ISSN: 1391 - 0531
Sunday May 18, 2008
Vol. 42 - No 51
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Doctors AND corruption?

By Kumudini Hettiarachchi and Tahnee Hopman, Pic by M.A. Pushpa Kumara

The allegations are not only numerous but also very serious. The common charge is that pharmaceutical or drug companies are influencing -- in harsher terms resorting to bribery and corruption to get -- practising doctors to prescribe “certain” brands of drugs whatever the illness of the patient.

Samples of drugs not just a few but boxfuls, souvenirs and prescription pads are handed out, charged a spokesman for the People’s Movement for the Rights of Patients (PMRP), who declined to be identified.

Going from souvenirs to more serious issues, the spokesman alleged that the annual convention of the Sri Lanka Medical Association (SLMA) held in March at a five-star hotel at a cost of several millions of rupees was funded by two pharmaceutical companies.

“There have been allegations that scholarships are given to doctors and family members. In addition to this, doctors are said to be given all-expenses-paid pleasure trips and cruises. There had been one to Goa in January,” said the spokesman.

When asked why the PMRP did not investigate such serious allegations, the spokesman said it did not have the resources to do so. The 10-year-old PMRP which says it is fighting for patients’ rights has a 25-member National Committee and a few hundred other members, The Sunday Times learns. It also has seven patrons including many retired medical academics.

Explaining that the theme of International World Consumer Day held worldwide recently was ‘Unethical promotion of medicinal drugs’, the spokesman said the corruption issue in the health sector has come under debate the world over.

“Among the Fortune 500 companies, five are top pharmaceutical companies. It has been said that in 2006, US$ 50 billion was spent on drug promotion alone. There is little regulation or monitoring of activities,” he said.

These are the very allegations that The Sunday Times checked out, interviewing face-to-face, on-the-phone and on email, the different players in the health sector – pharmaceutical companies and some of the main colleges of the different specialities in the medical field.

Conceding that these are issues the pharmaceutical industry is mindful of, which need remedying, the President of the Sri Lanka Chamber of Pharmaceutical Industry (SLCPI), Adrian Basnayake, says this is the very reason why they have formulated a Code of Pharmaceutical Marketing Practices for member-companies. “I cannot deny the fact that the industry has its faults, but then, corruption is deep rooted in every aspect of society here. But this industry is one of the most regulated industries in operation.”

A valid complaint against a member company may be forwarded to the Sri Lanka Chamber of Pharmaceutical Industry, 129, Kynsey Road, Colombo 8. Phone: 5337648/9. Website: www.slcpi.org.

The self-regulatory SLCPI which has a membership of around 60 pharmaceutical companies is the successor of the Pharmaceutical Traders’ Association, set up back in 1961. Of around 200 pharmaceutical companies in the country, about 100 handle 80% of the market, it is learnt.

The old Code which came about 10 years ago dealt more with promotional claims (such as this drug is “better”, acts “faster” or is “safer”) but the new one brought in last month deals more with corruption and issues such as sponsorships, The Sunday Times learns.

What of pharmaceutical companies hosting sessions for healthcare professionals?

The particular event, as specified in the Code, will have to be held at a suitable venue, one that is not too extravagant, according to Mr. Basnayake. “It is completely unacceptable to host a three-day stay at a luxurious hotel for doctors if the actual programme lasts only a few hours,” says Mr. Basnayake citing the example of a medical session or any such event being held at a golf resort being taboo. “Spouses and family members of participating doctors cannot and should not be sponsored by the pharmaceutical company. For personal tokens or gifts to doctors by pharmaceutical companies, the accepted upper monetary limit worldwide is US$5.”

And if there is a breach of the Code? “We’ll name and shame them,” he says, adding that any such conduct will result in severe disciplinary action. “The companies will be blacklisted.” Countering charges that drug companies spend more on marketing their new products than on research on new drugs, the SLCPI President is adamant that there is no evidence to prove this. Whereas a substantial amount of money is spent on marketing, this amount does not exceed investments on research. “Promotion is an expensive process because the best, most effective drug is of no use whatsoever if a physician is unaware of its presence in the market.”

