#India -Pharma firms ply doctors with gifts #medicalethics


Published: Thursday, Dec 27, 2012, 5:30 IST
By Sandeep Pai | Place: Mumbai | Agency: DNA

Even as the prime minister Manmohan Singh-led National Development Council meets on Thursday to discuss a law to curb unethical practices adopted by pharmaceutical companies to persuade doctors to promote their products, a four-month investigation by DNA has shown that the ‘pay-for-prescription’ practice flourishes.

While doctors admit that there is a grave danger of drugs being overused when pharmaceutical companies woo doctors and stockists with various sops for promoting their drugs, even the parliamentary standing committee on health and family welfare in a report dated May 8, 2012 says there is no let-up in this “evil practice”. It says, “… pharma companies continue to sponsor foreign trips of many doctors and shower them with high value gifts like air conditioners, cars, music systems, gold chains etc… to obliging prescribers who then prescribe costlier drugs as quid pro quo. Ultimately all these expenses get added up to the cost of drugs.” What’s more, the pharma firm-doctor nexus is not limited to innocuous over-the-counter drugs, a DNA investigation has found.

Take the example of US Vitamin (USV) Ltd, a major player in the oral antibiotics market. In August 2011, its product manager wrote to company representatives appreciating their efforts in making its product, Drego-D, the Number 1 prescribed brand in the preceding two months. The letter went on to say they should also push another drug, Drego, similarly, given the huge opportunity it presents. All doctors except paediatricians have the potential to prescribe Drego, the letter urged. Drego and Drego-D are both Schedule H drugs, to be sold only on the prescription of a registered medical practitioner.

The letter goes on to detail the promotional activities for the Drego group of drugs, including “on demand campaign” every month specifically for general practitioners, ENT specialists, orthopaedics, gynaecologists and more. l Turn to p9

The “engagement” and “development activity” for these doctors included investment of Rs65,000/ year or Rs80,000 per year on one or two selected doctors for a single drug, the letter revealed.

“…with such a line of promotion we are sure that you all will very easily achieve a minimum per member per month (PMPM) of 250 strips of Drego & 350 strips of Drego-D,” the letter said, going on to insist that representatives should, during their field work, ensure that doctors give Drego prescriptions “on priority”. The letter posted a target a business worth Rs14 crore for a single drug in a single year.

The company’s brochure also says doctors stood to win a smartphone or LCD television once they enter the “MPower Club” for a certain number of prescriptions of Zylera, a drug for nasal problems or asthma-like symptoms, also a Schedule H drug.
Franco India, expected to have a turnover of Rs2.1 billion this year, offers a variety of gifts to doctors, including a hamper of basmati rice, handmade orange soap, an all-in-one mobile phone charger and other stationery items.

Svizera Healthcare, a division of Maneesh Pharmaceuticals Limited, issued a brochure called Club Inspira 2010-2011, which invites doctors to become members by prescribing products worth Rs50,000 between May and August 2010. The prescriptions would have to be for Si-Fixim, Si-Fixim XL, Si-Fixim CV, FlanZen, FlanZen D/DP and others.

These are all highly sensitive drugs. Si-Fixim is generally used for the treatment of infections caused by susceptible bacteria. Doctors prescribe the medicine to patients suffering from upper respiratory tract infections, such as pharyngitis, sinusitis, tonsillitis and lower respiratory tract infections like acute bronchitis and acute exacerbation of chronic bronchitis etc. FlanZen is prescribed for reducing inflammation and edema occurring due to rheumatic disorders, surgeries, breast engorgements, pregnancy-related thrombophlebitis as well as fibrocystic breast diseases. It causes hypersensitivity reactions including rashes, abdominal discomfort and nausea if not taken properly.
Those entering the ‘club’ would be eligible for a gift, with their options ranging from a microwave oven, digital camera, a gold coin, etc.

While doctors get incentives for prescriptive drugs, incentives are offered to stockists for non-prescriptive drugs too. Though some may debate that there is nothing wrong in offering incentives to the stockists, but others believe it does make the stockist unethically push for product in order to win the gifts. While doctors get incentives for prescriptive drugs, incentives are offered to stockists for non-prescriptive drugs too.

A Gelusil festival extravaganza was announced by Pfizer to strengthen the product’s position as the Number 1 antacid in its category. Distributors were offered slab-wise gifts for achieving targets and also a chance to participate in a lucky draw. A similar offer had been launched last year for Becosules, the vitamin supplement. On offer was a chance to win diamond pendants, gold chains, travel bags, LCD televisions, home theatres, and wrist-watches.

While most pharma companies DNA approached refused to respond to queries on ethical practices while promoting drugs, Pfizer spokesperson Shyam Kumar said the company takes compliance with norms very seriously. “In fact, over the past several years, Pfizer has taken very significant steps to strengthen our internal controls and pioneer new procedures in the area of compliance. Corporate integrity is an absolute priority for Pfizer, and we will continue to take appropriate actions to strengthen public trust in our company.”

