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Continued from Previous……

Medicines are prescribed against money – It is now openly talked that doctors get money from Pharma companies to prescribe their products.

It is an important point and it is worth looking into in greater detail.

When I started 45 years ago, the Pharma companies promoted products to doctors in a simple manner. The market was dominated by the multinational companies. There was emphasis on academic content and discussion. Reduced packs as Physician Samples were given which were meant to be given out to patients free. Once or twice a year, some small gift came from parent office in small numbers was received. It was distributed and was received eagerly as these were few and far between.

The market started changing with in the 1980s. Generic manufacturers or Local Pharma organized themselves and started more aggressive marketing. In order to get better attention, the Local Pharma offered more frequent gifts. The variety increased, the quantity increased, and the frequency increased. Generic manufacturers did not have academic content to offer, and this was one way of compensating for that. As business started flowing in greater volume, the Local Pharma felt the urge to pay more gratitude. The gifts became more expensive, more customized and more personalized. MNCs were used to getting big business while it was a first for the Local Pharma. Though the analogy is not good, but it was sort of comparison between old-rich and new-rich, where new-rich prefer to show off their newly acquired wealth.

MNCs realized that the competition had started eroding their business base and they reacted to protect their own. They came up with offers which they thought Local Pharma would not be able to match. They offered sponsorships for international conferences abroad, mostly US and Europe. The MNCs were already offering this but at a rather limited scale. They became more liberal with this activity. Academic activities’ sponsorships are accepted as ethical marketing practice worldwide; with some restrictions.

During the last twenty years, the competition has intensified greatly. Local Pharma has successfully dislodged MNCs to gain about 80% market share, which is huge. MNCs are struggling but fighting back through multiple strategies. The customer, who is the doctor, has gained from this competitive fight. The MNCs try to please him and the Local Pharma tries to woo him. Marketers have gone from customer service to customer satisfaction to customer delight, and all has become fair in this war.

What is the impact on doctor prescription? Has he come under pressure to prescribe unnecessary medicine? Has he started prescribing medicines without justification?

The answer in one simple statement is – Not Really.

The doctor is prescribing medicines which are necessary, justified and needed by the patient. He does favor one company over the other, but it is not of much consequence because generic drugs are priced in the similar range. There are differences, but not huge. Remember, the prices are fixed by the government. The patient is not getting hurt, therefore. It is a misconception that doctors are prescribing large number of drugs unnecessarily. The fact is that that medical practice has changed internationally and also in Pakistan. Previously, the approach was conservative and cautious. Physicians would start with few drugs in low dose and monitor progress before increasing the number or dose. Presently, medical practice has become bolder and more aggressive. First, a battery of all possible tests is run which may help give a clue about the diagnosis. After diagnosis, whether confirmed or not, the doctor attacks the illness from all angles and covers all possible fronts. This has led to frequent labs and large prescriptions. There are allegations that labs are paying a cut to referring doctors, which we cannot prove with evidence. In any case, getting tests is the new order of the day. Similarly, prescribing 10-12 medicines at one time is also order of the day.

When it comes to prescribing supplements, nutraceutical products, plant-based phytopharmaceutical products and the likes in imported and local products, the situation may be different. The necessity of these products can be seriously questioned. Prices of these drugs are not fixed by the government, so the manufacturer can sell at any price he desires. These drugs are not entirely unnecessary; they have many benefits in the long term. It is their injudicious use which has put them in negative light.

The sum up is that Pharma companies and doctors are both responsible for maintaining order in the Pharma market. There are problems on both sides at present, but these can be resolved through dialogue between stakeholders. Patient is supreme, and so is patient interest. It should not be sacrificed for any reason.

To be Continued……

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