Explaining that 97% percent of research in this particular field is carried out by private pharmaceutical companies, he queried as to who has produced new anti-hypertensive, cancer, malaria drugs and vaccines. Marketing, however, is also essential because if not for marketing, doctors would not know of the latest and best drugs to use.

Adrian Basnayake

Going back in time, Mr. Basnayake says that some of the world’s major pharmaceutical companies have been in Sri Lanka since the 1950s. The pharmaceutical explosion in India (1970-1980) took place long after that.

Why is it that Sri Lanka which has reached world standards in garments, tea etc, has not been able to do so in pharmaceuticals, he asks and answers: Because there is strong anti-pharma sentiment whipped up by certain interested groups. Otherwise, Sri Lanka could have been a drug manufacturing country and internal prices would have been much lower.

“Park-Davis and Pfizer which are pharmaceutical companies which used to manufacture in Sri Lanka, sold up in the 1980’s because of this. Interested groups influence different governments from time to time to put the industry down,” he says. “We are now known for having an aggressive and vicious anti-pharma lobby.”

Pointing a finger at the People’s Movement for the Rights of Patients (PMRP), Mr. Basnayake is of the opinion that it frequently makes unsubstantiated allegations about corruption in the industry.

“But no one has made a complaint to us about corruption, with some kind of evidence,” he says, adding that the PMRP consists mainly of doctors and represents only a “small subset” of patients.

The Chamber has a disciplinary committee which, if a formal complaint is received, will investigate, The Sunday Times understands.

From the viewpoint of those all important-people, the patients, not only should there be no unethical influencing of doctors by the pharmaceutical companies but it should also appear to be so.

Transparency and good governance within the health sector are the keys.

How can doctor-colleges find funding for their activities? Is it ethical to get their sessions funded by drug companies? The link between doctors and drug companies is inextricable as the world needs pharmaceuticals.

Explaining that all organizations in the health sector such as international agencies and those working for the good of the masses cannot fund themselves but have to depend on sponsors to meet the costs of services provided to the public, many respected doctors were of the view that all parties concerned should, however, know the boundaries of give and take.

Most doctor-colleges do not have a way of generating their own money. The service to the people by the doctors is not limited to treating them but also expanding the doctors’ knowledge and learning the latest developments in the health field, The Sunday Times understands.

“As long as sessions etc are sponsored by the drug companies officially, through the colleges and everything is above board and there are perimeters such as only company names being displayed but individual products not being advertised, there is no problem,” said a senior doctor, whose view was echoed by many others.

Meanwhile, with regard to sponsorships of individual doctors to attend sessions abroad, amidst allegations and counter-allegations, a simple way to overcome criticism of undue influence will be for pharma companies to regularize their systems and do so officially through the different colleges of doctors. The colleges could then make selections on merit and merit alone.

The five-star hotel bill was paid by the Sri Lanka Medical Association and the PMRP should provide evidence in support of "frivolous" allegations, reiterated the SLMA, when asked by The Sunday Times.

The SLMA is the national professional medical association in Sri Lanka, which brings together medical practitioners of all grades and all branches of medicine.

Here are the questions put to the SLMA by The Sunday Times and the answers by its President Prof. Lalitha Mendis:

Question 1: Did the SLMA hold part of its 121st annual research sessions or any sessions at a 5-star Hotel in March 2008?

Answer: Yes, with the exception of the pre-congress workshops, the Annual Scientific Sessions of 2008 were held at a hotel.

Question 2: How much was the bill ?

Answer: The bill for facilities provided by the hotel was about Rs. 2 million.

Question 3: The PMRP alleges that the bill of the five-star hotel was paid by two pharmaceutical companies.Is this allegation true? If so, what are the pharmaceutical companies which paid the bills? If the allegation is true, is there no conflict of interest in accepting such favours?

Answer: May I suggest that the PMRP provide evidence in support of this frivolous allegation. The hotel bill was paid for by the SLMA.
The SLMA has always maintained a healthy and ethical relationship with the pharmaceutical industry where both parties are aware of the limiting perimeter of the relationship.

