Code of conduct: A pill to cure corrup

With frequent reports of prominent pharmaceutical companies indulging in unethical practices, corruption in the pharma industry is no longer a breaking news. In recent years, governments of various countries have taken stern actions against pharma companies, the most stringent been China. China has recently fined GlaxoSmithKline (GSK) $490 million. A court found the company guilty of bribing doctors and hospitals to promote their products. This is not an isolated case for GSK. In July 2012, GSK agreed to plead guilty to criminal charges and pay a $3 billion settlement of the largest healthcare fraud case in the US. Though GSK has emerged as a leader in pharma frauds, other pharma bigwigs are also close behind. Almost a year back, as per reports appeared in the Chinese newspaper, The 21st Century Business Herald, Novartis’ eye care unit, Alcon, bribed more than 200 Chinese hospitals. Another large global pharma player, Eli Lilly & Co, was accused of bribing government officials like hospital administrators and doctors, and agreed to pay $29.4 million to resolve federal allegations. The pharma industry deals with life and death of the consumer. Any sort of compromise on the services front would impact the patient as well. However, as per industry experts, pharma industry alone should not be isolated. Almost every case against any pharma company also points the finger at doctors who are prime beneficiaries of the bribes offered.

Why a code of conduct?

It is often said that a business runs on relations. Offering gifts, travel packages, hospitality etc. to doctors has always been a way of maintaining relations and increasing business for pharma marketers. However, these activities have also invited constant criticism for ignoring ethical practices. But criticising the pharma industry alone will be a biased move and as mentioned before, the healthcare fraternities should get equal blame. Uniform Code of Pharmaceutical Marketing Practices (UCPMP) in the pharma industry is widely seen as a tool to keep check on corruption in the pharma sector which in turn would also help in minimising engagement of doctors in such activities.

“It is a matter of practice. In practice when you find examples of punishment and reward then a code of conduct like this in a given situation would make a difference.” Dr RB Smarta, Mng. Director, Interlink Marketing Consultancy

“Although the pharma industry and its marketing methods, tactics for unethical practices are blamed, competitive compulsions and the recipients are equally responsible. Greed is an universal phenomenon and if it is stretched you have these consequences! So both recipients, inclusive of doctors, stockists and even some other stakeholders, are equally responsible for this unfortunate practice,” says Dr RB Smarta, Managing Director, Interlink Marketing Consultancy.

India is one of the largest pharma markets for generic medicines. The large size of the market and competition among pharma companies give ample scope for illegitimate activities. Over the last many years, the Organisation of Pharmaceutical Producers of India (OPPI) has been continuously striving towards making interactions/business activities between pharma industry and doctors ethical in the country. It has laid down rules to ensure ethical behaviour of its members.

“Currently, this code is voluntary, but we would welcome the government making this a statutory code. A statutory code would bring an increased level of transparency and accountability across the healthcare industry and remove ambiguity on all aspects of pharma marketing.” Ranjana Smetacek, Director General, OPPI

“Ethics and compliance is a core focus area for us and all our members follow OPPI’s Code of Pharmaceutical Practices, based on International Federation of Pharmaceutical Manufacturers and Associations Code 2012. Our code was created to ensure that our interactions with healthcare professionals, medical institutions and patient organisations is at all times ethical and transparent and always in the interest of the patient,” informs Ranjana Smetacek, Director General, OPPI.

Though the code of conduct is in place for both the pharma professionals and doctors, doubts have been raised over its effectiveness.

Smetacek adds, “A uniform code of medico-marketing practices will help regulate pharmaceutical marketing in India. UCPMP is a draft document, created by the Department of Pharmaceuticals (DoP). Currently, this code is voluntary, but we would welcome the government making this a statutory code. A statutory code would bring an increased level of transparency and accountability across the healthcare industry and remove ambiguity on all aspects of pharma marketing. It would also serve to address the recent concerns voiced against the industry and level the playing field for all drug manufacturers.”

According to Smarta, it is not a matter of policy, code of conduct etc. He explains, “It is a matter of practice. In practice when you find examples of punishment and reward then a code of conduct like this in a given situation would make a difference.”

Mission impossible?

In an era of cut throat competitions, a sense of insecurity always looms over company managements which in turn perhaps the paves way for unethical practices. With many companies offering drugs for the same diseases, making space for your business is bound to get tough. There are possibilities of marketing professionals changing their modus operandi while offering gifts to give a slip to rules/code of conduct. In one such prominent example, a few years back, Pfizer agreed to pay more than $60 million to settle a US Federal bribery investigation. Pfizer was accused of illegal payoffs to win business overseas such as bribing doctors, hospitals, regulatory bodies across many countries in Europe and Asia. Moreover, the company tried to hide bribery by including them in the accounting books as legitimate expenses such as freight and training. Is it indeed possible to completely stop these unethical practices in both pharma and healthcare sector?

“It is possible to stop these practices when there is transparency and compliance. Transparency can be brought by online transactions and compliance can be achieved by system through online transactions,” opines Smarta.

Smarta’s views may ensure ethical practices to a some extent, however, on the other hand, implementation of any new system would require big investment and resources. In India drug manufacturers who are already compelled to sell drugs at cheaper price may not vote in favour of any new expenses.

Joint responsibility

A one-sided effort will not help in the successful implementation of a uniform code of pharma marketing practices in the pharma industry. Responsible behaviour from the doctor community and government initiatives in framing strict policies/ laws will indeed help the cause.

Smarta says, “In my opinion, pharma industry not only wants to provide quality products, both generics and patented, but is also interested in building brands, both at the therapy level and also at the corporate level.”

While speaking about the government’s role in this regard, Smarta says, “The role of the Indian Government would be taking up stakeholders association such as Pharmaceutical Industry Association, Indian Medical Association, Distributors and Stockist Association and their board members to form a group along with lawyers who are dealing with the pharma industry. The government also has to make them accountable and suggest actions against those who deviate from ethical practices. With industry co-operation, the government can insist on disclosure of transactions which happen due to compulsion or deviation. Disclosure will not have any penalty for a given period of time, but will be a moral pressure. With the help of media professionals and chosen state wise stockists, the same transparency can be rewarded and also questioned through government intervention at the industry association’s level.”

Reiterating Smarta’s suggestion Smetacek says, “For the UCPMP code to be implemented successfully, the government needs the support of all stakeholders, in particular, members of the Medical Council of India (MCI) and the Indian Medical Association (IMA).” Smetacek signs off, saying, “Both medical practitioners and the healthcare industry carry the responsibility to safeguard the health of all patients.”

Implementation of uniform code of pharma marketing practices is seen as a step towards curbing unethical practices involved in the marketing of pharma products. However, pharma industry alone can not influence the prescriptions unless doctors are ready to play their part. As said by Potter Stewart, former Associate Justice of the United States Supreme Court, ethics is knowing the difference between what you have a right to do and what is right to do. Unless the pharma and healthcare professionals understand this difference, success of any such code of conduct would perhaps remain a distant dream.

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