ETHICAL RELATIONSHIP BETWEEN PHARMACEUTICAL COMPANIES & DOCTORS

The ethical issues surrounding pharmaceutical companies and healthcare providers, including physicians, are not unique to Pakistan but are global concerns. These issues include conflicts of interest, financial incentives, prescription practices, and their impact on patient care. But unfortunately little research and attention is given to this . 1) Conflict of Interest: The relationship between pharmaceutical companies and healthcare providers can raise concerns about conflicts of interest. Doctors receiving gifts, payments, or sponsorships from pharmaceutical companies may be influenced in their prescribing practices. This can undermine trust in the medical profession and potentially harm patients. 2) Influence on Prescription Practices: Doctors prescribing more expensive branded drugs when cheaper generic alternatives are available can lead to increased healthcare costs for patients and healthcare systems. This practice may be driven by financial incentives provided by pharmaceutical companies. 3) They fund doctors for Symposium & Educational activities to achieve the their sale targets but at times the purpose & objective of conference is not achieved even the agenda & presentation are set by Pharmaceutical companies as in recent 17th Gastroenterology at Rawalpindi (Zaidi et.al[2] happened as about a dozen of doctors were sponsored by same Pharmaceutical company and presentation was given by them on same drug finally the foreign delegates left the conference by saying that they came to gain insight and share their views on the issue of Gastroenterology but the conference seem to promote one drug. 4) Regulatory Measures: It's positive to note that the Pakistani government and regulatory bodies like the Drug Regulatory Authority of Pakistan (DRAP) have taken steps to address these issues. Implementing rules against cash payments, foreign tours, and issuing codes of conduct for pharmaceutical companies are important measures to curb unethical practices. 5) According to DAWN 19th April 2022 While DRAP after receiving a letter in response of complaints received to PM Performance Delivery unit about doctors that they are prescribing expensive branded medicines wrote to all Pharmaceutical companies & Health Department to ensure that drugs should be written in their chemicals rather than brand names to avoid economical & Financial burden to poor patients and discourage doctors for incentivized prescription. The Federal Cabinet has approved the rule which prohibits to pay cash payment to doctors and not allow doctors for foreign tours under the guise of “Medical or Scientific Conference) with out NOC from DRAP. DRAP has issued letter to Pharmaceutical Companies to ensure availability of Pharmacist at every medical store for the sale of medicines. A code of Conduct is also issued by DRAP to Pharmaceutical companies according to which any Financial incentives and expensive gifts to doctors will be considered as “BRIBE” The payment to doctors is only to be given for their services obtained from them which include Honoria for delivering lectures in conferences, Symposia, local speaker program and awareness program on latest research in various areas of medicines and awareness program for general public also. 6) According to Institute of Chartered Accounts April 2018 along other points it is clearly stated that Medical Representatives are given fixed Salary but variable incentives in terms of calls to doctors in their assigned territories and carry out Scientific & Promotional activities as well as sale. But unfortunately in Pakistan as As per FBR 5% of turnover is to be spent on sale promotion and it is duty of Finance officer to check that it should not cross define limits 7) Patient Impact: The real victims of these practices are often the patients. 8) When doctors and pharmacists prioritize financial incentives over patient well-being, it can lead to inappropriate medical treatment and increased healthcare costs for patients, especially in a country like Pakistan, where many people struggle with poverty. 9) Lack of Enforcement: While regulations are in place, enforcement appears to be a significant challenge. When regulatory authorities, drug inspectors, pharmacists, and medical store personnel do not uphold these regulations, unethical practices continue to thrive. 10) Transparency and Education: Increasing transparency in financial relationships between healthcare providers and pharmaceutical companies is crucial. Additionally, medical education should include training on ethical considerations and potential conflicts of interest to help future healthcare professionals make informed decisions. 11) Patient Advocacy: Patient advocacy groups can play a vital role in raising awareness about these issues and pushing for stricter enforcement of regulations. Patients have a right to expect that their healthcare providers prioritize their health over financial gain. In summary, the ethical issues surrounding pharmaceutical companies and healthcare providers are complex and have far-reaching consequences. While regulations and codes of conduct are important steps, effective enforcement and a cultural shift within the healthcare industry are necessary to ensure that patient well-being remains the top priority.