Question 4: In addition to the SLMA sessions in March, have any of the functions/ workshops etc., of the SLMA been sponsored by any pharmaceutical company over the past year? If so which company was it? What was the cost incurred? On what basis was the event sponsored?

Answer: Some of the educational workshops have been supported through various educational allocations of a few pharmaceutical firms.

Question 5: Have any research projects, surveys or clinical studies been sponsored by pharmaceutical companies? If so, what are they and who sponsored them?

Answer: The SLMA has not conducted research projects or clinical studies sponsored by the pharmaceutical industry. However, there is provision for the private sector to provide research grants through the SLMA. These research proposals are screened by Ethical Review Committees.

Question 6: Have there been instances in which doctors have been sponsored for workshops etc., abroad in the past year? If so, how many? Have the travel/accommodation expenses of family members accompanying these doctors been paid for by any pharmaceutical company?

Answer: When doctors travel overseas, they are not under any obligation to inform the SLMA about their travels.

Question 7: Has the SLMA got any information on any members of the SLMA being taken on a pleasure cruise to Goa by any pharmaceutical company?

Answer: No.

Question 8: Has the SLMA received any complaints about its members being influenced by any pharmaceutical company? If so, what action was taken?

Answer: In the year 2004, on the basis of some verbal complaints, the SLMA Ethics Committee issued the following advisory: "The SLMA Ethics Committee considers gifting of paid holidays for doctors and families - whether local or foreign - unethical; however it would be ethical to fund travel for doctors attending medical or scientific conferences abroad. Accepting expensive gifts such as tyres and spare parts of cars is likewise unethical."

Question 9: Does the SLMA have a Code of Ethics or guidelines for its members in dealing with undue influences by pharmaceutical companies?

Answer: In 1995, the SLMA published the document 'Ethical criteria for the promotion of medical drugs and devices in Sri Lanka'.

Q: Over the past year, have any of your functions/workshops etc. been sponsored by any pharmaceutical company? Which company was it? What was the cost incurred?

Sri Lanka College of Surgeons (SLCS): We being the main professional body representing the surgeons of this country endeavour to maintain the highest professional and ethical standards for the benefit of the profession and the public. The college seeks the support of pharmaceutical and other biomedical companies for the following activities: the Annual Scientific Sessions (the most important academic event of the college calendar which is an international conference attracting over 400 local and many international delegates; local and overseas workshops for the training and upgrading of the skills of surgeons; training courses for postgraduate trainees, and middle grade surgical medical officers; college and guest lectures conducted by local and overseas resource personnel held at regular intervals throughout the year.

The College of Surgeons, a non-profit making organization, is funded by its membership fee, voluntary contributions of members and special fund raising events such as the 'Surgeons Walk'.
We do not receive any state funds and the involvement of the pharmaceutical industry is for the above mentioned activities only.

The Annual Scientific Sessions: Last year's sessions were sponsored by around 20 different pharmaceutical and biomedical companies. The cost incurred was in the region of Rs. 4 millon which included travel, subsistence, hotel accommodation for around 15 overseas resource personnel, conduct of the three-day international conference in a reputed hotel, other organizational and running costs of this conference.

Surplus funds received at this event are being used for running costs of the college, building fund for the college auditorium and skills training lab which is currently under construction at the college premises. The estimated cost of this project is about Rs. 23 million.

At the Annual Scientific Sessions, College lectures and workshops, the sponsoring organizations are allowed to display and explain their banners and products at exhibition stalls in designated areas.

The college does not have any further obligations to these organizations and there is no conflict of interest.

Members of the College were sent to two overseas workshops in the last year -- laparoscopic training workshop in India for two young surgeons and national trauma management course, a training of trainers workshop, held in India for eight surgical delegates.

The candidates were selected following an open advertisement and a transparent selection procedure. The College has not undertaken any research project, surveys or clinical studies with the collaboration of the pharmaceutical and biomedical industry.

Sri Lanka College of Obstetricians and Gynaecologists (SLCOG): Yes, quite often. It was never one specific company. The usual form is that a group of companies gets together and sponsors an event. The cost varies. We have such programmes regularly, sometimes 3-4 times a month.

