Indian Journal of Pharmacology 2002; 34: 227-228
DRUG PROMOTION : CAN SELF-REGULATION WORK?
"All advertising is inherently unethical. That's how you
sell things" said a New York attorney. Selling drugs is
like selling any other commodity. Pharmaceutical com-
panies choose to spend more on medical drug pro-
motion rather than on research and development
because drug promotion is what earns them money.
There have been numerous studies which have in-
controvertibly stated that drug promotion influences
prescribing practices, a fact that is not acceptable to
many doctors. If drug promotion were not so suc-
cessful, would the companies spend billions market-
ing their ware?
The World Health Organization (WHO), in an attempt
to support and encourage the improvement of health
care through the rational use of drugs and to curb
unethical marketing practices, came out with a land-
mark "Ethical criteria for medicinal drug promotion"
in 1988 and has recommended their implementation
to its member countries. This document defines drug
promotion as "all the information and persuasive ac-
tivities by manufacturers and distributors in order to
induce the prescription, supply, purchase and/or use
of medicinal drugs". It also suggests what can be con-
sidered appropriate hospitality and gifts. There is evi-
dence that drug utilization problems are increasingly
encountered in many developing countries due to the
unethical marketing practices of the pharmaceutical
industry. Unfortunately the guidelines drawn up by
the WHO, are flouted in practice with impunity since
there are no effective legislative measures to sup-
port them.
The International Federation of Pharmaceutical
Manufacturer's Association which had first suggested
a self regulatory code of pharmaceutical marketing
practices in 1981, adopted the revised version in 1994.
There seems to be obvious double standards in adop-
tion of the code. While in the developed countries,
these firms often publish reasonably ethical adver-
tisements which are published in medical journals,
the very same companies promote the same drug
for different indications in developing countries. The
information is also insufficient, sometimes contains
unproven scientific claims and is published by many
medical journals from these countries. In an attempt
to get a grip on the situation the International Com-
EDITORIAL
mittee of Medical Journal Editors suggested that edi-
tors must take full responsibility for what appears in
their journals. Many journals appointed committees
to examine advertising material before publication. Yet
this was beyond journals in many developing coun-
tries who were eager to grab the money that adver-
tising (ethical or unethical) brought in.
Even though it has been proven time and time again
that drug advertising in India is unethical, nothing
much is being done to curb it. The annual conferences
of the various national bodies of medical specialities
are a glaring example of how deep the rot has spread.
Today no medical conference is organised without
getting financial support from the pharmaceutical in-
dustry. In return for the lavish financial assistance,
companies are allowed to select speakers, choose
the topics for discussion, advertise their brand image
and so on, a situation akin to the indoctrination done
in terrorist camps. If this situation is allowed to con-
tinue we shall have a nation full of doctors who rely
on the drug companies to dictate what they should
prescribe.
Unfortunately, though India had a head-start in this
direction with the constitution of the Drug Enquiry
Committee in 1930 under the chairmanship of Sir
R.N. Chopra which scrutinized the pamphlets of drugs
which made spurious claims, we have not made a
dent in this direction. The Drugs and Magic Remedies
Act which came into force in 1955 and was amended
in 1961, 1967 and in 1992 have not been enforced
due to the apathy and general disinterest of the health
care fraternity and the industry refuses to be cowed
down by legislative enforcements. Hamdard
Dawakhana was asked to recall 40 drugs. But they
chose to file a writ in Supreme Court in 1959 on the
grounds that their right to free speech and right to
carry on trade and business were violated. The
Supreme Court however, dismissed the petition. The
drug industry fast learnt to take advantage of the loop-
holes in the law and continued with unethical market-
ing practices. The problem became so serious that
S. Narayen, Commissioner, FDA Maharashtra, in the
foreword to a book on the Drugs and Magic
Remedies act by S.W.Deshpande in 1994, admitted
that 'economic liberalization seems to give the
228 EDITORIAL

impression that manufacturers have the right to sell
and the market place is what must decide the rules
of the game. In the dizzy of activity, various ploys are
used to sell the product. Some of these not only mis-
lead the consumer but can also be harmful'.
The internet is perhaps one of the greatest boons to
the medical establishment. Doctors are able to check
the validity of information given to them by drug com-
panies and therefore it is now being reported that drug
companies are hesitant to tell outright lies as before.
But the industry relies on the fact that doctors are
busy people who would not find the time to counter
check information they have received. The ever inno-
vative marketing executives have come up with yet
another brilliant ace in the form of direct-to-consumer
(DTC) advertising. This is the advertising of branded
drugs through popular media. In India we are already
exposed to television advertisements for inhalers in
bronchial asthma, insulin for diabetes mellitus. This
is a scaled down, modified version of DTC advertis-
ing. If DTC is approved, then drug companies will dic-
tate what doctors prescribe through their patients.
A small silver lining is perhaps the efforts of a few
medical colleges where undergraduate students and
interns are taught to critically analyze drug promo-
tional material and are sensitized to the "tricks of the
trade" of the pharmaceutical companies. The "one
on one" interview with the medical representative is
perhaps the most powerful tool of drug promotion
which is followed worldwide. Interns are now being
taught to "take control" of these interviews and use
them to get reliable information. Videos have been
made with the assistance of the WHO and are being
used to train interns on some aspects of dealing with
medical representatives. It is too early to judge what
impact these interventions will have, but it must be
kept in mind that tiny drops of water make a mighty
ocean.
These efforts, though isolated and small at present,
will nevertheless reach a critical mass which shall be
self propagating one day. It is hoped that in future we
shall have a new generation of doctors who demand
that all drug promotion be ethical. Unless this demand
comes from the medical establishment who refuse to
take lavish gifts, eat lunches and dinners sponsored
by drug companies, and attend CME programmes
paid for by the companies we can never expect drug
companies to self regulate.
VIJAY THAWANI
Department of Pharmacology,
Shri Vasantrao Naik Govt. Medical College,
Yavatmal-445001.
e-mail: thawani@nagpur.dot.net.in

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