Dr Kailash Sharma, member, board of governors, Medical Council of India, and director, academics, Tata Memorial hospital, said, \”MCI has already given strict guidelines but the practice of accepting gifts is so prevalent, it becomes difficult to monitor. Doctors must restrain themselves from accepting gifts or foreign trips from pharma companies. There is a need to bring in penal provisions for pharma companies, which offer gifts to doctors. There is also a need to audit the accounts of pharma companies to know how much they are spending on publicity.”

 

#India -2 tribal women die post ligation surgery #Westbengal #Vaw


pc courtesy indiamike

statesman news service

DURGAPUR, 14 DEC: Two tribal women died today post ligation surgery  at a rural block hospital in Asansol today. Chandmoni Hembram of Kalipathar village and Radharani Tudu of Gaurangadihi village, who underwent ligation at Kelejora Block Primary Health Centre along with 12 other tribal women, died while they were taken to Asansol District Hospital in the late afternoon.

The Asansol administration apprehended that the casualties might provoke the tribals residing in the villages surrounding the rural hospital to unleash attack on the block medical officer and his family. The ADM, Asansol, Mr Jayanta Aikat said: “We have asked police to beef up security surveillance across the hospital area to prevent any untoward situation.”

Tribal housewives queued up at the Kelejora Block Primary Health Centre in Baraboni, about 15 km from Asansol town today where a mass ligation camp was organised. In all 14 women from the adjoining villages underwent tubal ligation surgery at the Kelejora Hospital today.

Chandmoni Hembram and Radharani Tudu, both aged around 40 were also taken to the camp and according to the hospital authorities:

“Their cases became complicated as both complained of gradual deterioration within an hour of operation.” The ADM, Asansol, Mr Jayanta Aikat said: “The medical officers told me that both the women were physically weak, so the rural hospital referred them immediately to the Asansol District Hospital.” On their way to the hospital, both the women died triggering panic among the medical staff. The bodies were kept under supervision at the Asansol Hospital for the night. MLA, Baraboni, Mr Bidhan Upadhyaya said: “Baraboni is a block having 43 villages under eight panchayats and the tribal and downtrodden mass contribute a significant percentage of the demography. The casualties, besides making ligation a fear factor among the backward communities, would also create tension in the area.”

Tubal ligation is a surgery performed to block woman’s fallopian tubes for permanent birth

control.

The district administration has engaged the BDO, Baraboni to table a report on the matter at the earliest.

 

Open letter to Arnab Goswami by Madhu Kishwar


 

Dear Arnab ji,

When you started your innings with Times Now by demanding that power wielders provide honest answers to the general public for their various acts of commission and omission, many of us applauded your public spiritedness.  “The Nation-is-angry-and-wants-an-answer” approach gave much-needed vent to citizens’ frustration at our political masters’ lack of accountability. Every today, once in a while, your head-on approach works well, as it did when you ably stonewalled the attempts of Congress leaders in giving a communal colour to the recent killings and mayhem in Assam. Being from Assam yourself, you were on surer ground.  But trouble arises when you become an instant expert on a new subject every night and want your rage to be supported and echoed by all your panelists with the same intensity and fury as yours.

Over the years, you have let the success of your program make you forget the necessary dividing line between journalist and crusader and converted your prime time ‘News Hour,’ into a Kangaroo Court. Your jingoistic nationalism mimics the aggressive onslaughts of preachers of Born-Again Christian sects on North American TV channels.  Within the one-hour duration of your Kangaroo court, you bully your guest panelists to participate in a summary trial loaded with self-righteous harangues, aimed not just at the targeted wrong doer but also at those who dare resist your requirement that the verdict against the targets of your ire be pronounced right then and there. Unfortunately, some of the younger anchors are also catching on this disease. Therefore, it needs to be controlled before it assumes epidemic proportions.

You made it fashionable to see every issue through a prism which allows only two colors to permeate– black and white. That prism enables the anchor to see himself as lily white knight in shining armor out to save India from its various real and imaginary enemies and ills and ensures that all those whose alleged misdeeds you expose or whose views you target come out pure black, pure evil. You become enraged if someone tries to introduce a degree of complexity to the discussion. The panelists are expected to simply come and lend further strength to the anchor’s delusion that the one hour of News Hour will rid India of all its ills.

Dear Arnab, it is time you get over the illusion that if you wrap yourself in the national flag, everyone will automatically accept the purity of your intentions and the workability of your prescriptions on every single issue. Plenty of people are becoming exasperated with such posturing and want news channels to provide them real news instead of organizing daily cock-fights in T.V. studios.