Q: Have there been instances in which family members of doctors, accompany doctors to workshops etc., having had travel/accommodation expenses paid for by pharmaceutical companies?

SLCS: No family members were sponsored.

SLCOG: I am not aware of any such instance. We certainly don't ask for anything of that nature.

Q: The PMRP alleges that doctors were taken on a pleasure trip to Goa recently by a pharmaceutical company. Was this from your college?

SLCS: The college is not aware of any members being sent on a pleasure cruise to Goa.
SLCOG: No, not from our college.

Q: Have you received any complaints about your membership being influenced by any pharmaceutical company?

SLCS: The college has not received any complaints regarding its members being influenced by the pharmaceutical industry.
SLCOG: We haven't received any complaints.

Q: Does your college have any guidelines or code of conduct for your membership?

SLCS: The college follows the guidelines stipulated by the Sri Lanka Medical Council in its dealings with pharmaceutical and biomedical companies.

SLCOG: Yes, we do. We have certain guidelines within the constitution, but nothing specific pertaining to our relations with pharmaceutical companies.

To all the above questions, the President-elect of the Sri Lanka College of Community Physicians, Dr. Nihal Abeysinghe had a simple answer:

"Traditionally, the college does not seek any support from the pharmaceutical industry, but only from companies not related to it. Compared to other colleges, our sessions and service programme have no glory. Even the companies not related to the drug industry are allowed only to display material including banners of the company and not individual products."

Citing and example, he said a company producing pest-elimination products for cockroaches etc could display the company name but not a particular product name.

This is what a cross-section of the pharmaceutical companies had to say:

Q: Over the past year, has your company sponsored any medical sessions, congresses or workshops?

GlaxoSmithKline (GSK): Yes, we have. Medical knowledge continues to expand rapidly with the development of new medicines and systems of treatment. It is important that the medical profession in Sri Lanka is regularly updated on these developments. As an innovator company with wide pharmaceutical expertise around the world, GSK plays an important role in providing continuing medical education through medical associations in Sri Lanka.

Astron Limited: Yes, we do, on a regular basis, as they pertain to awareness and education.

A. Baur & Co: Yes, we sponsor any medical educational event and our sponsorships are strictly within the Code set by the SLCPI.

Harcourts Pvt Ltd: Yes, we do and there is no corruption involved. We fund such sessions because colleges do not have adequate funding. Everything is done officially, through the colleges and not through individual doctors.

Hemas Pharmaceuticals Pvt. Ltd: Our involvement has only been in a small way, we do not target specific doctors; rather any funding is done through the colleges.

Akbar Brothers: We haven’t sponsored events.

Q: Does your company sponsor doctors to attend congresses or workshops abroad?

GSK: Yes, because it is part of medical education.
Astron: No.

Baurs: Yes, all to attend medical educational congresses.

Harcourts: We do, once again as part of supporting medical education.

Hemas: As a company which is just an importer and distributor for many principals,we do not sponsor any individual doctor.
Akbar Brothers: No.

Q: How many spouses or family members have your company sponsored, to accompany these doctors being sent abroad for workshops etc?

GSK: We do not sponsor spouses. It is not permitted by the GSK Promotion and Marketing Code.

If a spouse comes along with a doctor who is sponsored, the doctor pays all expenses of his/her spouse. In fact we do not invite spouses for meetings organized by us. As spouses are normally invited for inauguration sessions and dinners of medical associations we do not sponsor inaugurations and dinners.

Astron: No, never.

Baurs: No, none.

Harcourts: We don’t sponsor spouses or family members, on principle. We also have no budget for that. We’re 100% ethical.

Hemas: We do not sponsor spouses or family members. We are an ethical company.

Akbar Brothers: We don’t.

Q: Does your company sponsor any form of medical research?

GSK: Yes we do. We have sponsored the annual Sri Lanka Medical Association-Glaxo Wellcome Award, to undertake medical research in Sri Lanka. The SLMA calls for applications and selects an awardee annually. We have also sponsored an International Study on Allergy and Asthma in Children (ISAAC) in Sri Lanka.

Astron: We do our own research in our lab.

Baurs: We don’t engage in medical research.

We don’t think that even our principals have done so in recent times.

 
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