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February 2022 marks my completing 47 years of working in Pharma Industry. Allah be praised. I am still working. The first half of my working career was spent in Multinational companies, and the latter half in the Local Pharma, making me well-versed with both innovators and generics markets. I also had the opportunity to work in business as well as operations.
My journey of near half century is also the journey of Pharma Industry in Pakistan. Great changes have occurred in this time and a lot could be written about it. In my blogs, which were started about four and a half years ago, I have covered several topics rel ated to Pakistan Pharma Industry. This multi-part series shall do and review the SWOT – Strengths, Weaknesses, Opportunities, Threats – of the industry as a whole.
Stakeholders 5 – Prescribers (Customers) …… continued
Pharma-Doctors Nexus has been in the news worldwide and both MNCs and Generic companies have unabashedly promoted practices that influenced doctors’ prescriptions to their advantage.
An excerpt from New York Times report. [Quote] Word quickly reached top executives at Abbott Laboratories that a Baltimore cardiologist, Dr. Mark Midei, had inserted 30 of the company’s cardiac stents in a single day in August 2008, “which is the biggest day I remember hearing about,” an executive wrote in a celebratory e-mail.
Two days later, an Abbott sales representative spent $2,159 to buy a whole, slow-smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei’s home, according to a report being released Monday by the Senate. The dinner was just a small part of the millions in salary and perks showered on Dr. Midei for putting more stents in more patients than almost any other cardiologist in Baltimore.
The Senate Finance Committee, which oversees Medicare, started investigating Dr. Midei….. The senators solicited 10,000 documents from Abbott and St. Joseph. Their report, provided in advance to The New York Times, concludes that Dr. Midei “may have implanted 585 stents which were medically unnecessary” from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for those procedures. [Unquote]
This is just one case out of hundreds of cases reported from various countries. I observed the most formal form of Pharma companies paying-for- prescriptions in Azerbaijan. The doctor makes all prescriptions in duplicate, original goes to the patient, and copy is retained by the doctor. Pharma companies’ sales reps collect these from doctors, verify from pharmacies that the prescription was filled, and pay the agreed amount to doctor.
Doctors in Pakistan take the position that they prescribe only those drugs that are necessary for patients and that nothing inappropriate is happening. They also claim that services they receive from Pharma Industry are a token of gratitude for routine prescriptions, and not for influencing them. The fact is that drug prescriptions are issued for companies who gratify the doctors. They also claim that huge sponsorships demanded for organizing local conferences is a matter of right; that the Pharma companies should sponsor academic activities. The fact is that local conferences have become money minting machines for organizers who rake millions of unaccounted-for funds. This is also a fact that the Pharma companies are not obliged to sponsor academic activities; the courtesy in the beginning has become a matter of right.
What is happening to the patients in all this chaos? Obviously, the patients have no option but to accept it. Lately, many patients have become vocal about it even in front of doctors. It does not help the situation much, but it may satisfy the person. The patients also have no chance of being saved from the effects of such practices because not all, but too many customers are indulged in it.
Stakeholders 6 – Patients
Patients are the main stakeholders because the entire Pharma business is run at their cost. However, patients have the least say in the entire healthcare system. Government claims that they are doing everything to provide healthcare to people of the land, but Pakistan is among countries where least percentage – 3.2% is spent on healthcare.
In a study conducted by The Lancet, healthcare in Pakistan currently ranks 154th out of 195 countries in terms of overall system performance. Borgen Project highlights following six facts about healthcare in Pakistan.
- Healthcare in Pakistan includes both private and public sectors. Private sector serves 70% of population at their own cost. Public sector caters to 30% patients only.
- Healthcare in public sector is not free of charge. 78% of population continues to pay for healthcare out of their own pockets.
- Healthcare in Pakistan became a focal point after the country signed the UN Millennium Development Goals – MDGs.
- The doctor to population stands at one doctor for every 1,764 persons. For adequate population coverage, Pakistan needs at least two doctors for every 1,000 persons.
- Currently, 92% of rural population and 100% of the urban population has access to health services. Quality of health services in private sector is better than public sector.
- The introduction of immunization programs such as the Expanded Program on Immunization – EPI has increased vaccination coverage in Pakistan from 5% to 84%.
These facts are encouraging but patients still face two major issues while trying to get healthcare: exorbitant cost in private sector, and poor quality service in both public and private sector.
To be Continued……
Disclaimer. Most pictures in these blogs are taken from Google Images which does not show anyone’s copyright claim. However, if any such claim is presented, we shall remove the image with suitable regrets.
Dr. Mark Midei Faces Suits Over Cardiac Stents – The New York Times (nytimes.com)
Countries are spending more on health, but people are still paying too much out of their own pockets (who.int)