Your crusading zeal and the style of interrogation has the effect of dumbing down the issues you pick up for debate.  For example, you are very fond of picking up sensational cases of police tyranny and callousness.  But your panelists are not allowed to go beyond expressing pious rage at these routine misdemeanors of our lawless police.  Whenever you asked me to join any such discussion, I have pleaded with you to go beyond raging over random cases and start a serious discussion on police reforms to channel the energy and anger of concerned citizens to think creatively of the systemic changes required in order to make our police a people friendly institution designed to protect citizens’ rights rather than tyrannize, fleece and harass them.  But that requires a great deal of homework and serious thought.  You have no patience for it because it would not allow your daily dose of righteous rage.

It is clear you are still stuck in the Oxbridge style of debating you are likely to have learnt as a student, whereby one is allowed to speak either “for” or “against” the motion. A good “debater” is one who makes mince meat out of his opponent’s arguments, caricaturing the views of others while proving the absolute superiority of his own. Debating” of the kind, taught in our elite schools and colleges involves being one-up on your opponents, even if in the process you end up with pompous posturing.  Those  who remain stuck in this mode of interaction become incapable of engaging in a dialogue, leave alone promote genuine “samvad.

Samvad, as opposed to debating, requires that one gives equal (sam) opportunity to one’s opponent to present her viewpoint, (vad). In fact, in the Indian tradition of holding Shastratha there is well-respected code that you acquire the adhikar (moral right) to criticize or debate someone’s views or ideas only if you first demonstrate that you have understood their position in great depth and appreciate the complexities and nuances of the opponent’s argument.

Take the example of how you went ballistic when all four of us on your panel invited to the News Hour on July 11, 2012 surprised you by our refusal to join you in condemning and demanding strict punitive action against the Medical Superintendent who allegedly allowed a “sweeper” to play surgeon that fateful morning in the   Banarsi Das Government Hospital of Bulandshahar. In your high voltage zeal, you converted 41 year old Mohammad Ayub who has worked for 19 long years as a ward boy in the Operation Theatre of that hospital into a “sweeper” who had dared trespass into the hallowed territory reserved for MBBS ( and above) doctors. Do you know that in neighboring Bangladesh, which has a far superior primary health care system, illiterate and barely literate women and men have been trained as very effective paramedics? Suturing a wound is no rocket science. Nineteen years is a long time for an OT assistant to learn something as simple as putting 5 stitches to close a wound.

Even alleged murderers get a chance to defend themselves during the course of trial. But you thundered at us for suggesting that you pay heed to the explanations being offered by the representative of the hospital before reaching final conclusions. He tried in vain to tell you that on that early morning, 17 injured persons had been brought to the hospital following a bus accident. Of the 23 doctors, 7 were present in the hospital. The rest were either on leave or had left after doing their shift. The ward boy assisted in stitching up a wound because it was an emergency situation and all 17 injured persons had to be attended to at once. The Medical officer had sounded the emergency alarm which meant all the staff members in the hospital were to assemble and be assigned duties. But, instead of waiting for other doctors to reach the hospital, those on duty decided to make the best use of available resources. You were outraged that all 23 doctors were not there to attend to this emergency as if you have never heard of shift duty. It is likely that more than the permissible number were on leave that day. But that had to be established only after a proper enquiry. But you can’t afford to wait a day or two for facts to be established since you need a new issue and a new sacrificial victim every night.

Your fury and insistence on “instant justice” and punishment during the News Hour itself was based on a 20 second grainy footage taken by some local photographer covering the bus accident. Neither you nor your correspondent cared to find out whether the ward boy had done a good job or messed up the wound. Incidentally, neither the injured boy whose wound was stitched nor his parents complained of any wrong doing. If you had made up your mind to convict all of the hospital staff based on a 20 second borrowed footage, why did you bother to invite the concerned medical officer on your program?

We pleaded with you to contextualize the “offense”­­­—even  if a ward boy putting 5 stitches on a wound could be called an offense—by seeing it as a symptom of the pathetic state of our public hospitals with their perennial shortage of doctors and nurses. If today, the country is short of 6 lakh doctors and 1 million nurses, it points to decades of government mismanagement and neglect of the health sector. But for you that meant we too had become guilty of the “Chalta Hai” attitude which you are determined to beat out of Indians.

