Pharmaceutical companies in Bangladesh spend more than Tk 6,000 crore on marketing a year, which burdens consumers as the companies recover the expenses through increased drug prices, health experts say.
The Bangladesh Institute of Development Studies in a study, ‘Pharmaceutical Industry of Bangladesh: Prospects and Challenges’ made public on December 1, said that the pharmaceutical companies spent 29.6 per cent of their turnover on marketing in 2018.
Data of IQVIA, a US multinational company serving combined industries of health information technology and clinical research, says that the drug market in Bangladesh was worth Tk 20,511.88 crore in 2018.
The BIDS study has not made it clear where the money has been spent, but it has mentioned ‘gifts to doctors in different forms’ as a marketing strategy.
According to the study, the companies employ 65 per cent of the work force in marketing — medical representatives accounting for 46 per cent and sales representatives 19 per cent. Their major tasks are to influence physicians by briefing them on ‘the superiority of the drugs’ and giving ‘gifts to doctors in different forms’, the study says.
In addition, medical representatives take photographs of prescriptions and send them to area manager through messenger or WhatsApp, the study shows.
It also shows that the expenditure on marketing was 28.55 per cent of the annual turnover in 2017 and 27.51 per cent of the annual turnover in 2016.
The study corroborates another study of 2015 conducted by Bangladesh Health Watch, an organisation affiliated to BRAC University.
The 2015 study says that because of high competition, aggressive marketing strategies are adopted by drug companies for a greater market share, which sometimes crosses the limits.
The BRAC study, ‘Qualitative insights into promotion of pharmaceutical products in Bangladesh: how ethical are the practices’, says, ‘Approaches such as inducements, persuasion, emotional blackmail, serving family members, etc are used.’
It says, ‘Popular physicians are cultivated meticulously by medical representatives to establish brand loyalty and fulfil individual and company targets.’
Terming the practice unethical, public health experts have said that it adds to patients’ expenditure on medicine in the absence of laws and oversight on the drug market to stop the unethical practice.
They have said that such unethical practice is the main reason for an increase in drug prices.
‘Anarchy rules the pharmaceutical sector on the excuse of marketing,’ Gonoshasthaya Kendra trustee Dr Zafrullah Chowdhury said.
He said that the drug prices would drop by 70 per cent if such unethical marketing could be stopped.
The costs of drugs increase because of the huge expenditure on marketing, he said. ‘The companies line their pockets with the money of patients to meet their marketing cost,’ Zafrullah said.
The Bangladesh Health Rights Movement chairman, Rashid-e-Mahbub, also a former Bangladesh Medical Association president, said that the practice of bribing doctors in selling products and physician’s taking the bribe are illegal and unethical.
‘Every nation has an ethical marketing practice and the regulators monitor the companies to ensure that the practice is followed properly,’ he said.
‘Even in India, the regulators monitor how much money doctors are paid, but unfortunately, our pharmaceutical companies do not have any ethical practice in terms of marketing,’ he said.
‘We should formulate a code of ethical marketing practice for pharmaceutical companies. The Directorate General of Drug Administration and the Anti-Corruption Commission should see whether the code is violated,’ Rashid said.
A code is very much in place, drug administration director Nayar Sultana said.
The Code of Pharmaceutical Marketing Practices says, ‘No gift or financial inducement shall be offered or given to members of the medical profession for purposes of sales promotion.’
Nayar said that ethical marketing practices depend on the will of companies, but there are no regulatory directives or punitive provisions for companies breaching the code.
‘The Drugs Act and the Drug Control Ordinance stipulate no punitive measure for violation of the code,’ she said.
Zafrullah said that the code and laws on drug should be amended keeping to international legal instruments and the World Health Organisation guideline.
Article 19 of the Ethical Criteria for Medicinal Drug Promotion of the WHO says, ‘Employers should be responsible for the statements and activities of their medical representatives. Medical representatives should not offer inducements to prescribers and dispensers. Prescribers and dispensers should not solicit such inducements.’
Article 7.5.1 of the Code of Practice of International Federation of Pharmaceutical Manufacturers and Associations says, ‘Payments in cash or cash equivalents (such as gift certificates) must not be provided or offered to healthcare professionals. Gifts for the personal benefit of healthcare professionals (such as sporting or entertainment tickets, electronics items, etc) must not be provided or offered.’
Experts say that many countries enacted laws criminalising such unethical practice and a similar enactment is needed in Bangladesh.
According to the Physician Payments Sunshine Act of the United States, doctors and companies have to report to the Food and Drug Authority about any payments or other transfers of value more than $10 and any small payments of other transfers of value less than $10 if the total annual value of payments or other transfers of value provided to a covered recipient exceeds $100.
Zafrullah Chowdhury said, ‘There is, unfortunately, no control over drug companies in our country.’
He said that in other countries, doctors have to inform their respective drug authorities if they were given gift by any drug company.
‘This is only to restrain the unethical marketing practice of pharmaceutical companies,’ he said.
Zafrullah said that the code of marketing practice should be updated and there should be punitive measures for the violation of the code.
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