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Avron J. says that “the proliferation of medical advertising is a symptom of the nation’s all-against-all vision of medicine as just another commodity”. This is the global situation because profit maximization has taken precedence over other considerations for healthcare.
The situation in the Low- and Middle-Income Countries (LMICs) is much worse. The regulatory agencies are not strong enough to implement policies and feel powerless against large Pharma houses and Healthcare Professionals.
Pakistan Pharma market is extremely unevenly divided. Over 90% market is taken by top 50 companies while rest of the companies, numbering around 700, are fighting for survival in less than 10% market. The truly aggressive marketing starts from the top. They must increase their revenue further, protect their market share and preserve their market ranking at all costs. In some ways, these giants are hostage to their own financial tyrants which they are unable to defy.
The aggression in promotional policies shows up in several ways, some of which are shown below. Most often, a combination of several weapons is deployed to achieve business objectives.
Blurring between Prescription Only and Over-the-Counter Drugs
Pakistan like other LMICs, suffers from lax regulatory policies about prescription drugs. All kinds of medicines can be purchased by anyone without prescription. Drug Regulatory structure does not try to implement this important step seriously. Antibiotics, Antipsychotics, antidepressants, anticancer drugs and what not, all can be bought off the shelf without any hassle.
While this ‘facility’ makes life easy for all patients, particularly those who like to self-medicate, it is not justified on merit. Drugs that should be available on prescription and those to be sold over the counter should be dispensed in their respective ways.
Pharmacies are not interested in this restriction either because they will also have to keep records, and they fear losing some business. In fact, many pharmacies ‘recommend’ medicines to street customers for treating some common ailments.
This situation leads to misuse and abuse of a lot of drugs which in turn is enhancing and complicating antibiotic resistance. Antibiotic resistance is a serious and imminent problem in Pakistan and elsewhere, but no one is paying heed.
Changes in Prescription Trend
General practitioners of old times dispensed few basic medicines which they purchased in bulk. They made cough cold type mixtures themselves and added few tablets. It was not common to give an additional prescription to every patient. Then, two things happened simultaneously. One, the GPs wanted to maximize their revenue but found it hard to charge the patients beyond a certain limit. They reduced the dispensing element to bare minimum and added a prescription which would be filled by the pharmacy. The number of prescriptions started rising steadily. Two, the Pharma companies introduced lucrative services for doctors which were linked to the number of prescriptions they issued. Prescriptions suited both parties and they embraced it wholeheartedly. Prescriptions containing multiple medicine became order of the day. The consultants always issued a prescription only. However, the size of their prescription has been increasing. GPs who did not give any prescription are now writing long prescriptions to every patient.
Blurring between Prescribing and Purchasing
Another change is that the GPs have established small pharmacies inside or adjacent to their clinics. They write a prescription, and it is filled there. This is another way of maximizing profit. Pharma companies find it to their advantage. They can entice customers by giving extra discount and it becomes assured business.
The practice of stock purchasing has given rise to additional problems. There is competition for more discounts which ultimately has a bearing on the quality of products purchased.
The issues related to Healthcare and Pharma in Pakistan are not unique. The same issues are there in all countries like ours. The ubiquity of problem does not justify its existence. Pharma companies alone are not responsible for it, but the desire and effort to maximize profits has brought them together with healthcare professionals at the peril of the patients.
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Acknowledgement. The central idea came from a research paper by Mainul Haq, Professor of Pharmacology, Faculty of Medicine and Defense Health, National Defense University of Malaysia, published in Bangladesh Journal of Medical Science Vol. 19 No. 04 October’20. Page : 589-59