Do you know what has been the net result of your crusade of July 11, Arnab ji? If not, please read a report filed by Shone Shatheesh Babu in Tehelka of July 28, 2012.  Ayub, a low paid class IV employee and the only breadwinner of a 10 member family– including a wife, three daughters, ailing parents and an autistic brother– was suspended from his job to placate your fury. In addition to facing penury, he is devastated by the ignominy of being called a “sweeper” who dared play surgeon by a whole host of TV channels who took their cue from you. By contrast, the Chief Medical Supervisor has only been transferred to another hospital. In addition, the administration has “issued warning to every employee to only stick to his/her area of expertise.” This means in future no hospital staff will dare go beyond their officially assigned duty even in emergencies for fear of being punished. From henceforth a ward boy hired to pull stretchers will think a thousand times before daring to offer a glass of water to a thirsty patient. Likewise an attendant meant for changing bed linen will avoid letting the doctor or nurse know if he sees that a medicinal drip of a patient has stopped working, lest he be held guilty of overstepping his limits.

Serious Political Consequences of Prejudiced Attacks

Your narcissism and oversimplification of political issues has serious political consequences since it is not limited to raving and ranting against corruption and mismanagement in this or that hospital or thana.

Take for example the way you handle issues relating to Kashmir. To begin with, you think of Kashmir only when there is a major upsurge of anger on the streets, leading to violence or shut down. Without doing proper homework, without taking the trouble to go see for yourself or get the best of your reporters to feed you reliable reports, you invariably take at face value the information and slant provided to you by either your favorite politicians in the state or the Home Ministry in Delhi.

Having already made up your mind that any protest against the government or manifestation of discontent against mal-governance in the state is “Pakistan-inspired mischief” you invite Kashmiris to your program only to tell them what you think of them. Either you deliberately pick those who live up to the image of being stereotypical secessionists or if they don’t oblige, you try to push them into that camp.  Your energy goes into showing them up to be anti-national elements whose grievances or point of view does not deserve to be heard, leave alone heeded. Even when Kashmiris come out to protest the killings of innocent men or young kids by their own state police, you only pour contempt at them at having invited such killings.

Equally important, you and your tribe rarely, if ever, celebrate anything good the Kashmiris do. For example, you have never covered the great hospitality shown to Amarnath Yatris by Kashmiri Muslims, including when bad weather conditions lead to life threatening situations en route to the shrine. Recently you went ballistic over Syed Ali Shah Geelani opposing the creation of separate enclaves for Kashmiri Pandits but you deliberately paid no heed to the main point he was raising that Pandits should be assisted in returning to their original homes. He is opposed to creating ghettos for them and has repeatedly emphasized the need to for them to come reclaim their homes in old neighborhoods. Ask any of the Kashmiri Pandits living in the Valley. They will tell you that any time, they feel threatened, they depend more on Geelani than on the state police for their safety. And he does live up to his promise. This is not to deny that at one time Geelani contributed to conditions that led to the mass exodus of Pandits from the Valley. But would you rather Geelani stay forever the same? Why not acknowledge and welcome his new avatar? If you are seriously concerned about the plight of Kashmiri Pandits why not have a calm and thoughtful discussion with them and key Kashmiri Muslims leaders, including Geelani, on steps that need to be taken for a dignified and safe return of Pandits to the Valley?

There are a lot of positive signals coming from the Valley. But our national media has no time for actions and incidents that convey a positive message. For example, during the recent Amarnath Yatra, a Youth leader Bashir Ahmed Mir from Kangan in Ganderbal district risked his own life to save a mother-son duo from Bihar.  A young boy named Rohit Kumar from Bihar had accidentally slipped into the Thajwas River at Sonmarg. In panic, his mother also jumped into the fast flowing stream to save her child. But neither knew how to swim. Mir, who happened to be nearby, at once jumped into the waters and saved the life of both mother and son. (See link: http://www.kashmirdispatch.com/more-news/16078676-political-leader-saves-mother-child-duo-of-amarnath-pilgrims-from-drowning.htm). Several friends from Kashmir wrote to me to say that “if a Kashmiri had picked up an argument or a petty fight with a yatri over some issue, Arnab Goswami would have raised hell for hours on end but such positive actions showing respect and care for Indian yatris and tourists do not receive even passing mention in his News Hour.”

The rough and rude treatment you give to senior and respected Kashmir leaders causes no less hurt than unjustified killings by the state police or paramilitary forces. Every time I have tried to present facts about Kashmir that you ignore you not only shout me down but also make it out as is I have joined in support of secessionists and Pak-supported terrorists.

You have no idea how much harm you cause in the process. Each such program leaves Kashmiris seething in rage. They are made to feel that they don’t have the basic democratic rights that people of other states have, and that they should neither protest police atrocities nor mal-governance and corruption of  the state , leave alone patently harmful policies adopted by the central government. Any manifestation of discontent on their part is invariably treated as an anti-national activity. In the process, you and your tribe weaken their faith in Indian democracy. As a result, what may have started off as a protest against the high handedness of the state government ends up turning into an anti-India protest. I have been repeatedly told in the Valley that Kashmiris would never be so estranged from Indian democracy if at least the Indian media learns had paid attention to their legitimate grievances.

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The author is a spokesperson, Kashmir Committee