Wednesday, February 12, 2014

Update: Detailing in India and Pakistan

The very nice people at the Centre for Biomedical Ethics and Culture, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, publish a newsletter. I was attracted by the cover story, "The Drug Industry and Doctors: An Unholy Alliance," by Sandhya Srinivasan, a journalist and researcher from India:

In many ways the issues in that part of the world are the same as here, but a few highlights of interest:
  • Presumably due to the general lower income enjoyed by physicians in poorer nations, it's become more acceptable and commonplace for drug reps to bribe physicians with less subtle "gifts" such as air conditioners, washing machines, microwaves, TVs, etc., compared to the pretense kept up in richer countries that the "gifts" relate solely to one's professional role.
  • While efforts have been made in both India and Pakistan to declare such bribes unethical, in India, especially, enforcement has been marred by numerous roadblocks--both the influence exerted over government by drug company interests; and also the dubious position of some of the folks issuing the "ethics" guidelines, for example: "The [Medical Council of India, who promulgated one Code of Ethics on the subject] is not viewed as a guardian of medical ethics. Less than a year after the amendment, its president was arrested on charges of corruption."
  • A study in Pakistan likewise found widespread acceptance of drug reps and their largesse, with doctors meeting with an average of seven reps daily.

It may be hard to imagine a part of the world where freeing medicine from the grip of industry influence is even more of an uphill struggle than here, but that seems to be the case in South Asia.

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