuous ways of securing Mind Space. Presently, the generic industry has literally ran over the Mind Space of entire medical community.
We return to Dr. Ahmed’s research and explore further.
Under ‘Definitions’, Unethical practices are defined as ‘The promotion of pharmaceutical drugs by avoiding the set of rules & regulations, which are given by the ethical bodies Worldwide & the local bodies & government’.
The Study Introduction states:
“This study not only evaluates the responsible variables for the unethical pharmaceutical marketing practices but also compare who is more responsible for these unethical pharmaceutical marketing practices in Pakistan. This study also examines, who has initiated these unethical pharmaceutical marketing practices in Pakistan and who is responsible for the continuation of these practices in Pakistan.”
“The phenomenon of the unethical drug practices is common worldwide, but its severity is deep rooted in developing countries. Unethical drug practices have two dimensions. One is drug related, and other is drug promotion related. Extensive research on drug related unethical practices has been carried out internationally. However, the author was not able to find any empirical study on unethical drug promotion practices except the one that was carried out by (Parmar, Jalees, 2004) in Pakistan. Parmar and Jalees (2004) in their study observed that pharmaceutical industry spends a substantial portion of its budget on market research but do not carry out the research on unethical drug promotion practices. One of the reasons is that the industry itself is indulged in this practice therefore it does not find any need to carry out the research on this issue.”
“Lack of research on the subject does not mean that unethical drug promotion practices do not exist. The pre-survey and focus groups discussions indicate that unethical pharmaceutical marketing practices have become an acceptable norm of the pharmaceutical diligence, and it is also well supported by more or less all the pharmaceutical groups with the cooperation of government hospitals, private hospitals, doctors and health allied organizations including pharmacies on patients’ interests. All the entities as discussed above appear to be corrupted; therefore, it may not be fair to blame any one of them, including pharmaceutical industry.”
The researcher developed three research hypotheses to assess the prevalence, initiation, and continuation of unethical practices. The fourth hypothesis was about relative prevalence among rural and urban areas.
Hypothesis about Prevalence.
“So, it is concluded that the null hypothesis is accepted because 4.29 lies in non- critical region and it is further concluded that the level of unethical pharmaceutical marketing practices is high (at least 4) on the scale of (5 to 1)”.
Hypothesis about Rural Urban comparison
“Therefore, it is further concluded that the levels of unethical drug promotion practices are higher in rural areas as compared to the urban areas.”
Hypothesis about who initiated Unethical Practices
“The hypothesis relating to no significant difference of opinions on who initiated unethical drug promotion practices in Pakistan was rejected.” [It means that the Pharma Industry was implicated as initiator unequivocally.]
Hypothesis about Continuation
“So, it is further concluded that the doctor community is more responsible for the continuation of unethical pharmaceutical practices.”
Next, we shall see the study conclusions and add current scenarios also. Study recommendations for Eradicating Unethical Practices shall also come under discussion.